During 2007–08, the Department ensured that the Medicare Benefits Schedule was kept up-to-date with changes in clinical services which supported and encouraged appropriate clinical practice standards, by introducing 532 new items, 331 amended items and deleting 23 out-of-date items. This compares with 249 new items, 249 amendments and 27 deletions in 2006–07. A major achievement was the introduction of items for geriatricians’ comprehensive assessment and management of patients over 65. The four items will help older patients, particularly those with complex medical, physical and psychological problems, to receive the care they need through sessions of 30 or 60 minutes duration. Other new items included comprehensive consultations with consultant physicians where the patient has at least two morbidities, and for psychiatrists to provide initial teleconsultations on new patients.
As a joint initiative between the Department and Medicare Australia, a package of incentives was rolled out to increase the take-up and use of electronic claiming of Medicare rebates and to provide greater patient convenience, as many people will no longer need to go to a Medicare Australia office to receive their rebate. The incentives include a lump sum payment for the initial use of Medicare Online or Medicare Easyclaim and a transaction-based incentive to encourage ongoing use, together with a payment to software vendors to assist practices to connect to Medicare Online and Easyclaim. Incentives also include a transitional support payment to pathologists changing electronic channels from Medclaims to Medicare Online, and access for specialists to the ‘90-Day Pay Doctor Via Claimant’ facility where claims are submitted electronically. During 2007–08, the rate of electronic claiming using Medicare Online and Easyclaim increased from 49 per cent to 65 per cent for general practitioners and from 16 per cent to 29 per cent for specialists.
Magnetic Resonance Imaging units use strong magnetic fields to generate images to assist in diagnosing and managing illnesses and injuries. In 2007–08, the Department commenced implementation of an expansion of Medicare-eligible Magnetic Resonance Imaging services. When fully implemented, this initiative will result in a 13 per cent increase in the number of Medicare-eligible Magnetic Resonance Imaging units in Australia, taking the total number from 112 to 127. In 2007–08, the first of these 15 additional Medicare-eligible Magnetic Resonance Imaging units commenced operation at Wollongong Hospital in New South Wales.
The Department also worked to provide capital funding for Kempsey Base Hospital to purchase a mobile computed tomography scanner and ultrasound machine, and for positron emission tomography facilities in Hobart and Newcastle.
The Department supported the provision of quality pathology services funded under the Medicare Benefits Schedule, through the work of the National Pathology Accreditation Advisory Council. Activities undertaken by the council included drafting accreditation standards and the establishment of a strategic framework for the promotion of quality laboratory service provisions. Project work under the Quality Use of Pathology Program also helped to identify best practice requesting patterns for the use of pathology funded under Medicare. Best practice in this area of clinical activity will mean that patients are more likely to get the right tests at the right time for the management of their health and also will be less likely to be subjected to unnecessary testing. This is particularly important for the management of chronic disease such as diabetes and cardiovascular disease.
A major achievement was the implementation of a framework for the Diagnostic Imaging Accreditation Scheme. Under the scheme, practices providing all diagnostic imaging services, except for cardiac imaging, nuclear medicine imaging, and obstetric and gynaecological ultrasound, must be accredited, or be registered to become accredited, to be eligible for Medicare benefits. Stage one of the scheme commenced on 1 July 2008 and will ensure that diagnostic imaging practices provide the same high quality, effective and safe services regardless of who, when and where the service is performed. Practices registered to participate in the scheme and practices new to the scheme will need to become accredited against entry level standards by 30 June 2010. Stage two of the scheme will commence on 1 July 2010 and will involve practices becoming accredited against more complex standards.
To help ensure that the Medicare Benefits Schedule reflects and encourages appropriate clinical practice, the Department established the Professional Services Review Advisory Committee to oversee the workings of the Professional Services Review Scheme, and to implement the outcomes of a 2006–07 review of the scheme.
The Professional Services Review Scheme protects the integrity of the Medicare and Pharmaceutical Benefits schemes by reviewing, investigating and determining whether a medical or dental practitioner, podiatrist, chiropractor, physiotherapist or optometrist has acted inappropriately when providing Medicare services.
Through the provision of secretariat services and the management of contracts to evaluate research into the safety, effectiveness and cost-effectiveness of new and emerging medical technologies and procedures, the Department maintained the Medical Services Advisory Committee’s capacity to provide advice on the circumstances under which public funding should be supported for such services, to help ensure the Medicare Benefits Schedule is sustainable and supports appropriate clinical care.
The committee completed 12 assessments of technologies and medical procedures in 2007–08, two of which were added to the Medicare Benefits Schedule: double balloon enteroscopy and endoscopic ultrasound for staging pancreatic, gastric, oesophageal and hepato-biliary neoplasms. A further two received permanent Medicare funding following a review of new evidence: hysteroscopic sterilisation and endoluminal grafting for abdominal aortic aneurysm.
The Department continued to support the Health Policy Advisory Committee on Technology, whose membership includes representatives from the Department and all state and territory health authorities, to undertake ‘horizon scanning’ (a process whereby new medical technologies are identified and appraised in terms of their potential impact on health care and associated systems, with the aim of considering these technologies before they are widely diffused so that their introduction can be effectively managed). The committee provides evidence-based advice on emerging medical technologies before they are likely to be considered for a full health technology assessment. In 2007–08, the committee reviewed approximately 80 technologies, including: quantitative ultrasound for osteoporosis screening; breast cancer diagnosis using ultrasound elasticity imaging; and kidney transplantation using incompatible blood group donors.
The Medical Service Advisory Committee advises the Minister for Health and Ageing on the strength of evidence to support public funding for new medical technologies and procedures. During 2007–08, the Department implemented a range of processes to strengthen the committee’s operation. Specific achievements included: the finalisation of conflict of interest guidelines; the development of guidelines for recording committee meeting deliberations; revision of the Medical Service Advisory Committee guidelines for economic evaluation; and more explicit articulation in assessment reports of the factors underpinning the committee’s advice, including routine acknowledgment of any dissenting or minority views.
In addition, work commenced on a number of longer term reforms including the introduction of a front end triage process and the addition of a streamlined assessment methodology for certain low risk applications to replace the Medical Service Advisory Committee’s current ‘one size fits all’ approach to evaluation of new technologies. Development of key performance indicators, that provide for better accountability in relation to the timeliness, quality and transparency of the committee’s processes and a review of current arrangements for engaging clinical experts and consumers in the assessment process is also underway within the Department.
During 2007–08, the Department introduced two new Medicare items to support better provision of health services to patients with chronic and complex conditions. The new Medicare items that commenced on 1 November 2007 make available increased funding for consultant physicians who provide comprehensive assessments, and treatment and management plans for patients. The higher Medicare fee recognises and remunerates consultant physicians for the additional time and complexity involved in treating patients with multiple morbidities. This initiative also increased the accessibility and affordability of consultant physician services for patients with multiple morbidities. The higher fee provides an incentive for consultant physicians to practise in the non-procedural specialities; and encourages new medical graduates to undertake training in these specialties. This will increase the consultant physician workforce in the future.
The Department developed these items in close consultation with the medical profession.
The Department continued to support a growing number of Aboriginal and Torres Strait Islander health services that provide pathology testing for the monitoring of diabetes at the point of care (100 sites), as at 30 June 2008. The technical support provided by the Flinders University and the Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd under the Quality Assurance of Aboriginal and Torres Strait Islander Medical Services project allows the services to provide a flexible and responsive model of care, with the aim of preventing further disease progression.
The Department helped improve access to radiation oncology services by assisting radiation oncology facilities to meet the high cost of purchasing expensive treatment and radiotherapy equipment. Through the Radiation Oncology Health Program Grant Program, the Department provided funding for 31 public and 20 private radiation oncology facilities. Two new private facilities in New South Wales and four in Queensland were approved to receive equipment grants, and funding was also provided for seven items of radiation oncology equipment at existing centres.
In addition, the Department provided capital funding contributions for new radiation oncology facilities in Bunbury in Western Australia, Lismore in New South Wales, and Darwin in the Northern Territory; and for expanded services at Royal Prince Alfred Hospital in Sydney. Initial project payments have been made and this has allowed for the planning and/or construction of facilities in these areas to commence. The Department also partly funded a new radiation oncology facility which has opened in Toowoomba, Queensland.
A focus during the year was on increasing the non-medical workforce trained in radiation therapy and medical physics. The Department worked with the radiation oncology sector on a number of workforce projects. As part of this activity, the Department provided funding for five clinical tutor positions to support additional radiation therapy students to complete their training. In addition, eight radiation therapy students were jointly funded by the Department of Health Western Australia and Perth Radiation Oncology (a private radiation oncology provider). The Department also provided incentives to radiation oncology facilities to take on additional radiation therapy trainees and radiation oncology medical physics trainees by contributing to the salaries of these positions. These incentives assisted with increasing the available workforce and thus the capacity to provide treatment services.
The Priority-driven Collaborative Cancer Research Scheme is a new funding program to support Australian researchers to work collaboratively to generate evidence, increase knowledge and improve the translation of research into policy and practice in identified priority areas. In 2007–08, the Department commenced collaborations with Cancer Australia, the National Breast Cancer Foundation, and the Prostate Cancer Foundation of Australia to deliver the cancer research scheme. The Department also signed funding agreements with six research institutions that will undertake research with a specific radiation oncology focus.
A priority during this year was to implement new arrangements for the Visiting Optometrists Scheme. The scheme provides improved access to optometry services for people in rural and remote communities. The Department introduced new arrangements that directed services towards areas of greatest need, particularly remote and very remote communities and Aboriginal and Torres Strait Islander communities. The Department also provided improved financial incentives to optometrists to encourage their participation in the scheme.
As a first step in the implementation process, the Department ‘grandparented’ 65 optometrists, previously approved to participate in the scheme, into the new arrangements. New funding agreements will enable these optometrists to continue to deliver outreach optometry services in approved locations from 1 January 2008 to 30 June 2010.
The second phase of the implementation process, undertaken by the Department in April 2008, involved a national call for expressions of interest seeking optometrists to provide outreach optometry services to identified national priority locations. These locations were determined by the Department, in consultation with key stakeholders, including State and Northern Territory Governments, the Optometrists’ Association Australia and Vision 2020 Australia. Thirty-one applications were received and additional services will commence in the second half of 2008.
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