AMA calls for urgent review of cardiac MBS changes

The AMA is backing calls by some medical professional groups for an urgent review of Medicare changes to cardiac diagnostic services that came into effect on 1 August.

A coalition of professional associations representing GPs and imaging groups have told Federal Minister for Health Greg Hunt that the changes to ECG and stress echo test rebates will leave patients out of pocket and deter patients from having diagnostic tests.

The groups, which include the AMA, RACGP and bodies for nuclear medicine specialists, pathologists, diagnostic imaging specialists, radiologists, and rural doctors, have told Minister Hunt that their advice was ignored when the changes were put out for consultation as part of the Medicare Benefits Schedule (MBS) Review.

On 1 August, the MBS replaced 18 cardiac test items with 29 new items that changed which doctors can request tests, which tests they can provide, and for which patients.

The changes reduce the rebate for an ECG done by a GP to $19 instead of the previous rebate of $32.25. And almost all patients with suspected coronary artery disease must now be referred for stress echo tests first, not a myocardial perfusion scan (MPS).

“For medium-to-high risk patients, there will be a substantial increase in the volume of subsequent unnecessary and expensive tests, such as invasive coronary angiograms, to obtain the information that could have been acquired non-invasively using MPS,” the AMA said in a statement.

The AMA notes that prior to the changes, 64% of cardiac stress tests and imaging were requested by GPs, 26% by cardiologists, and 10% by other health professionals.

“Patients who have previously received cardiac diagnostic services by a GP, nuclear medicine specialist, or pathologist are either no longer funded to receive those services, will face higher out-of-pocket costs, or will only access those services in limited circumstances,” said AMA President, Dr Omar Khorshid.

“It makes no sense to make patients pay more, or have to be referred to a non-GP specialist, to have a basic heart test.”

Minister Hunt has indicated that some of the changes will be reviewed in six months time, but the medical groups say that will be too late.

“During this time, patient access to care will be compromised, and some patients will also face higher costs,” their letter to the minister warns.

They say that care that could easily be provided in a primary care setting will now need to be referred, and this will result in increased costs to the MBS. Several of the changes will significantly reduce patients’ access to prompt and appropriate cardiac diagnostic services, they predict.

“Nuclear medicine specialists and pathologists, including those within admitted hospital settings, are now also restricted from providing care that is accepted as clinical best practice and that supports and complements the services of cardiologists,” the letter notes.


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