‘We’re not just conduits to cardiologists’: GPs call for restoration of ECG items

Restrictions on Medicare rebates for ECGs performed by GPs have resulted in reduced access for the most needy patients to detection and monitoring of cardiac arrhythmias, according to the RACGP.

In a submission to the Medicare Review Taskforce, GPs are calling for a partial reversal to the changes to MBS items introduced in August 2021 that saw rebates restricted to ECG tracing only rather than tracing and report.

The RACGP accuses the Taskforce of making the changes based on flawed assumptions about geographical variations in use of ECG item numbers and the mistaken conclusion that this showed GPs were over-servicing and providing low value care.

And by curbing rebates for ECG reporting, the Taskforce had effectively rendered GPs mere conduits to hospital-based cardiologists, and created a major barrier to timely and affordable access to ECG, the submission stated.

“GPs are skilled at conducting, interpreting and reporting on ECGs,” the RACGP said.

“GPs usually do not need to refer ECG results to medical consultants for ECG interpretation except in circumstances where further advice is required from another specialist practitioner.”

The MBS changes meant that GPs were no longer able to use item 11700 (ECG tracing and report), with a rebate of $27.45, and had to use item 11707 (ECG tracing) with a rebate of $16.15, resulting in an increased cost to the patient of $11.30.

“Having developed this skill, GPs are saving the health system a considerable amount of cost by providing this service directly to patients and responding to issues in a timely manner. This prevents the need for additional secondary and tertiary investigations and care that results in increased costs to the patient and the health care system.”

The submission noted that in practice this meant an effective funding cut for ECG services particularly for doctors in rural areas and Aboriginal medical services that bulk billed patients.

Since the introduction of the changes in August 2020, GPs had provided almost half a million ECG services, or an average of 79,000 per month at the lower rebates, equivalent to  a reduction in benefits paid to patients of $5.4 million (nearly $900,000 per month).

“It is likely that reduced access to ECG tracing and interpretation due to excessive costs will increase demand to hospital departments or result in lack of early detection of heart disease, the RACGP said.

“Timely access to ECGs through a patient’s GP results in early diagnosis and management to prevent secondary complications. This is of serious concern for Aboriginal and Torres Strait Islander people, for whom there is a high rate of cardiovascular disease, and therefore a greater need for ECGs.

The College recommends a compromise in which GPs would be allowed to use MBS item 11714 to support access to ECGs performed by GPs in line with other specialists and consultant physicians.

“This would allow GPs to continue to claim item 11707 for tracing only, as well as item 11714 where a trace and clinical note (not a formal report) is provided as part of a patient’s care. This reflects current usual practice,” it said.

“GPs are medical specialists, and it is the RACGP’s position that GPs should be paid the same as other medical specialists for doing the same work. This is particularly relevant in rural and remote areas where a GP may be the only provider offering a particular service.

While the rebate for item 11714 ($21.25) is still lower than the $27.45 rebate for item 11700, allowing GP access would reduce the financial impact on patients and go some way to improve timely access to ECGs, the RACP submission said.

“Our shared goal should always be ensuring we support high-quality care, while prioritising care that can be provided in community settings to reduce pressure on secondary and tertiary services,” it concluded.

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