Medicare Benefits Schedule overhaul ‘not an attack on doctors’

Health Minister Susan Ley has insisted an overhaul of the Medicare Benefits Schedule (MBS) is not an attack on doctors.

Doctors ordering too many scans and x-rays cost Medicare and a “spring clean” of the schedule is needed, Ms Ley told News 24.

“We … want to reflect what doctors are doing and remove and change practices that don’t make sense, that are inefficient,” she said.

The Australian Medical Association (AMA) has accused the scheme Ms Ley is overseeing of undermining confidence in doctors by suggesting the Government pays for unnecessary and outdated medical procedures under the schedule.

A special Four Corners investigation reveals many of the treatments and tests we get are unnecessary, sometimes harmful and needlessly expensive, costing the health system billions of dollars every year.

Figures from the Australian Institute of Health and Welfare show Australia spends just under $155 billion on health each year, and it is estimated one-third of that amount — about $46 billion — is being squandered. This is total spending by federal and state governments, private health insurance and in hard cash from patients in gap fees.

Ms Ley said the Government would be guided by consultations with the medical profession, but the Opposition has accused her of “mucking up” what could be a good way forward for the medical system.

Chris Maher, from the George Institute for Global Health, spoke to Four Corners about the common medical condition, lower back pain.

“If we just look at imaging for low back pain, the amount we spend in Australia each year just for Medicare is $220 million,” he said.

“Best estimates would be that the majority of that money is a complete waste. We’re just wasting hundreds of millions of dollars sending people off for unnecessary tests.”

Associate Professor of Healthcare Policy at Sydney University Adam Elshaug is an authority on what is called low-value care and has identified at least 150 unsafe, inappropriate or ineffective medical services that receive Medicare and health insurance rebates.

He said the system is wasting precious health dollars and putting patients at risk.

“We know that patients are being harmed by receiving tests and treatments that they should never have received,” he said.

“There’s a cost too, and that cost should also be counted because those are dollars that are wasted and could’ve been reallocated to other areas of medicine.”

The review follows yesterday’s opening of public consultations on a review of the 5,700 procedures on the MBS.

Ms Ley’s announcement of consultations touched off an angry protest by the AMA, which is accusing her of undermining confidence in the procedures doctors order for their patients.

“I’m not attacking the integrity of the medical profession,” she told Radio National.justified in some circumstances and not in others, writes Stephen Duckett.

The Minister has argued the profession had plenty of notice of the review.

“This process was started in April, so I’m a bit bemused by commentary that suggests it’s an ambush and something that’s only recently come to light,” Ms Ley said.

She also cited lower back pain as an issue that could be looked at under the review.

“For example, excessive scans for lower back pain when the best possible first intervention is exercise or leaving it alone,” Ms Ley said.

“Subjecting patients to x-ray — which they probably don’t need — and going through a lot of scans, some of these things don’t necessarily cause patients harm, but the visibility of the cost is important.

“So no-one sees the costs, except I do, because the Government pays for it.”

There has been a suggestion in overseas studies that part of the problem with paying for such procedures is because doctors benefit financially from ordering them, but Ms Ley said she would not go that far.

“I am not suggesting that the MBS is being disused, I am not suggesting that doctors are doing the wrong thing, I want to make that very clear,” she said.

“Parallel with this process is a very important one which is the listing of new items, new technology, new procedures.”

Government starting war with doctors: Labor

Labor seized on comments on the AMA to suggest the Government started another war with the medical profession after its ill-fated attempt to bring in the Medicare co-payment.

“The way in which they’ve announced the review and announced the consultation process yesterday has obviously pitted doctors now against the Government,” Opposition spokeswoman Catherine King told AM.

“And that is unfortunate, because the review has some potential, but unfortunately the way in which they’ve handled it has really mucked it up.”

Labor disputed the figure of 30 per cent that Ms Ley and Four Corners suggested could be wasted in the health system.

Ms King said only about 150 items on the MBS needed to come under review.

“What this Government seems to have done is literally, like a bull in a china shop, thrown it all up on the table, let’s review all 5,700 items. They’ve got the medical profession offside,” Ms King said.

Not all medical groups are as angry as the AMA, the Royal College of Surgeons Graeme Campbell told ABC News Radio.

“We actually welcome the review and we’re happy to engage,” he said.

“The Medicare schedule has been around for a very long time and there doubtless are things that could be improved about it.”

But, like Labor, the college had doubts about exactly how much a broad-ranging review could save.

“I think we’d be better to take some of the emotion out of this. I agree that the figure of 30 per cent is being pulled out of thin air effectively and it seems to be designed to alarm rather than to educate,” Mr Campbell said.

“So I think what we do need to do is sit down, we’re happy with the processes in place, as a College we are quite concerned about sustainability in the healthcare sector.”

Susan Ley has promised she will rely on an expert task force to help decide on the complex medical issues that will be debated during the review.

“The task force itself is comprised of clinicians because the last thing I ever want it to be is the Department of Health or politicians telling doctors what Medicare should look like,” Ms Ley said.

Mr Campbell said the college was “quite comfortable” with the experts on the overseeing group.

“But they’re going to need to engage a large number of medical experts because it’s across so many fields of medicine and that’s where the devil’s in the detail,” he said.