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Changes to MBS items for knee imaging: What GPs should know


Mark Morgan


22/05/2018 1:27:33 PM

Associate Professor Mark Morgan, GP and member of the Diagnostic Medicine Clinical Committee of the Medicare Benefits Schedule Review Taskforce, writes for newsGP about changes to MBS items for knee imaging.

There have been a number of changes to MBS items for MRI knee scan referrals by GPs.
There have been a number of changes to MBS items for MRI knee scan referrals by GPs.

The stated aims of the Medicare Benefits Schedule (MBS) Review process are to promote affordable universal access, encourage best practice medicine and increase value to the individual and to the community.
 
Knee imaging items were subject to a working group of the Diagnostic Imaging Clinical Committee (DICC), which produced a report on its findings. The MBS Review Taskforce considered the report and sought feedback from public and key stakeholders before recommending changes to the Federal Minister for Health.
 
A number of key facts from medical literature were critical to the decisions of DICC knee imaging working group:

  • Since the introduction of GP-requested magnetic resonance imaging (MRI) scans for acute knee injuries, the taxpayer spend on knee MRI scans increased from $16 million to $38 million in just two years, and this number continues to grow at 35% a year.
  • Since the introduction of direct GP-requested MRI scan for knees there has been a slight reduction in the number of these scans ordered once the patient has attended a consultant specialist. But this is far outweighed by the total number requested by GPs.
  • Meniscal tears were found by MRI in 63% of symptomatic people aged over 50, compared to 60% of asymptomatic people aged over 50. This suggests MRI adds little to the diagnosis.
  • Following a knee MRI, 67% of people in the over-50 year group are seen by an orthopaedic surgeon, and 35% get an arthroscopy.
  • Although not stated in the DICC report, systematic reviews have suggested very little, if any, benefit from knee arthroscopy for degenerative changes in knees.
The DICC’s final analysis recommended that GP direct-referred MRI scan for knee injury in people aged over 50 either be removed or contingent on consultation with a specialist. There was also a recommendation to bring GP direct-referred MRI scans in line with consultant specialist MRI scans, with a limit to three MRIs per patient, per year.
 
Therefore, from 1 November, there will be several changes to MBS patient rebates relating to MRI scans of knees:
  • People aged under 16 no longer need to have a plain X-ray prior to requesting an MRI scan.
  • Patients will only receive MRI rebates for up to three MRI knee scans per year.
  • People aged 50 and older will no longer receive a rebate for GP-requested MRI scans of knees.
I believe that one way to limit harms from potentially unnecessary knee arthroscopies is to reduce the number of MRI scans done in people with clinical signs and symptoms of osteoarthritis of knees. I also feel that money saved by greater stewardship of after-hours item numbers and imaging item numbers in the already-released MBS Review Taskforce recommendations should be recycled into greater patient rebates for important and beneficial primary care activities.
 
GPs should look out for the RACGP’s soon-to-be released Guideline for the management of knee and hip osteoarthritis for further guidance on these changes and associated issues. 

The RACGP’s Handbook of Non-Drug interventions (HANDI) also has a section on exercise for knee osteoarthritis, which says exercise ‘is recommended as a core treatment for osteoarthritis in all clinical guidelines regardless of patient age, pain levels or disease severity’.



MBS-Review-Taskforce MRI-scans osteoarthritis



Iain Anderson   9/10/2018 11:08:34 AM

In response to the article on restriction of MBS item numbers for knee MRI over 50 I would like to point out that many patients are having non rebate MRI requests by Physio and then go to see surgeons, and that mechanical symptoms caused by maniacal injury are amenable to arthroscopic treatment. There is no doubt OA is not treatable by arthroscopy but GP requested MRI does not consent the patient for surgery, the surgeon does. Perhaps the MBS item number Taskforce could stop working to control the lowest common denominator in GPS who order MRI rather than refer appropriately to sports physicians or actually examine the patient. For those of us GPs who try to practice effectively it would be lovely if we were treated like professionals and not like naughty children at the cookie jar as our GP representatives seem to do.


Annetta Palfrey   12/12/2018 4:54:17 PM

I recently had an ultrasound of my knee due to acute pain and altered ability to mobilise due to pain and impingement. The results indicted a meniscal tear and my GP requested an MRI to confirm this. As I am over 50 I am not eligible for the medicare rebate. the government has determined I need to work until I am 67 but I am not being supported in my health and well being to manage to work to this age without being a burden on the healthcare system. I understand that with any procedure there are some who misuse the system but that should not be a reflection on the rest of the population especially those who take ownership and accountability of the decisions they make which are based on their skills, knowledge and expertise. GPs are able to make appropriate diagnoses as well as Specialists.


Gail Temple   23/01/2019 11:16:45 PM

I totally agree with Anetta Palfrey above and am in the exact same position as her as my ultrasound shows a meniscal tear and my GP suggested MRI to confirm so I can have it sorted. I hardly ever use the Medicare system as I am fortunate I am in good health, it is actually the second time I will need an MRI in my life!’ I look after my health and go to gym etc, pay my taxes, am law abiding, work in a job taking care of the elderly which I really enjoy. To my horror I found out when I called to book the MRI which my doctor had asked to be ‘bulk billed ‘ on my referral that I do not qualify because I am ‘over 50 years’ and have to outlay $355 with no rebate!!! This is such discrimination and like Annetta we are genuine cases who through no fault of ours have had this happen.


Susan Murphy   6/02/2019 7:50:22 PM

I have the same issue. After a fall I have symptoms of a meniscal tear and my specialist has told me there is no rebate because I am over 50. The Imaging place confirmed this. This is blatant discrimination against the over 50s whi still, I might adf pay Medicare Levies, heath funds and taxes. Imagine if the government stopped rebates for pregnant women fowpr ultrasounds


Barbara Kallio   27/02/2019 7:55:45 PM

Age discrimination is alive and kicking! Who do you think has paid the taxes for this country for the past 40 years yes the over 50s. Disgusting.368758


hung   2/03/2019 12:49:29 PM

I am 51 yrs old had a meniscal tear after a fall from recent skiing trip to Whistler. Called the MRI scan place in Annerley Qld, booked and got it done and paid $295 in full thinking that I will get some sort of Medicare rebate or my health fund "top cover" rebate. Only to find out later what 's a big disappointment on both counts. My wife had the same problem with her knee from the skiing trip as well, went to see a different GP and got booked a different MRI scan place and was only been charged for $200. WHY? I just realized that I have been ripped off at the MRI scan place I went by 1.5 times ($200x1.5). Its always a good idea to check around first.


Marg Wenham   4/06/2019 4:32:07 PM

Am in the same boat as others on this site. Following a week of pain in my right knee, something seemingly catastrophic happened as I was coming down some stairs this morning. A clunking sound was followed by appalling pain and I am almost unable to walk. My GP just referred me for an MRI and when trying to make the booking I was informed it would cost between $290 and $365 and no rebate would be available for me as I am 59. This is an outrageous betrayal of older Australians by the Morrison Government and those in the medical profession who supported this change.


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