In a major overhaul of chemotherapy MBS remuneration, 11 existing administration items will be replaced by a single parenteral administration item from 1 November, that will now include subcutaneous therapy.
But a recommended new item for oral chemotherapy will take longer to deliver, according to oncologists.
In an amendment recommended by the Medicare Review Taskforce, from 1 November, MBS item 13950 will cover parenteral administration of one or more antineoplastic agents – including cytotoxic chemotherapy or monoclonal antibody therapy – and attendance for one or more episodes of administration, with a 75% fee of $83.55.
It replaces items that offered different fees depending on whether chemo administration took less than an hour, one to six hours or more than six hours.
The change represents the advice of the Taskforce’s oncology clinical committee, which in a 2018 report concluded that chemotherapy MBS items were out of date because administration of chemotherapy was now simpler than in the past and often delivered by nurses rather than medical oncologists.
“Historically, medical oncologists administered chemotherapy directly into a vein or artery. The existing items assume that the type of the administration determines the levels of medical professional involvement required, with higher schedule fees for longer durations of administration, and for more difficult routes of administration,” the report said.
“In modern practice, however, the therapeutic agent is typically administered by a nurse into a long-term implanted vascular access device … and carries less risk of immediate complications.”
The committee said that oncologist involvement had shifted from activities relating to the physical administration of chemotherapy to activities relating to the oversight and management of antineoplastic therapy and its associated effects, such as bone marrow suppression.
“Removing different benefit levels based on duration and route of administration removes incentives favouring one administration route over another,” it added.
In its rationale for abolishing time-tired items, the Taskforce highlighted wide and unexplained variations in billing of time-based items by oncologists, with Victoria having three times the rate of claiming for chemotherapy of more than six hours duration compared to NSW.
Similarly the Taskforce recommended removal of the item for accessing a long-term implanted drug delivery device, noting that this was now an integral aspect of chemotherapy and should not be subject to a co-claimed item.
The review highlighted that there were highly irregular and variable patterns of use for this item with 30% of providers never using it while a handful were billing between $100,000 to $180,000 a year for it.
The committee also recommended the creation of a new item for oral cancer therapies including newer agents such as TKIs, but this is subject to approval by MSAC.
Dr Christopher Steer, one of the oncologists involved in the Taskforce stakeholder consultation process, said one of the key aspects of the amended item for parenteral therapy is that it now recognises the increasing use of subcutaneous route of administration of chemotherapy.
But he told the limbic that the major challenge will be getting an item to recognise the role of oncologists in providing oral chemotherapy.
“It was, and still is, a desired outcome of the oncology clinical committee of the MBS review that an item number be placed on the MBS for the supervision of oral anticancer therapy but it’s going to be more work so it’s not part of the relatively simple changes that were made for 1 November,” said Dr Steer, a medical oncologist in Albury Wodonga and representative of the Private Cancer Physicians of Australia (PCPA).
“It may well require further applications to MSAC to see that through and that will be a large process that I’m pleased MOGA have taken leadership on, supported by PCPA and the Haematology Society of Australia and NZ (HSANZ),” he said.
“It’s further work, it’ll be ground breaking, novel when it happens. We’ve talked about supervision of oral anticancer therapy for many years and once we get into the detail of trying to work out what an oral anticancer therapy is, what the value of that is and why we as oncologists should be rewarded for that, that will be very interesting.”
“We’ve been calling on it for years there’ll be major challenges to work out how we actually define each individual oral anticancer treatment. We have shied away from this previously because it’s an argument that we weren’t really sure that we could win but now it’s coming from the department and we’ve been told we can go forward – well, let’s see what we can do.”
Dr Steer will feature in the limbic podcast tomorrow (Friday 23 Oct) on the new MBS chemotherapy items.