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