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Department of Health says ECG interpretation still allowed in ‘bizarre’ claim


Doug Hendrie


14/08/2020 3:39:38 PM

There is growing confusion over the recent DoH decision to effectively strip GPs of the ability to bill Medicare for the interpretation of ECGs.

Looking at ECG and MBS online
Ensuring compliance with MBS rules has long been a source of anxiety for GPs.

In response to questions over the controversial decision to prevent GPs from billing Medicare for the interpretation of electrocardiograms (ECGs), a Department of Health (DoH) spokesperson told newsGP that GPs can still do so.
 
‘Item 11707 provides for a service for a trace and interpretation by a general practitioner,’ they said.
 
Professor Richard Harper, Chair of the Cardiac Services Clinical Committee (CSCC) of the Medicare Benefits Schedule (MBS) Review Taskforce, has similarly claimed in medical media that there are ‘no restrictions on GPs performing and interpreting ECGs … the new item 11707 specifically allows this’.
 
These claims do not appear to be correct, given MBS item 11707 permits any medical practitioner to undertake 12-lead electrocardiography ‘to produce a trace only’ and only if the trace ‘does not need to be fully interpreted or reported on’.
 
The new item came into effect on 1 August, alongside other changes.
 
The DoH statement is certain to further inflame the issue, which prompted a major backlash from furious GPs. Ensuring compliance with MBS rules has long been a source of anxiety for GPs, particularly if the rules are ambiguous or unclear.
 
DoH Secretary Professor Brendan Murphy recently promised in a letter to the RACGP that there would be a review of the changes in six months.  
 
GP and University of Western Australia academic Dr Brett Montgomery told newsGP it seems ‘bizarre’ and ‘contradictory’ to say item 11707 provides funding for trace and interpretation when the actual wording of the item states that it should only be claimed when the trace does not need to be fully interpreted.
 
‘The final Taskforce report recommended separate ECG item numbers claimable by GPs: one for tracing only, and another for tracing plus interpretation,’ he said. ‘The Government has given us just one item number – 11707 – for tracing alone.
 
‘What are GPs supposed to do, then? A trace and an incomplete interpretation?
 
‘Of course ECGs need to be interpreted. An ECG that does not need to be interpreted is an ECG that doesn’t need to be done in the first place.
 
‘I only ever arrange an ECG when I think it is worth interpreting.’
 
The DoH response came after newsGP asked why a specific recommendation by the relevant committee of the MBS Review Taskforce to create an ECG trace and interpretation item for all practitioners had been seemingly ignored.
 
In response, the spokesperson said:
 
‘The intent of the recommendation has been implemented through items 11714 and item 11707. Item 11714 provides for a service that involves a trace and interpretation by a specialist or consultant physician. Item 11707 provides for a service for a trace and interpretation by a general practitioner [emphasis added].
 
‘The implementation of the ECG item changes more clearly delineates the important roles of GPs and specialists, focused on providing high-value patient-centred care.’
 
The spokesperson noted a GP consultation item can be co-claimed with MBS item 11707 to ‘enable time to consider the outcome and advise the patient on next steps’.  
 
‘The ECG changes reflect the Taskforce recommendation and resulted from extensive consultation with clinicians and representatives from peak bodies and the Implementation Liaison Group,’ the spokesperson said.

‘Professor Harper and Professor Bruce Robinson, Chair of the MBS Review Taskforce, have both confirmed that the intent of the recommendations has been fulfilled in the implementation of the ECG items.’

newsGP asked for further clarification as to whether this means GPs can still undertake ECG interpretation – as long as they privately bill the patient for that component. 

In response, a DoH spokesperson said that clause ‘a’ of 11707 ‘enables an interpretation of the trace to inform a clinical decision to be made’.

‘Clause “c” highlights that the provider does not need to interpret the ECG to a level that would be required for a formal report,’ the spokesperson said. 
 
The DoH removed item 11700 – which covered an ECG trace and report – to ‘reduce low value care’, according to its reference guide to the changes
 
GPs have been universally critical of the changes, which were announced in mid-July before coming into effect on 1 August.  
 
GP Dr Mariam Tokhi labelled the change ‘cuts to Medicare by stealth’ on Twitter.


GP Dr Ern Chang wrote an open letter to Federal Health Minister Greg Hunt.
newsGP has approached Professor Harper for comment.  
 
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Dr Stuart Nash   15/08/2020 7:40:58 AM

By saying 11707 does allow for interpretation is even more insulting. It literally says that a GPs care is less valuable than our ‘specialist’ colleagues in the big shiny buildings.


Dr Brian George Wall   15/08/2020 11:41:50 AM

Has any organisation/system run efficiently once government became intrinsically involved? Medicare (Medibank originally) is an insurance scheme which replaced private health funds but also included GP consultations. One advantage for GPs was the removal of the 5% running debt we carried if we bulk billed. We reap what we sow and perhaps a 5% running debt would have been worth it to avoid our present situation.
There was considerable argument among GPs as to whether to accept bulk billing and a significant minority against it fearing it was the first step towards the creation of a National Health Service. I was told by my surgical chief in U.K. that the initial vote by the medical profession was against working to introduce it. However various inducements to GPs were made to do with rent etc. and the GPs reversed their position in a second vote and the NHS was born. GPs may win skirmishes with governments but never the war.


Dr Brian Kevin Hollins   15/08/2020 5:49:15 PM

So when we use the ECG to decide to cardiovert, thrombolyse, administer adenosine or anticoagulate our patient, is our interpretive skill not worth some recognition? This latest assault on the GP role has to be a line in the sand.


Dr Andrew Scott Jackson   15/08/2020 9:48:53 PM

Pt presented once with classic chest pain. Tomb-stoning STEMI noted on ECG (as per my interpretation of ECG). QAS attended and we lysed, successfully (again, confirmed by my interpretation of ECG). However, pt then arrested (confirmed by my interpretation of ECG). A few chest compressions later and we were beating, but at rate of 20 (as per my interpretation of ECG and the unconscious patient). Atropine push and back to sinus rythym (interpretated by another ECG). I do not recall even billing a single ECG for that case. But maybe I should have kept the traces, posted them to my local cardiologist for 4-5 separate interpretations as part of my QC and also self directed self auditing. Not sure what the patient would have thought, but at least that may medicare could sleep safe at night knowing that they were not getting low value care.


Dr David Zhi Qiang Yu   23/08/2020 4:07:45 PM

Item number of 11707 is an insult to GPs. All GPs, who do the trace of ECG and interpret it should be claimed for item 11700.

According to DoH Secretary Professor Brendan Murphy to take 6 months to review the issue is too slow and too late.

FRACGP should continue to put pressure to the government to settle the issue.