The MBS fee for capsule endoscopy will drop substantially from November this year following an MSAC review of the service.
Capsule endoscopy was initially flagged by the Gastroenterology Clinical Committee of the MBS Review Taskforce due to ‘significant variations in service volumes between and within states and territories that could not be explained on clinical grounds alone’.
Committee chair Professor Anne Duggan told the limbic there were concerns about the overall number and types of patients who received the capsule endoscopy service.
Data showed total services for item number 11820 had grown to about 12,000 in 2014-15 compared to a prediction of about 4,000.
“So we thought MSAC needs to go and look at that again.”
“And if you look at ages between menarche and menopause, there were about 1,700 more women than men who had a capsule that year.”
“We actually thought people weren’t using it for the indications that it was designed for – recurrent iron deficiency anaemia – so we recommended that the descriptor be more robust to ensure people exclude things like coeliac disease and heavy menstrual bleeding.”
Professor Duggan said she thought it was an extraordinary imposition on so many women to be referred for a gastroscopy, colonoscopy and a capsule.
“We shouldn’t be subjecting people to that test when they didn’t need it. All those women should have been seeing their GP for a Mirena or their gynaecologist for endometrial ablation.”
“We were concerned the descriptor wasn’t reminding people of the importance of history. We’re hoping a tighter descriptor will also lead to more appropriate use.”
The revised MBS fee for both item numbers 11820 and 11823 will be $1,229.35 based on a professional fee of $334.35 and capsule consumable cost of $895.
MSAC has requested the federal health department regularly review the MBS fee for this item to ensure that any decrease in the capsule cost is reflected.