CHANGES TO THE MEDICARE BENEFITS SCHEDULE FOR 1 NOVEMBER 2019 Stakeholder Forum Tuesday, 17 September 2019 17 September, 2019 1
Agenda Time Item Presenter 10.30am – 10.50 Welcome and overview Mr Andrew Simpson, Assistant of the MBS Review Secretary, MBS Reviews 10.50am – 12.00pm Anaesthesia changes Dr Andrew Singer, Medical Advisor 12.00pm – 12.45pm Lunch 12.45pm – 1.45pm Colonoscopy changes Professor Fin Macrae Member, Gastroenterology Clinical Committee Mr Ransome Mclean A/g Director, MBS Reviews 1.45pm – 2.00pm Other MBS changes Mr Andrew Simpson, Assistant • Eating Disorders Secretary, MBS Reviews • GP telehealth • Diagnostic Imaging Ms Mary Warner, Director, Medical • Amended Medicare Specialist Services Section items 2.00pm – 2.30pm Q&A 17 September, 2019 2
Welcome and overview of the MBS Review Presenter: Mr Andrew Simpson, Assistant Secretary Department of Health MBS Reviews 17 September, 2019 3
Stakeholder Forum • Changes are coming to the MBS on November 1 2019. • Combination of new items, amendments and deletions. • Complex, covering specialist services and primary care. • Purpose of today is to give an overview of changes coming on November 1 • Discuss the rationale for changes • Provide detail on the changes • Answer questions and prepare for a smooth transition on November 1. 17 September, 2019 4
The MBS Review • The MBS has not been reviewed in 30 years • The MBS Review Taskforce was established in 2015 • The MBS Review aims to improve quality care and ensure services funded though the MBS are high-value. • The Taskforce is reviewing the 5,700 items under the MBS to ensure they: • align with contemporary clinical evidence and practice • improve health outcomes for patients • do not put patients at unnecessary risk • The Taskforce provides advice to the Minister, including: • Evidence for services • Appropriateness • Best practice options • Levels and frequency of support through the MBS 17 September, 2019 5
The MBS Review cont. • Over 70 clinical committees and many more working groups established • It is anticipated that more than 60 reports will be delivered by the Taskforce to Government by the completion of the MBS Review • The Review is clinician led • Over 700 clinicians, consumer and health system experts involved in the Review 17 September, 2019 6
The MBS Review Process • The process of reviewing and implementing changes to items taking approximately 2 years • More than 30 reports have been delivered to government • 5 phases of activity • Initial Review • Consultation • Consideration by Government • Implementation • Evaluation Approximately 30 reports remain to be delivered to government or have just been finalised 17 September, 2019 7
Implementation • Agreement by Government • Establishment of an Implementation Liaison Group (ILG) • Drafting of item descriptors, ensuring intent of changes is achieved with minimal administrative disruption • Approval of regulatory changes by the Governor-General • Communications activities including forum 17 September, 2019 8
Future MBS Changes and Stakeholder Forums • Stakeholders, including the AMA, RACGP and a variety of colleges and societies have been engaged in the MBS Review and are supportive of enhanced communications activity • Feedback from the AMA has highlighted the need for earlier, proactive communication of MBS changes • It is the intention of the Department to hold stakeholder forums on a regular basis at approximately 8-12 weeks prior to the implementation of MBS changes. • 2-3 forums a year 17 September, 2019 9
1 November 2019 Changes ALL changes referred to in this presentation are subject to finalisation of regulatory amendments and parliamentary scrutiny 17 September, 2019 10
ANAESTHESIA MBS ITEM CHANGES Presenter: Dr Andrew Singer, Medical Advisor MBS Reviews 17 September, 2019 11
The MBS Review of Anaesthesia • The Anaesthesia Clinical Committee (ACC) of the MBS Review Taskforce was established in 2016 • The ACC was assigned 528 MBS items to review and made 67 recommendations • Consultation was undertaken on the ACC recommendations between 2016 and 2018 • The report was amended as a result of consultation • The Taskforce endorsed the final report in late 2018 17 September, 2019 12
The Anaesthesia changes – 1 November 2019 • From 1 November 2019, MBS items for anaesthesia services are changing to reflect contemporary anaesthesia practice • These changes are a result of the Taskforce recommendations and extensive consultation with stakeholders • Billing practices from 1 November 2019 will need to be adjusted to reflect these changes 17 September, 2019 13
Summary of Changes • The revised structure contains twenty eight amended items, proposes ten new items and deletes thirty one items • The revised structure: • Better describes the procedures being performed by anaesthetists • Simplifies the MBS • Reflects contemporary practice of anaesthesia services 17 September, 2019 14
Regional nerve blocks – epidural injection • 18216, 18219, 18226 and 18227 have been amended to allow for Combined Spinal-Epidural (CSE) infusion • No change to fees Item Descriptor 18216 Intrathecal, combined spinal-epidural or epidural infusion of a therapeutic substance, initial injection or commencement of, including up to 1 hour of continuous attendance by the medical practitioner (Anaes.) Applicable once per presentation per medical practitioner 18219 Intrathecal, combined spinal-epidural or epidural infusion of a therapeutic substance, initial injection or commencement of, if continuous attendance by the medical practitioner extends beyond the first hour (Anaes.) 17 September, 2019 15
Regional nerve blocks – epidural injection cont. Item Descriptor 18226 Intrathecal, combined spinal-epidural or epidural infusion of a therapeutic substance, initial injection or commencement of, including up to 1 hour of continuous attendance by the medical practitioner — for a patient in labour, if the service is provided between 8 pm to 8 am on any weekday, or on a Saturday, Sunday or public holiday Applicable once per presentation per medical practitioner 18227 Intrathecal, combined spinal-epidural or epidural infusion of a therapeutic substance, initial injection or commencement of, where continuous attendance by a medical practitioner extends beyond the first hour, for a patient in labour, where the service is provided in the after hours period, being the period from 8pm to 8am on any weekday, or any time on a Saturday, a Sunday or a public holiday. 17 September, 2019 16
Regional nerve blocks – epidural injection • An Explanatory Note has been added to items 18216 and 18226 to clarify the intention of the items TN.10.7 The administration of epidural anaesthesia during labour is covered by Item 18216 or 18219 in Group T7 of the Schedule whether administered by the medical practitioner undertaking the confinement or by another medical practitioner. Subsequent "top-ups" are covered by Item 18222 or 18225. For the purposes of items 18216 and 18226 items, one attendance means that the medical practitioner cannot claim either of these items if the additional attendance is to optimise the initial treatment. Optimise means extension or improvement in analgesic quality of an existing block, without the insertion of a new block as a separate procedure. 17 September, 2019 17
Anaesthesia for Eye Surgeries • Three anaesthesia for eye surgeries MBS items have amended fees to reflect the anaesthesia complexity • A new item for complex eye blocks is also being introduced Item Descriptor Proposed Fee 20142 Initiation of the management of anaesthesia for lens $120.60 6 Units surgery (no change) $100.50 5 Units 20144 Initiation of the management of anaesthesia for corneal $160.80 8 Units transplant (no change) $140.70 7 Units 20145 Initiation of the management of anaesthesia for $160.80 8 Units vitrectomy (no change) $140.70 7 Units New Descriptor Proposed Item Fee 22042* Introduction of a nerve block performed via a retrobulbar, $20.10 1 unit peribulbar , or sub Tenon’s approach, or other complex eye block, when administered by an anaesthetist perioperatively 17 September, 2019 18
Anaesthesia for Eye Surgeries cont. • The Explanatory Note for new item 22042 clarifies co-claiming of the item TN.10.8 - Additional Services Performed in Connection with Anaesthesia - Subgroup 19 These items (with the exception of peri-operative nerve blocks (22030-22042) and perfusion services (22055-22075) have also been retained in the MBS in the non-RVG format, for use by practitioners who provide these services other than in association with anaesthesia. Item 22042: This item can be co-claimed with item 20142 (anaesthesia for lens surgery), when anaesthesia or sedation was also provided by the same anaesthetist. Item 22042 cannot be co-claimed with item 20142, 20144, 20145 and 20147 when a general anaesthetic is the primary anaesthetic approach. 17 September, 2019 19
Recommend
More recommend
