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 Its remit was to delete items that were out of date or not supported by science and to update items that weren’t previously in the schedule.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