The department is looking forward to receiving your feedback with regard to clarifying appropriate use of MBS items for spinal fusion.  The email below invites feedback by 25 May. This email confirms an extension until Sunday 3 June, 2018.

If you have any questions, please contact Mary Warner, Director, Medical Specialist Services Section, on (02) 6289 7315 or at surgicalservices@health.gov.au.


Dear Stakeholder

Over the weekend Professor Bruce Robinson, Chair of the MBS Review Taskforce, announced that the Government will be making several changes to the Medicare Benefits Schedule (MBS) items for spinal surgery, to take effect on 1 November 2018 subject to the passage of legislation. The changes are part of the 2017-18 Budget.

The following web-link provides a fact sheet outlining the Government’s changes for spinal surgery: http://www.health.gov.au/internet/main/publishing.nsf/content/MBSR-Spinal-surgery.  You will be familiar with many of the changes that were recommended by the MBS Review Taskforce. These changes include: replacing the existing 74 items for spinal surgery with around 60 spinal surgery services; introducing new rules, including item co-claiming restrictions; and removing three obsolete items that will not be covered by the new items (items 40336, 48600 and 48603).

You will note the Government’s decision to also clarify the MBS items for spinal fusion, so that they are not claimed for the treatment of ‘uncomplicated axial chronic lower back pain’. This change is in accordance with the recommendation in the February 2018 Choosing Wisely Australia report that lumbar spinal fusion is not recommended for the treatment of this condition: http://www.choosingwisely.org.au/recommendations/fpm.

The department therefore intends to introduce an explanatory note clarifying appropriate use of spinal fusion items and would welcome your advice, noting that no MBS spinal surgery services should be performed or claimed for unnecessary, unexplained or unclear clinical reasons.

We ask that you please respond to the following questions, bearing in mind that the outcome could be a change to item descriptors or explanatory notes, so practical suggestions would be most helpful:

  1. Is ‘uncomplicated axial chronic lower back pain’ an appropriate definition?
  2. Is there any place for surgical treatment of low back pain without radiculopathy? Please describe possible indications.
  3. If surgery is performed for low back pain without radiculopathy, are there any pre- or post-operative requirements in care?
  4. What would be a form of words to prevent spinal fusion being performed and claimed inappropriately for unexplained low back pain?
  5. Do you have other recommendations that would improve outcomes in surgery for low back pain without radiculopathy?
  6. Is there any additional information or evidence that the department should consider?

You can submit your feedback to surgicalservices@health.gov.au by 25 May 2018. Depending on feedback received, we may need further assistance from your organisation.

It should be noted that the department intends to closely monitor utilisation of the new spinal surgery items once implemented. This includes monitoring of spinal fusion items and co-claiming of items. Significant variation from forecasted expenditure may warrant review of the new schedule.

For your information, I have also attached proposed item descriptors and fees from the MBS Review, at Attachment A. You may be familiar with a previous version of this document shared with stakeholders in January 2018.

The department will remain in contact with stakeholders to provide advice of any updates including final items numbers and descriptors, closer to their listing in November 2018.

If you have any questions, please contact Mary Warner, Director, Medical Specialist Services Section, on (02) 6289 7315 or at surgicalservices@health.gov.au.

 

Yours sincerely

 

Natasha Ryan
Assistant Secretary
MBS Policy & Specialist Services Branch

2018-05-28T15:28:15+00:00May 28th, 2018|News|