The use of spirometry and sleep studies in thoracic medicine are set to change under proposed changes to a raft of MBS items relating to these commonly accessed diagnostic tools.
The Thoracic Medicine Clinical Committee tasked with reviewing the MBS items hopes the changes will address problems of under-utilisation of spirometry and over-utilisation of sleep studies as well as better remunerate health care professionals.
The committee, set up by the Medicare Benefits Schedule (MBS) Review Taskforce in 2015 to review relevant MBS items, released its recommendations for consultation this week.
The committee is chaired by Professor Christine Jenkins, senior staff thoracic medicine specialist, at Concord Hospital and head of Respiratory Trials at The George Institute.
Fellow committee member, Professor Matthew Peters, told the limbic that too much lung disease was being diagnosed without the use of spirometry, in particular the before and after bronchodilator test in patients suspected of having asthma.
“The low remuneration was part of that,” he said.
The committee has recommended that the MBS rebate for undertaking diagnostic spirometry before and after bronchodilator be increased.
“We think spirometry is a very important tool to measure airway disease,” Professor Peters said.
“There is a long held belief that a large number of people are being treated for asthma without confirmation of a diagnosis.”
Professor Peters is head of Respiratory Medicine at Concord Hospital; Professor of Respiratory Medicine at Macquarie University; and past President of the Thoracic Society of Australia and New Zealand (TSANZ).
He said that while asthma puffer medication was viewed as “generally harmless”, it was concerning that people without asthma are being treated for the disease with subsidised medicines.
“Medical waste is not a victimless crime,” he said.
According to the report, in Australia and internationally it is accepted that well performed spirometry is underused in primary care.
“Pre and post bronchodilator spirometry (“reversibility testing”) has an important role in confirming the diagnosis of asthma, COPD and other causes of airflow limitation,” the committee wrote.
“Underuse of testing means that these conditions are both under and over diagnosed and as a consequence, patients are under and over medicated. Both situations generate avoidable healthcare costs.”
Concern that sleep studies are over-used
On the flip-side, the committee noted the high number of sleep studies used to diagnose obstructive sleep apnea, especially those undertaken at home.