Medicopolitical

COPD blueprint: Medicare funds ‘heart health checks’, why not lung checks?


A Medicare item is needed encourage lung screenings to detect COPD, which remains “under recognised, underdiagnosed and under treated” the Lung Foundation Australia has argued in a new blueprint on the future of the condition.

The proposal echoes the Heart Foundation’s successful campaign four years ago which resulted in the creation of MBS items funding GPs to perform CVD assessments in asymptomatic adults.

Since then, more than 360,000 ‘heart health checks’ have been claimed under Medicare, despite early criticisms the item’s $76.95 rebate offered no incentive for GPs beyond that for a regular 20-minute consultation.

But the same period has seen a worrying decline in claims for spirometry with claims for the MBS covering the test for diagnostic purposes falling from 89,000 in 2019 to 58,000 in 2020 and 49,000 in 2021.

Use of the MBS item for spirometry monitoring has also plummeted, from 214,000 claims in 2019 to just 70,000 last year.

The figures reflect the fact that doctors avoided the procedure during the COVID-19 pandemic, but the urgent re-establishment of services is critical, the Lung Foundation says.

“Given the substantial number of people with COPD who are not yet diagnosed, there is a clear case for targeted case-finding strategies for COPD,” it said in the policy paper released last week (link here).

Unlike T2DM and heart disease, there were current no COPD prediction models or risk calculators available to clinicians, the foundation noted.

But with these now under development, a similar approach could soon be used to the Heart Health Check items, it said.

Otherwise, it suggested incorporating lung health assessment using a validated pragmatic risk calculator into existing GP Medicare items for health assessments.

“Embedding risk assessment and the earlier identification of those at risk of COPD and those with COPD within Medicare services would recognise the time and skill required by GPs in delivering such preventive health care, and is recommended against the backdrop of persistently inadequate investment in COPD and respiratory health,” it said.

“Two new Heart Health Check items introduced to the MBS in 2019 provide a clear example for how Medicare can support the earlier identification of chronic conditions, enabling more timely and appropriate medical intervention with a view to supporting improved outcomes.”

The blueprint, developed in consultation with more than three dozen clinicians and stakeholders, also called for major investments in research, prevention, community management and acute care.

“Amongst lung diseases, COPD suffers from stigma that has relegated it to a much lower priority in attracting health care resources and research funding dollars than can be justified, given its burden and cost to the community,” wrote its steering group chair Professor Christine Jenkins.

“The view that COPD only results from tobacco smoking is also no longer tenable.”

“The origins of COPD from early life and through the lifespan develop in response to a range of environmental insults creates a golden opportunity for preventative interventions to ensure lung health for all Australians, rather than waiting until lung disease is taking a toll on an individual that is both costly and irreversible.”

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