How are GPs finding the MBS changes for thoracic medicine?

Amanda Lyons

9/07/2019 2:27:07 PM

The Department of Health and the RACGP ask how changes to items for respiratory function tests and sleep studies are affecting general practice.

MBS items for thoracic medicine.
What has been GPs’ experience of the MBS changes for thoracic medicine?

On 1 November last year, the Department of Health (DoH) implemented changes to Medicare Benefits Schedule (MBS) items for respiratory function tests and sleep studies. These changes followed MBS Taskforce recommendations based on a thorough review by the Thoracic Medicine Clinical Committee (TMCC).
The changes are intended to ensure MBS services are reflective of modern clinical practices by updating some items to capture current scope of procedures, removing outdated items and consolidating services to minimise confusion when billing.
The changes implemented in November included: 

  • redefining the criteria for complex lung function testing, including the introduction of new MBS items to reflect the complexity of these tests
  • amending requirements to encourage appropriately performed spirometry in the primary care setting
  • restructuring MBS items for sleep studies to ensure patients with proven sleep disorders are better identified and more appropriately managed
  • allowing GPs to directly refer eligible patients for diagnostic home-based (unattended) or laboratory-based sleep studies for obstructive sleep apnoea when an approved assessment tool has been used
  • introducing a new set of items for multiple sleep latency testing and maintenance of wakefulness testing in adult and paediatric patients. 
The DoH is now conducting a six-month review into whether these changes are achieving their desired aims.
Dr Kerry Hancock, Chair of the RACGP Specific Interests Respiratory Medicine network, told newsGP data gathered by the DoH shows the changes are meeting some of their intended outcomes in respiratory medicine.
‘For example, the listing of the higher rebate for the 11505 spirometry item number was intended to incentivise general practice for well-performed spirometry to confirm the diagnosis of obstructive airways diseases, such as asthma and COPD [chronic obstructive pulmonary disease],’ she said.
‘The data suggests this has had the outcome desired by the TMCC, with more office-based spirometry testing being undertaken from November 2018 to April 2019.
‘Compared to the same time period in the previous year; about 20–25% of the spirometry tests have been billed utilising the new item number, 11505, indicating that many GPs and their spirometry operators are aware of the new item number.’ 
However, Dr Hancock also observed that better communication of the changes and their implications for GPs and practice teams may be required, as up to two-thirds of spirometry billers have not yet utilised the new item number.
‘It is likely that much of the spirometry being undertaken in general practice in this first year of the incentivisation does meet the criteria for billing item number 11505, but GPs or their administrative or nursing staff are continuing to bill item number 11506, which is now intended for monitoring of obstructive airway diseases,’ she said.
Dr Hancock said that while the provided boost in MBS funding does not reflect the full value of the services, she is happy to see the increase.
‘Although the new rebate of about $35 for item 11505 is still below the true cost of undertaking properly-performed office spirometry, it is at least an improvement on what was previously available to those GPs who want to provide this important service, in preference to referring their patients to specialist or hospital providers with the subsequent added cost and inconvenience,’ she said.
The RACGP is providing feedback to the DoH about GPs’ experiences of the MBS changes for respiratory function tests and sleep disorders, and would like to hear from members about their experiences to inform its submission.
Members can visit the RACGP website to provide their feedback, or email, until Sunday 14 July.

MBS items MBS Review Taskforce Medicare Benefits Schedule Respiratory medicine sleep studies Thoracic medicine

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Dr Bijay Pandey   10/07/2019 1:36:13 PM

Would you suggest any other way of requesting overnight sleep study on patient who has high pre-test probability of OSA but do not meet the medicare criteria of Epworth Sleepiness scale >8 and STOP BANG >4.