respiratory
COPD

Date set for MBS pulmonary rehab decision


There are high hopes that community-based pulmonary rehabilitation will be subsidised by Medicare before the end of the year, after the government set a date to consider the request.

It’s been more than three years since the Lung Foundation Australia first made its bid for MBS Item 1405, which it says would benefit approximately 750,000 with COPD the majority of whom currently can’t access the therapy due to lack of service availability.

The initial application was for five proposed items numbers – including an initial eight-week education and exercise program and a follow-up maintenance program to help patients maintain the gains they had made.

In late 2016, the Medicare Services Advisory Committee (MSAC) refused to fund the maintenance program, finding there was currently not enough evidence to support it.

At the same time, MSAC also asked the Lung Foundation to furnish it with more evidence to support its application.

All eyes are now on November this year, when MSAC is due to reconsider the application after examining its economic impact.

Lung Foundation CEO Heather Allen said there is strong evidence that community-based pulmonary rehabilitation is effective for COPD – and emerging evidence for interstitial lung disease and bronchiectasis – yet currently less than 10% of people who could benefit have access.

This is because the therapy is delivered almost exclusively through hospital system, usually in urban and larger regional centres, often with long waiting lists, she says, while other barriers include limited after-hours availability and in some cases a requirement for specialist referral.

“Our application doesn’t aim to replace hospital programs, but pulmonary rehabilitation can safely be delivered in the community for the bulk of COPD patients.”

Ms Allen said she does not believe the application could be jeopardised by new evidence suggesting minimally resourced home-based pulmonary rehabilitation was equal to – even in some cases superior to – centre-based models.

The paper, co-authored by Australian senior physiotherapist and researcher Dr Anne Holland, was published last year in the BMJ’s Thorax journal [see our coverage here].

“Different models suit different needs and different populations,” Ms Allen said.

“But the main gap the Lung Foundation was addressing in its application is to begin to address the lack of pulmonary rehabilitation for patients in the community.  Our application is for group programs – Anne Holland’s paper was published after our application was lodged.

“That said, with emerging evidence to support a home-based model, it will be exciting to think about how to implement that so that patients have even more choice.”

Pulmonary rehabilitation was not among the 19 items recommended by the Medicare Review taskforce looking at thoracic medicine in 2016.