Interventional gastroenterology

MBS review targets overuse of colonoscopies

The choice of item numbers for colonoscopies will increase more than tenfold if recommendations from the MBS Review’s Gastroenterology Clinical Committee are implemented.

Committee member and gastroenterologist Dr Katie Ellard said the plan to replace existing colonoscopy item numbers 32090 and 32093 with 22 item numbers would better support clinical guidelines and help contain costs.

“700,000 colonoscopies are performed each year in Australia and we’re worried that some of them are done inappropriately. The new item numbers will help prompt people to follow the guidelines but will also help gather useful data about colonoscopy practice,” she said.

Under the proposed scheme, descriptors against item numbers include how often the benefit would be payable for colonoscopies.

“For example, a patient with a moderately increased risk due to family history but no personal history of polyps would be eligible every five years, a patient with a history of 3-4 polyps could access colonoscopies at three yearly intervals, while someone with more than five polyps would have annual checks,” she said.

Dr Ellard said there had been no negative feedback from the profession since the recommendations became public.

“Clinicians have no problems with these changes in principle despite the complexities of the new scheme. They recognise the current system is not sustainable,” she said.

The report also recommended GESA submits an application to the Medical Services Advisory Committee (MSAC) for a new item number for endoscopic mucosal resection of very large polyps.

“We certainly feel the specialists who do these procedures should be adequately remunerated for their skill and as an alternative to surgery, it’s better for patients and for the public purse,” Dr Ellard said.

The committee also recommended MSAC reassess the schedule fee for capsule endoscopy given a review of the data suggested it was being overused.

“We also felt strongly that where public money is concerned, it is important to be ensuring compliance with the standards – that technology is not being used excessively. It would be appropriate for the department to follow through with an auditing process and application of fines or consequences where necessary,” she said.

Public consultation is open until 7th October. The full report can be accessed here. 

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