Osteoarthritis

Major MBS overhaul to curb knee arthroscopy and rheumatology tests


Knee arthroscopy will no longer be funded by Medicare for uncomplicated osteoarthritis, according to new recommendations from the MBS Review Taskforce.

The restriction is one of numerous changes to MBS items recommended in a series of Taskforce reports released in December, which include reinstating MBS items for unguided joint injections and changes to testing items for rheumatoid factor and citrullinated peptide antigens.

On knee arthroscopy, the Taskforce’s Orthopaedics Clinical Committee says that multiple clinical trials have shown it has no meaningful benefit in patients with uncomplicated OA and therefore MBS items should not be used except where a patient has a surgeon-confirmed locked or locking knee.

Restrictions are needed because surgeons have been slow in changing their clinical practice to reflect Australian Orthopaedic Association guidelines that recommend against arthroscopic surgery of the knee with OA, the committee says.

It also recommends reinstating two MBS items for unguided joint or bursa injection/aspiration that were removed from the MBS in 2009. The removal of the items led to an increase in the use of more expensive guided injection items using ultrasound and CT scanning.

“Although some rheumatologists and GPs have continued to provide the unguided injection/aspiration as part of a consultation, many consumers have been referred to specialists for guided injection/aspiration. This can create access and cost issues for consumers and increases their exposure to radiation from scanning,” the Taskforce report states.

However the restored items will limit injections to PBS-listed corticosteroids and local anaesthetics, with the committee noting that the injection of hyaluronic acid derivatives and platelet-rich plasma is not supported by conclusive evidence.

Other recommendations made by the MBS Taskforce include:

  • Restrict use of rheumatoid factor testing (item 71106) to four tests within a 12-month period, and developing an education program aimed at rheumatologists on how frequently to request the test.
  • Create a new item for cyclic citrullinated peptide antigens, which is currently billed under item 71119. The committee recommends a limit of three tests within a 12-month period since there are other biomarkers available that are superior for disease monitoring, such as CRP or swollen and/or tender joint count.
  • Curb inappropriate use of musculoskeletal cross-sectional echography (items 55850 and 5585) by requiring a complete diagnostic musculoskeletal ultrasound report be produced each time the service is provided.
  • Curb inappropriate repeat requesting of antinuclear antibody testing with a reworded item and an education program to inform rheumatologists of the appropriate guidelines for testing.
  • Re-wording of item for double-stranded DNA antibody testing for SLE so that so that the ‘Crithidia method’ is not excluded.
  • Mandatory Clinical Decision Support for clinicians who request lower back imaging, with feedback to those who are requesting at higher rates than their peers.

The MBS Taskforce reports are available here.

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