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Medicare Benefits Schedule
(MBS) Review
Stakeholder Forums
Australian Government – Department of Health
Canberra (8 July 2015) / Adelaide (24 July 2015) / Perth (25 July 2015)
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Contents
▪ Introduction
– Background to the MBS review
– Why review the MBS?
▪ What are the major shifts we need to make to
how the MBS works?
▪ What specific issues should the review consider?
▪ What barriers will we need to address in
changing the MBS?
▪ How should we prioritise where to focus?
▪ What are the most effective methods for
consulting stakeholders?
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Australian high-level health outcomes
82
82
82
82
82
80
80
80
83
83
79
80
81
81
8181
81
81
81
81
82
82
82
82
83
83
84
USA
Slovenia
Chile
Denmark
Belgium
Netherlands
Ireland
Greece
United Kingdom
Portugal
Germany
Finland
Austria
Sweden
Israel
South Korea
Norway
New Zealand
Luxembourg
Iceland
France
Canada
Switzerland
Spain
Italy
Australia
Japan
Life expectancy at birth (years)
Years per capita, 2013
Self-reported health score
(%) of population aged 15+ who report their health
to be good/very good, 20111
89
68
71
63
65
66
66
67
68
69
70
74
74
74
75
75
76
77
79
81
82
83
84
85
88
90
Slovenia
Germany
Finland
France
Italy
Turkey
Austria
Denmark
Luxembourg
Spain
Belgium
United Kingdom
Greece
Netherlands
Iceland
Norway
Sweden
Switzerland
Ireland
Israel
Australia
USA
Canada
New Zealand
Mexico
Slovak Republic
2
4
1 2011 data for most countries. Exceptions: for some countries only prior data is available (2006-2010). Newer data is used (2012-2013) where available.
SOURCE: World Health Organization (life expectancy), OECD (self-reported health score)
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Number of services per person, by age group
SOURCE: MBS
Per capita per year
Number of services per capita Patient Age
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Expenditure through Medicare since 1984
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Medicare Benefits Paid in 2013-14 ($19.1 billion)
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.
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The history of the MBS
1984
1999- 2000
2004-05
2015
1986
1991
1970 1950
Medicare introduced (replacing Medibank), bulk-billing restored, and Medicare Levy introduced
Enhanced Primary Care (EPC) MBS items introduced
Chronic Disease Management (CDM) items were introduced to replace the existing EPC care planning items
Listing of separate fees for each state replaced by uniform fees across Australia
MBS reconstructed into Categories, Groups and Subgroups (replacing previous Parts and Divisions) to better reflect sequence or services
Over 5,500 active items listed in MBS, 70% of which have not been amended since they were created
MBS to include a list of “Most Common Fees” for each state
First schedule underpinned by the National Health Act 1953
SOURCE: Department of Health
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There are a variety of reasons to review the MBS
Items not consistent with best practice
Poor value/superceded
Inappropriate frequency / intensity
Rebate inappropriate over time
Need to create space for new items
| 8
Terms of reference for the MBS reviews
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
In scope Out of scope
All current MBS items and the services
they describe
Increasing the value derived from
services
Concerns 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
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Methods 1
MBS Review Taskforce
… Discipline
1
Review
group 1
Review
group 2
Review
group 3
Review
group 4
Review
group 5
Review
group 6
Review
group 7
Review
group n
…
Discipline
2
Review
group 1
Review
group 2
Review
group 3
Review
group 4
Review
group 5
Review
group 6
Review
group 7
Review
group n
…
Discipline
3
Review
group 1
Review
group 2
Review
group 3
Review
group 4
Review
group 5
Review
group 6
Review
group 7
Review
group n
…
Discipline
4
Review
group 1
Review
group 2
Review
group 3
Review
group 4
Review
group 5
Review
group 6
Review
group 7
Review
group n
…
Discipline
5
Review
group 1
Review
group 2
Review
group 3
Review
group 4
Review
group 5
Review
group 6
Review
group 7
Review
group n
…
Discipline
6
Review
group 1
Review
group 2
Review
group 3
Review
group 4
Review
group 5
Review
group 6
Review
group 7
Review
group n
…
Discipline
n
Review
group 1
Review
group 2
Review
group 3
Review
group 4
Review
group 5
Review
group 6
Review
group 7
Review
group n
…
Macro
issue/rule 2
Macro
issue/rule 3
Macro
issue/rule n
Macro
issue/rule 1
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Methods 2
Evidence
Consult
Recommend
▪ Rapid Review of Published Evidence
▪ Medicare Data
▪ Discipline Group
▪ Broader Consultation—community and
professional group input
▪ Changes to items
▪ Changes to rules/systems
| 11
Overview of MBS review process and where this forum fits
June Taskforce
Established
July Stakeholder
Forums
September Discussion
Paper
December 1st Report to Government
2016 Bulk of
Reviews
December 2016
2nd Report to
Government
| 12
Contents
▪ Introduction
– Background to the MBS review
– Why review the MBS?
▪ What are the major shifts we need to make to
how the MBS works?
▪ What specific issues should the review consider?
▪ What barriers will we need to address in changing
the MBS?
▪ How should we prioritise where to focus?
▪ What are the most effective methods for consulting
stakeholders?
| 13
From… To…
What are the major shifts we need to make? (NOTE: This is the input received at the Canberra forum)
Sickness focus Wellness focus
Activities Outcomes
Opaque Transparent (evidence based, data driven,
linked/integrated, pricing assumptions)
Inflexible, discrete Flexible, bundled
Static Dynamic and evolving
Dense and lengthy Simple and short
Prices out of step with cost of delivery Prices aligned to cost
Silo-ed structure System view, team-based focus
Inconsistent (across providers, settings) Consistent
Conservative towards new technology Embrace new technology
Consumer views not considered Consumer views considered
| 14
Contents
▪ Introduction
– Background to the MBS review
– Why review the MBS?
▪ What are the major shifts we need to make to
how the MBS works?
▪ What specific issues should the review consider?
▪ What barriers will we need to address in changing
the MBS?
▪ How should we prioritise where to focus?
▪ What are the most effective methods for consulting
stakeholders?
| 15
What specific changes should the review consider?
Please discuss specific changes in your groups and populate this page
Macro/system changes Cross-discipline changes Specific changes to item #s
e.g., increase frequency of
MBS review
e.g., review of #22020 and
investigate whether to
bundle this item
e.g., identify substantial
mismatches between prices
and cost of delivery
| 16
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
| 17
Contents
▪ Introduction
– Background to the MBS review
– Why review the MBS?
▪ What are the major shifts we need to make to
how the MBS works?
▪ What specific issues should the review consider?
▪ What barriers will we need to address in
changing the MBS?
▪ How should we prioritise where to focus?
▪ What are the most effective methods for consulting
stakeholders?
| 18
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,
clinicians
Communication – case for change – and
consultation
Financial implication to livelihood Ensure sustainable business models
(understand impact, ensure sustainability)
Lack of research / evidence Build behind evidence base / gather
“Here we go again” Communication – evidence of political will
Inertia Clear articulation of benefits and reasons
for change
Workload and magnitude of change Well-designed implementation
Poor data availability Use linked systems (and improve)/ better
use data we have
Complexity of services provided Focus on quick wins with simple services,
acknowledge “reasonable practice”
threshold
| 19
Contents
▪ Introduction
– Background to the MBS review
– Why review the MBS?
▪ What are the major shifts we need to make to
how the MBS works?
▪ What specific issues should the review consider?
▪ What barriers will we need to address in changing
the MBS?
▪ How should we prioritise where to focus?
▪ What are the most effective methods for consulting
stakeholders?
| 20
It will be challenging to evaluate over 5,500 items in the review timeframe
0
10
20
30
40
50
60
70
80
90
100
#5
85
03
#1
65
00
#7
21
#6
67
19
#7
39
30
#7
30
53
#6
65
36
#3
#6
51
20
#6
93
33
#6
67
16
#6
66
08
#7
39
39
#1
09
60
#8
00
10
MBS item number
#7
23
#5
75
21
#7
39
26
#1
09
18
#8
011
0
#1
76
10
#11
0
#3
5
#6
66
02
1
#1
09
62
#11
70
0
#1
09
00
Number of services Millions
#6
65
96
#7
39
28
#11
6
#6
50
70
#6
65
12
#5
3
#7
39
38
#3
6
#2
3
#1
05
#5
02
0
#1
04
The 40 most common MBS items (0.7%) account for ~70% of all services
SOURCE: MBS online, accessed 2 July 2015
Top 40 Medicare Benefits Schedule services, 2013-14
1 Item recently amended which will change service volumes
TOP 15 items ▪ #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
| 21
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?
| 22
Contents
▪ Introduction
– Background to the MBS review
– Why review the MBS?
▪ What are the major shifts we need to make to
how the MBS works?
▪ What specific issues should the review consider?
▪ What barriers will we need to address in changing
the MBS?
▪ How should we prioritise where to focus?
▪ What are the most effective methods for
consulting stakeholders?
| 23
What are the most effective methods for consulting stakeholders? (NOTE: This is the input received at the Canberra forum)
▪ 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
Consumer
▪ 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
Clinicians
▪ Media – educate, engage
▪ Q&A response sheets
▪ Lots of various stakeholders listed! Other
| 24
Who would you like to nominate for the Discipline Groups?
Name of Nominee Organisation Specialty / Expertise
