Health minister battles ‘Mediscare’ claims over knee MRI restrictions

Federal Minister for Health Greg Hunt is mounting a media campaign to explain the rationale for the impending withdrawal of Medicare subsidies for GP-ordered knee MRIs in patients over 50.

The minister is emphasising that the decision to remove Medicare items 63560 & 63561 for GPs to request knee MRIs for patients aged 50 years of age and over from 1 November is based on independent advice from the MBS Review Taskforce.

The move  – announced as part of the May 2018 Federal Budget – has been portrayed by some as a Medicare cut that will force patients with knee OA to wait months to see a specialist or pay up to $500 for an MRI scan.

But the minister says the decision is one of a raft of recommendations from a panel of clinicians to tackle a surge in inappropriate imaging for patients with knee pain.

“The clinical experts … were deeply concerned that there was a practice emerging which was [GPs] sending patients over 50 for MRIs when that wasn’t necessarily the appropriate diagnosis or treatment for them,” he said on talkback radio.

“There had been a very odd change in practice in the last couple of years, a dramatic increase in the number of direct [GP] referrals for knee MRIs as opposed to other forms, and the medical experts themselves said this was potentially having a detrimental impact on chronic knee pain and that it was deferring treatments which could have and should have been occurring immediately, which weren’t appropriate and didn’t require an MRI.

“So what happens on 1 November is that instead of going directly from a GP to an MRI for the over-50s, it would have to be referred via specialist,” Mr Hunt said.

“This came about entirely because of the recommendations of the Medicare taskforce which it has GPs, surgeons, pathologists, radiologists, public health experts, medical administration experts and they recommend some things come on, some things be changed.”

Other recommendations from the MBS Review in relation to knee imaging that come into force from 1 November include:

  • Patients under 16 will no longer be required to have an x-ray of the knee prior to receiving a magnetic imaging resonance (MRI) scan of the knee (63513, 63514).
  • Existing x-ray items for the lower limb (which currently encompass foot, ankle, leg, knee or femur) will be amended to remove the knee (57518, 57521, 57535, 57536) and four new items for x-ray imaging of the knee only will be created (57522, 57523, 57537, 57540).
  • Note IN.0.1 amended to include new knee x-ray items 57523, 57540 in the list of items which dentists, podiatrists and nurse practitioners can request, following upcoming amendments to the Health Insurance Regulations 2018.
  • Existing computed tomography (CT) items for imaging of the extremities will be amended to exclude imaging of the knee only (56619, 56625, 56659, 56665), and four new mirror items for CT imaging of the knee will be created (56620, 56626, 56660, 56666).

The changes to knee MRI rebates have been criticised as Medicare cuts by groups such as the Australian Diagnostic Imaging Association, the Australasian Musculoskeletal Imaging Group and the Royal Australian and New Zealand College of Radiologists  (RANZCR).

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