Renewed push to reverse ECG Medicare restrictions

David Lam

4/04/2024 4:51:19 PM

‘Unnecessary’ changes instituted in 2020 have only served to reduce patients’ access to care – particularly in rural areas – GPs say.

ECG read-out.
MBS changes made in 2020 have restricted GPs from interpreting ECGs.

The RACGP has again called on the Federal Government to revise Medicare billing rules to allow GPs to interpret their own ECGs and ensure the best possible care for patients, in a new submission to the MBS Review Advisory Committee (MRAC).
The submission was recently provided in response to a review of MBS changes made in 2020, which meant that item numbers for interpretation of an ECG could only be accessed by physicians and no longer by GPs.
At the time, GPs railed against the move and described it as a cost-cutting exercise that would impact patient care. More than three years later, RACGP Vice President and Rural Chair Associate Professor Michael Clements maintains this view, saying the change has created a barrier to affordable care, timely diagnosis, and management of heart conditions.
‘This risks people’s health getting worse,’ he said.
‘When GPs lost this subsidy for patient care, it resulted in a 33% reduction in ECG services from GPs and other medical professionals. This may save the Government’s bottom line, but it’s risking the health of our community.
‘We know the need for ECGs is increasing due to our demographics – an ageing population and increasing rates of chronic illness.
‘GPs are specialists and do the same eight years medical training as any other specialist doctor. We have the skills to conduct, interpret and report on ECGs. General practice is also the most cost-effective care for patients, our health system, and taxpayers.’
A draft MRAC report on the ECG billing changes, released in February, concurred that fees for ECG interpretation should be based on responsibility and clinical duty rather than subspecialty.
ECGs have long been an important tool used by GPs to undertake many life-saving clinical duties and it makes sense that Medicare incentivises this accordingly. They are used daily to not only detect cardiac disease and heart attacks, but also facilitate monitoring of cardiac side effects of common long-term medications for a range of mental health and metabolic conditions.
Coronary artery disease is often first picked up on ECG and remains the leading cause of death in Australia, according to the Australian Institute of Health and Welfare.
Recent research from the Victor Chang Cardiac Research Institute also shows that up to 10% of patients on long-term antipsychotics develop arrhythmias, again highlighting the importance of GPs using ECGs to monitor patients with chronic conditions.
Co-Chair of the Queensland General Practice Liaison Network, Dr Edwin Kruys told newsGP the ECG items should be revised as soon as possible, but he stresses that, rather than reducing costs, the changes have simply bred harmful inefficiency in the system.
‘It is so important that we enable and empower primary care to provide more care closer to home, where possible and safe,’ he said.
‘ECGs are simple, non-invasive and cost-effective investigations that can assist GPs to monitor their patients in the community without specialist input. 
‘The funding change has taken this part of the diagnostic process away from general practice and moved it towards more expensive secondary and tertiary care.
‘This is not only unnecessary in most cases, it is also unsafe as it causes delays in diagnosis and treatment. It is also more expensive and puts additional strain on the workload of hospital doctors.’
Sadly, rural Australians are yet again the hardest hit by the ECG billing changes.
In its report, the MRAC noted a consistent reduction in the number of ECGs performed in MMM 6 areas following the 2020 changes and acknowledged the difficulty in accessing pathology services.
It also acknowledges that the decrease in ECGs in these areas may indicate that rural people are being forced to travel elsewhere to access this type of care. The costs of travelling huge distances and its disruption to everyday life can constitute significant barriers to rural people accessing appropriate care.
South Australian rural GP, Dr Simon Lockwood, has felt the brunt of this in recent years.
His town of Roxby Downs is located more than 500 km from the nearest major city and tertiary hospital. Like many rural towns, it does not have a pathology centre where ECGs can be performed and sent electronically to a physician for interpretation, nor does it have any visiting cardiologist.
Instead, the town relies upon the skill and clinical acumen of GPs alone to recognise dangers to the heart on an ECG.
Dr Lockwood and his rural colleagues feel that to have disincentivised ECGs in general practice simply means that rural people are just not getting the same standard of care as others.
‘The 2020 changes just demonstrate a fundamental misunderstanding of rural health,’ he told newsGP.
‘In rural Australia, we don’t have easy access to cardiologists or pathology services. So it is incumbent upon the rural GP to do an ECG, interpret and treat. To disincentive this is profoundly unfair for rural populations.
‘Interpreting my own ECGs performed in the clinic have allowed me to diagnose and immediately treat numerous cases of pericarditis, myocardial infarction and atrial fibrillation over the years.
‘I’m not going to send a patient 300 km elsewhere just to get care … [or stay] on the phone for half an hour to an hour waiting for a physician to do what I am capable of doing myself.
‘It’s a waste of time and bad for the patient.’
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Dr RS   5/04/2024 8:27:05 AM

This policy was the Likely result of recommendations by a cardiologist advising the government via a committee that reviews MBS items to trim “ wasteful” expense
It just reflects the arrogance that some of our specialist colleagues have and try to tar all GPs as substandard and Inexpert in areas such as interpreting ECGs . The massive divide in status between subspecialists and GPs is the biggest in Australia, in many other countries such an hierarchy does not exist and the work of GPs is valued a lot more
These are the reasons ( apart from a massive pay gap) Australia has a GP crisis and new medical graduates don’t want to take up General Practice ( Add to this the fact that Nurses and Pharmacists will soon have the same prescribing and patient care rights as us!)

A.Prof Christopher David Hogan   5/04/2024 10:33:32 AM

Unnecessary! In these days of expanding “scope of practice “ it is & has always been an attack on commonsense, on the integrity of General Practice & a further example of false economy..

Dr Ragupathy Renganathan   5/04/2024 1:57:42 PM

ECG recording/reading has become a basic tool at General Practice, more so in the case of 'chest pain or palpitations' presentation.
I am confident a GP is at least capable of interpreting the RATE, RHYTHM(if any irregularity) and ST changes of elevation or depression or widened QRS complexes
Most of my GP colleagues will agree with me based on these findings the URGENCY of appropriate management required.
We are not far behind a cardiologist with due respect !!

Dr Peter James Strickland   5/04/2024 7:51:28 PM

It may interest RACGP members that a recognized consultant cardiologist failed to detect my own ECG changes on an exercise ECG on the treadmill at age 67 years --there were definite signs to my experienced eye of ischaemia, but told it was all OK! I was playing veteran field hockey, and ended up with 4* stents in the arteries just off the left and right main coronaries after waking up twice with typical anterior crushing chest pain later, and needing urgent cathererisation --lucky I was taking 100mg aspirin/day on my own suspicion! I knew how to read all common ECG changes due to work as a GP physician type for >40years, and never missed ischaemia on patient history + ECG, and if uncertain ,went for coronary arteriography like all well-trained GPs. ECG reading restriction by GPs has nothing to do with clinical things, and everything to do with dollars!!