ASA Engagement in the MBS Review

Since the MBS Review was first announced in 2015 the ASA has been active on behalf of members. Below is a summary of the level of engagement.

For the full commentary including relevant documents please click here.



The full commentary and documents are available for ASA members only. If you are not a member but would like to become one, please apply here.


Introduction

Since the announcement of the MBS Review in 2015, the ASA has been actively campaigning on behalf of our membership. The ASA has approached the MBS Review Taskforce, the Federal Minister for Health, and their departments in pursuit of a fairer deal for all patients in Australia. Our delegations have always encouraged a more equitable and transparent process during our many meetings and submissions. During this time, the ASA has been represented at twelve important meetings. Those have been with the MBS Review Taskforce Chair and representatives, ANZCA, AMA, two Federal Health Ministers, the Prime Minister’s Office senior health advisor, the Opposition Leader, and the Federal Shadow Minister for Health. Our ASA senior delegation and the ASA MBS Review Subcommittee partook in these meetings, submissions, and letter writing. All activities have been communicated to our membership via our regular President’s enews, ASA magazine and social media. 



2001 The Turning Point – ASA RVG Introduced

The ASA RVG was introduced into the Medicare Benefits Schedule (MBS) after a 30-year campaign by the ASA in 2001.

2015 The MBS Review Announced

The Federal Minister for Health approved the modernisation and review of the MBS with accompanying stakeholder’s forums. More than 5,700 items were considered of which 70% have not been amended since their creation. As part of this process a Taskforce Chaired by Professor Bruce Robinson was set up with the undertaking of creating over thirty different clinical committees. Committee chairs and members were appointed by the MBS Review Taskforce from their direct selection and from various nominees.

2016
The Anaesthesia Clinical Committee (ACC)

ACC is announced. No one nominated by the ASA selected for the ACC or any of the other clinical committees. The ASA intensified its advocacy with several submissions and meetings with Taskforce representatives, the College and the Prime Minister’s Office senior health advisor.

2017 Preparations for the ACC Report

ASA advocacy had resulted in twelve important meetings with all major stakeholders accompanied by written submissions and letters. A new Federal Minister for Health was installed in January and after great effort the ASA managed to achieve a face to face meeting in August. ASA MBS Review Subcommittee meets on 17 Sept 2017.

Next Steps

So far, the ASA has been represented in ten forums and twelve important meetings with Taskforce representatives, ANZCA, AMA, two Federal Health Ministers, the Prime Minister’s Office senior health advisor, the Opposition Leader, and the Federal Shadow Minister for Health. At this point, there is no clear indication when the Draft Report for anaesthesia will be available for public comment.

The ASA will continue to inform its membership as to our progress.
TGA suspension of the PB 980 ventilator

Members are advised of the following decision by the TGA.
TGA
 has taken regulatory action to suspend from the Australian Register of Therapeutic Goods (ARTG) a device that is used in the intensive care environment. A suspension from the ARTG means that the device can no longer be imported or supplied by the device’s Australian sponsor. The device under suspension is known as the Puritan Bennett 980 ventilator.  This ventilator is used in the ICU and possibly other critical care settings. For more information click here


AMA supports ASA in MBS Discussions

Date: 7 September 2017

Many of you would be aware of the concerns surrounding the MBS Review of Anaesthesia items, which were raised with me via AMA Federal Council representatives, members and colleagues. 

Whilst the AMA maintains the policy that the Colleges, Associations and Societies (CAS) are best placed to respond to specific clinical and practice issues relating to the MBS, I have always sought to engage with the profession on broader issues of patient safety and proper process. These are issues the Government cannot ignore and where the AMA’s independent opinion has great impact.  

Thankfully, I can report that Minister Hunt has been consultative and highly engaged with the health sector. He and I speak most weeks and I believe he genuinely wants to be across the complexities of his portfolio.

A testament to his commitment is the result of recent conversations Minister Hunt and I had about the draft Anaesthesia MBS recommendations, where we discussed their potential impacts in depth. I am pleased to report that the Minister’s understanding of the profession’s views has translated into a productive outcome.

The Australian Society of Anaesthetists and the Minister are now discussing a way forward, hopefully to resolve their concerns with the MBS review.

The AMA will continue to broadly support the MBS reviews, and without hesitation intervene when recommendations introduce limitations that jeopardise patient safety or access to care, undermine overall clinical opinion or have restrictions that run counter to evidence-based best practice. We will also continue to highlight where we are aware there are concerns and even disagreement within the profession.

We will work to ensure relevant CAS organisations are aware of and engaged in the relevant MBS Review consultations and encourage their members to engage with the reviews and shape the narrative.

For example, the Obstetrics review both delivered in terms of increased funding to the sector and asking of doctors enhanced and evidence-based measures to improve patient care. The After Hours review demands accountability and a higher standard of care for patients.

Whilst there is much work ahead with the MBS reviews, I look forward to continuing a constructive relationship with the Government, representing the entirety of the profession throughout the process.


Dr Michael Gannon 
Federal President, Australian Medical Association (AMA)

MBS Review update from David M Scott
Date: 15 August 2017

As you may be aware, the ASA has held deep concerns with the MBS Review’s Anaesthesia Clinical Committee’s (ACC) report and recommendations. The MBS review was set up to modernise the schedule, to delete out of date item numbers, to improve access for private patients and to ensure value for taxpayers.

From the presentation made at the ASM in Brisbane by representatives from the ACC, we believe the ACC report does not meet these criteria. We are concerned that the ACC may have made recommendations for significant cuts. We have seen no evidence or science to support these cuts. We expect these recommended cuts will significantly disadvantage over a million patients who traditionally were billed at no out of pocket. It also concerned us that there has been no meaningful consultation with the ASA, ANZCA, or any of the Special Interest Groups.

The Medicare rebate system is there to reimburse patients who choose to access private healthcare, for their out of pocket costs (OOP). Medicare does not pay doctor’s bills, patients do. For many procedures like endoscopy and cataracts the rebates from Medicare and insurers have almost always been adequate to cover these costs, however if the cuts to Medicare recommended by the ACC are adopted then this group of patients will be facing a new OOP.

The ASA has been actively engaging with Government Ministers, Department advisors, leaders from gastroenterology, ophthalmology, obstetrics and psychiatry, and the AMA at the highest levels to advocate for our patients to ensure that their rebates are not slashed.

On August 9th, I met with the Health Minister Hon Greg Hunt, along with Dr Andrew Mulcahy and Associate Professor Alicia Dennis, to express our concerns. The Minister has recommended a further working group to address these concerns and ensure a broader key stakeholder engagement. It is his intention that the recommendations be fine-tuned to adjust the tone and recommendations of the draft report to ensure the best outcomes for our patients. The working group will include senior representation from the ASA and College and will consult with other experts in the field. Once the draft report is re-worked it will be delivered to the minister for consideration and release for public consultation. Members are advised that an MBS Review session will be staged as part of the upcoming NSC in Perth, and I would encourage everyone to attend that session.

I take this opportunity to express my gratitude to the President of the AMA Dr Michael Gannon for his support in this matter, along with the ASA senior leadership group. We are hopeful that an appropriate outcome will ensure the best results for our patients. 

Associate Professor David M. Scott
ASA President


JMO Wellbeing and Support Forum Event Summary

Date: 12 July 2017

The JMO Wellbeing and Support Forum was convened on the 6 June 2017 to consider options to further improve health and wellbeing support mechanisms for Junior Medical Officers (JMOs) in NSW.
This issue requires joint solutions to be developed by all stakeholders involved in training and supporting junior doctors.
The forum outputs, together with ongoing consultation activities, will inform the JMO Wellbeing and Support Plan, currently being developed by the Ministry of Health.

Please read the detailed event summary report.
 
Medicines Safety Update Therapeutic Goods Administration - June 2017 issue
Date: 29 June 2017

The TGA have recently published their June 2017 issue of Medicines Safety Update.
In this edition, members are informed that:
Intravenous solution bags are designed for single use only, and are not be reconnected after its first use.
New implementations of improved information labeling for potential allergens on medicines.
MedSearch App is now available for all to access, providing up-to-date Product Information and Consumer Medicine Information for registered prescription medicines.

The publication can be found here

WebAIRS
Date: 22 June 2017

To capture, analyse and disseminate information about incidents relative to the safety and quality of anaesthesia is the mission of ANZTADC. The Publications Group overseeing the dissemination of webAIRS data analysis is privileged to have Professor Alan Merry at the helm.

Prof Merry has contributed much to the thinking and practice around patient safety across the world. In an Editorial in the May issue of Anaesthesia and Intensive Care he explores the history of incident reporting, how its origins lie in aviation, and how webAIRS continues to contribute to anaesthesia-specific quality improvement activity.

Prof Merry reminds us that improving safety is a long-term commitment, and webAIRS is one of the activities that help to provide the means. His interesting and thought provoking editorial will be of interest to all anaesthetists.

Update: Information about Dantrium Norgine, temporary alternative to Australian registered Dantrium powder for injection 20 mg (AUST R 14435)
Date: 19 June 2017

Update: Information about Dantrium Norgine, temporary alternative to Australian registered Dantrium powder for injection 20 mg (AUST R 14435), available here.

Please be aware that Australian registered Dantrium powder for injection 20 mg (for intravenous injection) AUST R 14435 sponsored by Pfizer is unavailable. It is expected to resume in February 2018. Pfizer has advised that they have a supply of an alternative product, Dantrium® Intravenous 20 mg powder for solution for injection [Norgine] on a temporary basis. Should use this alternative supply, please take note of the filter needle that is provided.

To read the notice from Pfizer Australia please click here.
ASA Letter to Medicare Benefits Schedule Review Taskforce Chair in reference to Medicare Benefits Schedule Review
Date: 5 June 2017

On 30 May 2017, President David M Scott submitted a letter to Professor Bruce Robinson, Medicare Benefits Schedule Review Taskforce Chair in reference to Medicare Benefits Schedule Review – Relative Value Guide for Anaesthesia.

The letter is now published on ASA website (member access required) under ASA submissions page.
President's article in reference to Kate Cole-Adams' article: Anaesthesia: what we still don't know about the 'gift of oblivion'
Published on: 29 May 2017
 
A review of the Medicare Benefits Schedule (MBS) has been underway since 2016. It’s arguably the most important thing to happen to private medicine since the introduction of Medicare in 1975.

The MBS review was set up to modernise the schedule for reimbursing doctors’ fees to patients who receive care in the private health system. Its remit was to delete items that were out of date or not supported by science and to update items that weren’t previously in the schedule.

These are all admirable objectives.

In the most recent Good Weekend, Kate Cole-Adams describes the marvel of anaesthesia. Indeed, it is safe and effective anaesthesia that has allowed surgery to evolve as it has. And it is the continued availability of safe anaesthesia that will be the cornerstone of surgery into the future.

Which is why the near total exclusion of anaesthetists from the MBS review’s key advisory body defies logic and risks invalidating the review before it’s ever completed.

As President of the Australian Society of Anaesthetists (ASA) – I lead an organisation that represents 3500 anaesthetists and GP anaesthetists in Australia. The ASA has been in existence since 1934 and is the oldest representative body of anaesthetists in Australia.

Anaesthetists are the largest speciality group in any surgical hospital. They represent 5% of the total medical workforce in Australia. And they are involved in almost every procedure carried out in hospitals right across Australia.

Anaesthetists not only completely understands your operation, they also know how to manage its effects to minimise harm. They understand your health, what other diseases you have, what medications you take and how all these affect your ability to survive surgery and recover well.

We carefully plan your anaesthetic to keep you safe during and after your procedure, while making sure that the whole experience is either not remembered or not unpleasant (if you’re meant to be awake).

In short, anaesthetists know and understand more of the whole patient and therefore the MBS schedule than any other craft group – because we have to.
 
Conversely no other craft group even looks at the anaesthesia section of the MBS – where the Relative Value Guide (RVG) is found. The RVG is a simple billing system that describes what anaesthetists do and how we bill. It’s authored by the ASA and takes into account, among other things, what surgery is occurring, the duration of that surgery, how sick the patient is and whether it’s an emergency or elective procedure.
 
So, it’s a reasonable expectation that any clinical committee considering items requiring anaesthesia should include an anaesthetist. But of the 17 clinical committees that have met and have made their reports or are considering issues, only one anaesthetist has been invited on only one committee.

Worse still, the 12-member anaesthesia clinical committee only has six anaesthetists on it. And not one of these committee members is a president of a society or college, and none holds an academic professorial position. In fact most are in fulltime public practice and so they are providing advice to government about an RVG they neither use regularly nor fully understand.

And yet this is not the case for almost all other clinical specialities on the various MBS review committees. On these committees professors and presidents abound – and are there because of their affiliations.

Of the members of the task group there are 6 Presidents or ex-presidents and 2 vice presidents. But none are from anaesthesia.

 On the clinical committees there are 29 presidents, vice presidents and chairmen scattered across 18 committees. Once again, none are from anaesthesia.

 Could it simply be an unfortunate oversight that the craft group with the widest understanding of procedural medicine in Australia has been cut out of the discussion?

 Or is this a deliberate attempt to remodel the MBS without anaesthetists’ input?

 When the MBS was established 30 years ago, the amount it paid to patients was similar to what most doctors charged. Since that time, poor and absent indexation coupled with an on going 8-year freeze has led to payments by government which bear little or no resemblance to actual medical costs. Now patients pay out of pocket fees when they see their doctor because the schedule doesn’t reflect reality.

 So a review of the ageing MBS is a great idea and essential to the sustainability of our health system – but only if it’s inclusive and evidence-based.

 Not if it’s based on bad advice from people who have an incomplete picture of what they’re advising on.

 The MBS review is about ensuring Australians get the best value for their tax dollar. And anaesthesia in Australia provides exactly that value. It accounts for only 23% of surgical costs while delivering the world’s best safety record. Between 2009 and 2014 anaesthetists services were responsible for only 2.1% of the overall growth in Medicare expenditure. Over the same period the cost to Medicare of surgeons and operations grew by 9.3% and by 10.9% for other specialist attendances including physicians.

 It seems clear that anaesthesia leads the way in saving both money and lives - we should at least be invited to the table.

Associate Professor David M. Scott
ASA President



Anticipated Shortage of Fentanyl
Date: 31 May 2017

The Therapeutic Goods Administration has advised the ASA that one of their sponsors has publicly announced an anticipated shortage of Fentanyl for both strengths of GH Solution for Injection 500 microgram/10 mL ampoule and 100 microgram/2 mL ampoule. The reason being an unexpected increase in demand. Shortage dates are anticipated between 15 Jun 2017 to 30 Jun 2017. We await if other sponsors will make a similar declaration.

For further progress please refer to http://apps.tga.gov.au/prod/MSI/search/


Anaesthesia and Intensive Care’s May issue available now!

Date: 10 May 2017


Anaesthesia and Intensive Care
’s May issue is another scintillating read for those interested in anaesthesia and intensive care alike! Our Correspondence is getting interesting with replies all around; and Chief Editor, Neville Gibbs, has written a fascinating Editorial on NFRs and shared decision-making.

We also acknowledge the passing of Professor Ross Holland, who was a significant contributor to the Journal. He will be sadly missed.

Our Original Papers range from the patient’s perspective of cardiopulmonary resuscitation by Wee et al, to the relationship between functional status prior to onset of critical illness and mortality by Rivera-Lopez et al; and the effect of RRS revision on standard and specific ICU outcomes in a regional hospital by Ohashi-Fukuda et al.

In addition to the array of Original Papers, there is also an in-depth Point of view – Coming full circle: thirty years of paediatric fluid resuscitation – by Glassford et al, and a Review of Endothelial glycocalyx by Pillinger et al.

For more information please visit: http://aaic.net.au/


Epidemiology of Critical Care provision after Surgery (EpiCCS)
Date: 26 April 2017

EpiCCS will describe the epidemiology of perioperative risk and outcome and critical care referral after inpatient surgery in Australia. It also aims to examine whether planned postoperative critical care admission is effective as an intervention to reduce postoperative morbidity.

EpiCCS is supported by the Australian Society of Anaesthetists (ASA) and the Australian and New Zealand College of Anaesthetists Clinical Trials Network (ANZCA CTN).

The principle investigator is Professor Paul Myles (Alfred Hospital, Melbourne) and the National Trainee Lead is Dr Scott Popham (ASA Trainee Member Group Chair, based at Gold Coast University Hospital).

Date of study: Patient recruitment will commence at 0700 on Wednesday the 21st June and end at 0659 on Wednesday the 28th June. There is a 7-day and 60-day follow up.

Inclusion: Patients included are all patients aged 18 years and over undergoing any surgery or procedure requiring the support of an anaesthetist and who are expected to require an overnight stay.

Data collection methods: CRFs will be distributed by the site lead at the participating hospital. The site leads are anaesthetic registrars who have liaised with their departments prior to the data collection date, and should be known to each department.

Aside from the main patient data CRF there is a Clinician Perception CRF which requires completion. The questions on these forms explore clinician approach to risk stratification and decision making around postoperative care. The clinicians invited to complete them are

  • - Anaesthetists
  • - Intensivists
  • - Surgeons

 
Nurses in charge of ICU/HDU within the participating hospitals will be approached twice a day to survey critical care occupancy status.

If you have any further questions please contact the site lead at your hospital or Scott Popham.



Shortage of Dantrium powder

Date: 19 April 2017
Update: Information about Ryanodex (dantrolene sodium), temporary substitute to Dantrium, available here

7 April 2017 
Shortage of Dantrium powder for injection 20 mg (for intravenous injection) vials and alternative supply arrangement under Section 19A of the Therapeutic Goods Act.

The ASA has received communication from Pfizer regarding the following:
- DANTRIUM® powder for injection 20 mg (for intravenous injection) AUST R 14435 sponsored by Pfizer Australia Pty Ltd is unavailable due to an unexpected third party manufacturing issue.
- It is expected to be back in stock by late December 2017.
- Pfizer has arranged a supply of an alternative product, RYANODEX® (dantrolene sodium) for injectable suspension (250mg) on a temporary basis.
- This product is NOT registered in Australia and supply is authorised under an exemption granted by the Therapeutic Goods Administration (TGA) under section 19A of the Therapeutic Goods Act 1989 until late May 2017.

For more information please see here