Reviews of Existing MBS Items
A key component of the MBS Quality Framework was the implementation of a systematic approach to reviewing existing MBS items to ensure they reflect contemporary evidence, offer improved health outcomes for patients and represent value for money.
The new MBS Quality Framework review process involved several stages from identification to decision implementation, being:
- Environmental scanning – identifying potential review topics
- Prioritisation and scoping of potential reviews
- Evidence-based review of selected services
- Review outcomes considered by an expert advisory committee - now the Medical Services Advisory Committee.
- Advice to Minister
- Government decision
- Implementation.
Environmental Scanning
A number of environmental scanning activities were undertaken, including analysis of MBS data, literature scanning, referrals from stakeholders or advisory committees and investigations of compliance. These activities identified existing MBS services that did not reflect current evidence or clinical best practice.Prioritising review activity
Once identified, Prioritisation Statements were developed for each review candidate. This document informed decision making regarding the priority for review.Evidence-based reviews
There were four demonstration reviews. Each review was conducted in a two stage process, involving the development of the review protocol and the evidence-based evaluation of the service/s, in line with the agreed protocol.Each review was supported by a Clinical Working Group (CWG), made up of a group of expert advisors with experience relevant to the Medicare Benefits Schedule (MBS) services being reviewed. The duties of the CWG were to:
- provide clinical input to an evaluator, particularly in relation to specific clinical questions that formed the direction for the review, as documented in the draft review protocol; and
- ensure that the review reflected an understanding of current Australian clinical practice and drew valid conclusions from the available evidence as documented in the draft review reports.
Development of review protocol
External consultants with demonstrated expertise in health services evaluation, including health technology assessment, were engaged to conduct the evaluations. The evaluators initially developed a review protocol that outlined the methodology for each review.The draft protocols were uploaded to the Medical Benefits Reviews Task Group’s webpage. The public, relevant stakeholders and craft groups were invited to provide written comments. All submissions were considered prior to finalization of each review protocol.
