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Calls to delay changes to B12 testing
Potential changes to item descriptors, fees and claim frequencies are scheduled for July, but doctors are calling for further consultation, saying ‘additional red tape for GPs should be avoided’.
In the last financial year alone, Medicare item 66839 was processed 4.7 million times.
Healthcare professionals are calling to be further consulted on a Federal Government plan to alter MBS items for vitamin B12 tests and urine examinations, saying it could result in changes to frequency or a reduction to schedule fees.
The changes were first proposed within the 2024–25 Federal Budget to ‘reduce unnecessary testing for better patient outcomes’, with the Department of Health and Aged Care (DoHAC) promising to engage with the pathology and clinical sectors.
But medical experts, including GPs, are now urging the DoHAC to expand its consultation before any changes are made, citing concerns including an increase in red tape.
Under its plan for more ‘clinically appropriate pathology testing’, from 1 July 2025, those changes could include amendments to vitamin B12 test items 66838 and 66839 to ‘clarify the appropriate vitamin B12 testing pathway’.
‘This is intended to reduce unnecessary duplicative testing for patients that are not vitamin B12 deficient,’ the Federal Budget paper said.
It also plans to amend urine examination item 69333 to clarify appropriate asymptomatic patient testing to those with clinical need.
It says this is intended to reduce ‘unnecessary testing of patients with no risks, signs or symptoms of urinary tract infection’.
In the last financial year alone, Medicare item 66839 was processed 4.7 million times, item 66838 was processed 1.4 million times, and item 69333, 4.6 million times.
According to the Royal College of Pathologists of Australasia’s (RCPA) submission to the plan, DoHAC has proposed an 11-month restriction for vitamin B12 testing, which the college says should be replaced with a ‘three-month minimum interval in the explanatory notes’.
‘The college does not support any reduction in funding for individual vitamin B12 items, and the current vitamin B12 fees for individual items should remain unchanged,’ it added.
‘Any changes to B12 testing must be mutually agreed and accompanied with appropriate education and resources to support pathology requesters. The college agrees to support these efforts.’
It also raised ‘deep concerns’ around inconsistencies, saying it ‘strongly believes that the decision to test should rest with the treating clinician’.
‘The Australian MBS schedule should support clinically appropriate referrals and best practice in vitamin B12 testing,’ its submission said.
‘The fee for the proposed active B12 MBS item number has been either halved to $23.60 or rendered $0 when included with a total B12 … these fee reductions are unjustified.’
Chair of the RACGP Expert Committee – Quality Care Professor Mark Morgan said further consultation must be done before any changes are made.
‘It is important that batteries of tests are not requested as a form of poorly targeted population screening,’ he told newsGP.
‘Tests cost money, damage the environment and often are the precursor to low-value care or patient anxiety. It goes without saying that tests should only be requested for sound clinical reasons.
‘Using levers such as updated “appropriate use criteria” and “appropriate frequency criteria” helps reduce over testing.
‘The levers are a blunt instrument because there are often exceptions to general rules.’
Ultimately, Professor Morgan said clinician discretion is important.
‘There should be a way for clinical details accompanying requests to override restrictions on test indication and frequency,’ he said.
‘This would allow some flexibility while not opening flood gates to inappropriate testing. I don’t have a clear idea of how this could be operationalised without soaking up too much clinician time.
‘GP time is valuable and ultimately costs patients’ money. GPs need to focus on patient needs. Additional red tape for GPs should be avoided.’
In its submission, the Australian Medical Association (AMA) has also called for increased consultation, saying it does not support proposed amendments to item descriptors and claim frequencies to consolidate follow-up testing.
‘We do not agree with the proposed changes to frequency or any reduction to schedule fees,’ the submission said.
‘A new item (668XX) may be required to assist necessary follow-up and testing for patients with known risk factors for vitamin B12 deficiency, addressing potential gaps in the previous framework.
‘Schedule fees should be maintained at current levels, acknowledging Medicare rebates provide the majority of funding for outpatient pathology services in Australia. The AMA does not support reducing rebates for the items in question.’
The proposal comes after a Diagnostic Medicine Clinical Committee of the MBS Review reviewed requesting data and appropriate use criteria for B12 testing.
Here, Professor Morgan said, the MBS Review committees were presented with information about the volume of requesting and demographics about who was being tested and what other tests were requested at the same time.
He said there was a ‘complete absence of answers about why testing was being requested’.
‘How could the MBS review make reasonable suggestions to manage what looks like unwarranted increases in use of some item numbers for pathology testing and imaging without a clear understanding of what proportion of tests are clinically appropriate?,’ he said.
‘Frequency criteria seems a clunky way to reduce MBS spending because it is often not clear to the patient, requesting clinician or pathology provider if the test has been done before.’
The plan comes after GPs across Australia were sent ‘nudge letters’ in 2022, targeting those who were above the 90th percentile for rates of pathology requests through the MBS, including for vitamin B12.
newsGP contacted the DoHAC for comment.
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