Anger over MBS changes that curb ECG report items

Major changes to MBS Cardiac Imaging Service items will come into effect on 1 August which include restrictions on ECG reporting by GPs.

The changes cover items for ECG, ambulatory ECG, ECG stress testing, plain and stress echocardiograms and myocardial perfusion tests, and reflect recommendations from the MBS Review Taskforce to curb inappropriate claiming of unnecessary ‘low value’ services.

The changes include the replacement of many cardiac service MBS items with new items with more restrictive descriptors and co-claiming restrictions that prohibit claiming of multiple services for the same attendance.

For example, a new item for 12-lead ECG trace and report, 11704, specifies that it can only be requested by a specialist or consultant physician and is not claimable with a specialist or consultant physician attendance item.

A controversial aspect of the changes is the blocking of GP eligibility to claim for tracing and reporting, effectively restricting these services to consultant physicians and other specialists, which has drawn an angry response from GP groups. From 1 August a new item 11707 will only cover a $19 fee for ECG tracing in primary care, a move that has been strongly opposed by the Royal Australian College of General Practitioners (RACGP).

RACGP President Dr Harry Nespolon warned that the changes would result in reduced access and longer waits for ECG interpretation for patients.

“The decision completely fails to recognise the work GPs do with ECGs – we perform interpretation, report results in patient records and determine actions that need to be taken, very often without needing to refer patients to another specialist for interpretation and reporting,” he said.

“The changes mean patients will more likely have to go to more expensive specialists for these services and face higher out of pocket costs,” he added.

The restriction on ECG items was recommended by the Cardiac Services Clinical Committee of the MBS Review Taskforce, whose report found that “many ECGs are of low value, particularly those performed without a referral.”

It also found that many GPs were performing routine/baseline ECGs, screening ECGs or repeat ECGs in the absence of symptoms.

“These are almost entirely claimed as a trace and report, despite many lacking a formal report or an appropriate clinical indication. For this reason, there was consensus that defining a service for referred ECGs would significantly increase the clinical value of the services provided, and that involving two providers would ensure an element of gatekeeping, thereby enhancing the value of the services.”

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