MBS sleep test restrictions lead to hospital waiting list blowouts

By Louise Durack

12 Nov 2019

Public hospital waiting lists for sleep studies are rapidly increasing following last year’s MBS restrictions, according to new data reported from a Queensland hospital.

Results presented at SleepDownunder conference in Sydney appear to confirm concerns that the MBS Review Taskforce changes implemented in November 2018 may push more patients with sleep disordered breathing into the already overburdened public system.

Three new and two revised MBS items were introduced requiring GPs to determine patient eligibility for sleep study direct referrals using approved assessment tools such as ESS and Stop-BANG scores. The revised items were introduced with the rationale to curb the growth in sleep tests conducted by private clinics and ensure appropriate  clinical review of patients starting CPAP therapy.

Now figures released by Dr Adrian Barnett and colleagues from the Gold Coast University Hospital have shown that following these changes, referrals to its sleep services have increased 20%, while the nature of the referrals has changed from predominantly diagnostic problems of sleep discorded breathing to management problems of GP-diagnosed sleep disordered breathing.

Compared to a pre-MBS two-month period (Jan 2018–Feb 2018) when the sleep service received 67 referrals, a post-MBS period (Jan 2019–Feb 2019) saw 80 referrals.

In the post-MBS period more patients were referred for OSA diagnosis and management compared to non-OSA sleep disorders compared to the pre-MBS period (94% vs. 82%). A higher  proportion of patients in the post-MBS period had undergone home/private sleep laboratory tests compared to the pre-MBS period (75% vs. 58%) and more patients were referred for sleep disordered management versus diagnosis in the post-MBS period (75% vs. 42%). Post-MBS referrals contained the results of a patients’ Epworth Sleepiness Score more often than the pre-MBS referrals (29% vs. 10%).

Dr Sutapa Mukherjee, Clinical Chair of the Australasian Sleep Association Board, told the limbic that that the burden of waiting lists “would only continue to increase” as a result of the changes but said that efficiency measures such as increasing GP training, could be implemented to alleviate the situation.

“Yes waiting lists for sleep studies are very long – they certainly are in my hospital in South Australia – and I don’t believe that there will be more public funding coming in this direction either. However one of the unintended consequences of MBS changes is that they went through without the upskilling of GPs to be able to manage sleep problems,” she said.

“We do not at all blame GPs but unfortunately they do not receive extensive training in sleep problems as part of their medicine curriculum. With sleep now recognised as being crucial to overall health, the ASA is lobbying government to help organisations such as the RACGP to help GPs receive more training in this area.

“It’s very important to be able to take a good sleep history and to provide a good quality referral, so that hospitals can more quickly identify what’s urgent. Until we can develop more capabilities in this area, patient waiting lists will continue to rise.”

Regarding the additional perceived risk of the private health insurers’ move to force patients to have gold tier insurance for sleep studies, Dr Mukherjee maintained that many of the larger health funds have continued to offer access across all levels of their cover – bronze, silver and gold. “Overall, we have not seen a major impact from insurers despite the risk of less availability for patients,” she said.

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