Introductory presentation - MBS Review stakeholder forums July 2015

Presentation to the Medicare Benefits Schedule Reveiw stakeholder forums held in July 2015.

Page last updated: 25 February 2016

PDF version: Introductory presentation - MBS Review stakeholder forums July 2015 (PDF 662 KB large file)

Slide 1: Medicare Benefits Schedule (MBS) Review Stakeholder Forums

Australian Government - Department of Health
Canberra (8 July 2015) / Adelaide (24 July 2015) / Perth (25 July 2015)

Slide 2: Agenda item - Introduction

  • Background to the MBS revview
  • Why review the MBS?

Slide 3: Australian high-level health outcomes

Life expectancy at birth and self-reported health score. See following table for a text description of these graphs. Larger version of slide 3 (PDF 198 KB)Top of page

Text version of slide 3

This image consists of two bar charts:

Life expectancy at birth (years)

Years per capita, 2013
CountryLife expectancy (years)
Japan84
Australia83
Italy83
Spain83
Switzerland83
Canada82
France82
Iceland82
Luxembourg82
New Zealand82
Norway82
South Korea82
Israel82
Sweden82
Austria81
Finland81
Germany81
Portugal81
United Kingdom81
Greece81
Ireland81
Netherlands81
Belgium80
Denmark80
Chile80
Slovenia80
USA79
Highlighted on this graph is that Australia has the second-highest life expectancy of the listed countries.

Source: World Health Organization Top of page

Self-reported health score

Percentage of population aged 15+ who report their health to be good/ very good, 2011.

Note. This graph provides 2011 data for most countries. Exceptions: for some countries only prior data is available (2006-2010). Newer data is used (2012-2013) where available.
Country% of population aged 15+ who report their health to be good/ very good
New Zealand90
Canada89
USA88
Australia85
Israel84
Ireland83
Switzerland82
Sweden81
Norway79
Iceland77
Netherlands76
Greece75
United Kingdom75
Belgium74
Spain74
Luxembourg74
Denmark71
Austria70
Turkey69
Italy68
France68
Finland67
Slovak Republic66
Mexico66
Germany65
Slovenia63
Highlighted on this graph is that Australia has the fourth-highest self-reported health score of the listed countries.

Source: OECDTop of page

Slide 4: Number of services per person, by age group

Per capita per year
See following text for a text description of Number of services per capitaTop of page

Text version of slide 4

This line graph shows number of services between the years 2003-04 to 2013-14 for age groups 0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 and 80 and over. Over this period the number of services per person has been trending upwards for all age groups, with the greatest increases occurring for older people. Approximate data for 2003-04 and 2013-14 is as follows (please note that this data is approximate as it has been read from the graph):

Age group2003-042013-14
0-96.27.4
10-195.06.7
20-298.110.1
30-399.712.8
40-4910.613.7
50-5914.317.7
60-6920.525.7
70-7926.937.3
80 and over24.940.6
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Slide 5: Expenditure through Medicare since 1984


Larger version of slide 5 (PDF 203 KB) Top of page

Text version of slide 5

This cumulative graph shows expenditure through Medicare from about $0.7 billion in 1983-84 to approximately $19.3 billion in 2013-14. The graph is sub-divided into GP services, diagnostic imaging, pathology, operations and procedures, other and specialist attendances. Approximate expenditure for these categories in 2013-14 was as follows (please note that this data is approximate as it has been read from the graph):
ServiceApproximate expenditure in 2013-14
GP services$6.4 b
Diagnostic imaging$2.9 b
Pathology$2.6 b
Operations and procedures$2.1 b
Other$3.2 b
Specialist attendances$2.1 b
Top of page

Slide 6: Medicare benefits paid in 2013-14 ($19.1 billion)


Medicare benefits paid in 2013-14 is a pie chart showing: GP services - 33%, diagnostic imaging - 16%, pathology - 13%, operations and procedures - 11%, specialist attendances - 11%, other MBS services - 10%, and other health professionals - 6%.
Operations and procedures include anaesthetics services.
Other MBS services include radiotherapy, obstetrics, IVF and other diagnostics.
Other health professionals include optometry, allied health and psychology services.Top of page

Slide 7: The history of the MBS

Timeline:
  • 1950 - First schedule underpinned by the National Health Act 1953
  • 1970 - MBS to include a list of "Most common fees" for each state
  • 1984 - Medicare introduced (replacing Medibank), bulk-billing restored, and Medicare Levy introduced
  • 1986 - Listing of separate fees for each state replaced by uniform fees across Australia
  • 1991 - MBS reconstructed into categories, groups and subgroups (replacing previous parts and divisions) to better reflect sequence of services
  • 1999-2000 - Enhanced Primary Care (EPC) MBS items introduced
  • 2004-05 - Chronic Disease Management (CDM) items were introduced to replace the existing EPC care planning items
  • 2015 - Over 5,500 active items listed in MBS, 70% of which have not been amended since they were created Top of page

Slide 8 - There are a variety of reasons to review the MBS

  • Items not consistent with best practice
  • Poor value/ superseded
  • Inappropriate frequency/ intensity
  • Rebate inappropriate over time
  • Need to create space for new items

Slide 9 - Terms of reference for the MBS reviews

In scope

  • All current MBS items and the services they describe
  • Increasing the value derived from servicesConcerns about safety, clinically unnecessary service provision and concurrence with guidelines
  • Evidence for services, appropriateness, best practice options, levels and frequency of support
  • Legislation and rules that underpin the MBS

Out of scope

  • Division of responsibilities between Governments – Federation White Paper
  • Innovative funding models for chronic and complex – Primary Health Care Advisory Group
  • Introduction of new MBS services – Medical Services Advisory Committee
  • No savings target – scope for reinvestment Top of page

Slide 10: Methods 1


This diagram shows the structure of the MBS review.  Review groups will be established for any number of disciplines and any number of macro issues or rules.  The MBS Review Taskforce will overarch all of these groups.
Top of page

Slide 11: Methods 2

Three stages in the review process:
  • Evidence
    • Rapid review of published evidence
    • Medicare data
  • Consult
    • Discipline group
    • Broader consultation - community and professional group input
  • Recommend
    • Changes to items
    • Changes to rules/ systems

Slide 12: Overview of MBS review process and where this forum fits

  • June - Taskforce established
  • July - Stakeholder forums
  • September - Discussion paper
  • December - First report to government
  • 2016 - Bulk of reviews
  • December 2016 - Second report to government Top of page

Slide 13: Agenda item - What are the major shifts we need to make to how the MBS works?

Slide 14: What are the major shifts we need to make?

Note: This is input received at the Canberra forum.
FromTo
Sickness focusWellness focus
Silo-ed structureSystem view, team-based focus
ActivitiesOutcomes
OpaqueTransparent (evidence based, data driven, linked/ integrated, pricing assumptions)
Inflexible, discreteFlexible, bundled
StaticDynamic and evolving
Dense and lengthySimple and short
Prices out of step with cost of deliveryPrices aligned to cost
Inconsistent (across providers, settings)Consistent
Conservative towards new technologyEmbrace new technology
Consumer views not consideredConsumer views considered
Top of page

Slide 15: Agenda item - What specific issues should the review consider?

Slide 16: What specific changes should the review consider?

Please discuss specific changes in your groups and populate this page. Consider:
  • Macro/ system changes e.g. increase frequency of MBS review
  • Cross-discipline changes e.g. identify substantial mismatches between prices and cost of delivery
  • Specific changes to item numbers e.g. review of #22020 and investigate whether to bundle this item

Slide 17: Top issues for the MBS review

Note: This is the input received at the Canberra forum.
Macro issues:
  1. Increase frequency of MBS review
  2. Review referral mechanisms and gatekeeping
  3. Improve transparency on MBS usage and variation
Cross work stream issues:
  1. Identify substantial mismatches between prices and cost of delivery
  2. Create shift from activity to outcomes focus
  3. Review of literature to determine impact of new standards of care and technologies
  4. Structuring the MBS arrangements to support best clinical practice Top of page

Slide 18: Agenda item - What barriers will we need to address in changing the MBS?

Slide 19: What are the barriers we need to address in changing the MBS?

Note: This is the input received at the Canberra forum.
What are the barriers?How can we overcome them?
Skepticism on purpose/goal from public, cliniciansCommunication – case for change – and consultation
Financial implication to livelihoodEnsure sustainable business models (understand impact, ensure sustainability)
Lack of research / evidenceBuild behind evidence base / gather
"Here we go again"Communication – evidence of political will
InertiaClear articulation of benefits and reasons for change
Workload and magnitude of changeWell-designed implementation
Poor data availabilityUse linked systems (and improve)/ better use data we have
Complexity of services providedFocus on quick wins with simple services, acknowledge "reasonable practice" threshold
Top of page

Slide 20: Agenda item - How should we prioritise where to focus?

Slide 21: It will be challenging to evaluate over 5,500 items in the review timeframe

The top 15 Medicare Benefits Schedule services in 2013-14 were:
  • #23: Standard consult (under 20 minutes)
  • #73928: Pathology episode Initiation - collection of a specimen in an approved collection centre
  • #66512: Pathology item: 5 or more chemical tests
  • #36; Long consult (over 20 minutes)
  • #65070: Pathology item: full blood count
  • #116: Subsequent consultant physician consultation
  • #73938: Pathology episode Initiation - collection of a specimen by or on behalf of the treating practitioner
  • #105: Subsequent specialist attendance
  • #5020: After hour attendances
  • #104: Initial Specialist attendance
  • #66716: Pathology item: Thyroid-stimulating hormone (TSH) quantitation
  • #66596: Pathology item: Iron studies
  • #69333: Pathology item: Urine examination
  • #66608: Pathology item: Vitamin D test (replaced by items 66833 to 66837)
  • #53: OMP short consultation
The 40 most common MBS items (0.7%) account for approximately 70% of all services.

Source: MBS online, accessed 2 July 2015
Top of page

Slide 22: How should we prioritise them?

Note: This is the input received at the Canberra forum.
  • Various category filters
    • Disease types
    • Patient types
    • Craft groups
    • Areas where models of care rapidly changing
    • Areas with poor outcomes
  • High cost / volume / growth
  • Degree to which obsolete / unnecessary
  • “High priority rules” (e.g., referral requirements)
  • Consensus view / expert hypothesis (incl leverage college / society / association expertise)
  • Complaint volumes
  • Variation – geographic, provider
  • Feasibility
  • Disparity in prices for same procedure across settings of care
Question – should the approach vary across disciplines?

Slide 23: Agenda item: What are the most effective methods for consulting stakeholders?

Slide 24: What are the most effective methods for consulting stakeholders?

Consumer

  • Consumer groups / focus groups
  • Citizen juries
  • Social media
  • Engage through clinicians
  • Case studies
  • Issues / discussion areas
    • Expert consumer vs “normal” consumer
    • Co-design
    • Survey/email
    • Inform them beforehand
    • Potentially chair Discipline Groups

Clinicians

  • Peak bodies / Colleges / Boards
  • Case studies
  • Scientific meetings
  • Written submissions / consultations (2-3 month window)
  • Issues / discussion areas
  • “Scare campaigns”
  • Nominate champions
  • Next generation of leaders

Other

  • Media – educate, engage
  • Q&A response sheets
  • Lots of various stakeholders listed! Top of page

Slide 25: Who would you like to nominate for the discipline groups?

Provide name of nominee, organisation, and specialty/ expertise.

Slide 26: MBS review email address

email MBS Reviews