Appendix BSummary for consumers

This table describes the medical service, the recommendation(s) of the clinical experts and why the recommendation(s) has been made.

Section 4: Emergency medicine recommendations: Recommendation 1, Recommendation 2 and Recommendation 2.1
Item(s) What it does Committee recommendation What would be different Why

501–
536

These items cover instances where an Emergency Physician attends to a patient in a recognised ED at a private hospital. These attendances involve the unscheduled evaluation and management of a patient with an unknown diagnosis. The Emergency Physician typically does not know the patient.

The first five items (501–515) cover attendances with different levels of complexity (Levels 1 to 5).

The remaining six items (519– 536) cover prolonged attendances for critically ill patients with immediately life‐threatening problems (requiring resuscitation). They are tiered by time into six categories: up to one hour, two hours, three hours, four hours or five hours, and five or more hours.

Restructure ED attendance items into three tiered base items with add‐on items. The three base items reflect the differing levels of professional involvement required in ED attendances, including the amount of time required and the complexity of the medical problem (based on the number of diagnoses and medical problems that require consideration). The add‐on items reflect the significant additional professional involvement needed for additional issues or tasks, such as managing a fracture or helping to define goals of care for a patient potentially nearing the end of his or her life. These add‐on items are to be used instead of other MBS items.

Use a consistent item framework for all emergency attendances, regardless of what type of medical provider attends to the patient. Item descriptions for ED attendances in accredited private EDs should specify the provider type and applicable schedule fee but should otherwise be the same.

–The MBS benefit should be lower if the provider is not an Emergency Medicine Specialist. The benefit amount should be a fixed proportion of the benefit available for services provided by Emergency Medicine Specialists.

Patients would receive similar MBS benefits for similar services, rather than benefits that differ based on how providers interpret MBS item descriptions. Patients receiving ED attendance services will consistently be billed using ED attendance items, rather than a different set of items depending on whether the medical practitioner is an Emergency Medicine Specialist or otherwise.

This recommendation is intended to ensure that the ED attendance items accurately reflect the key factors that determine the amount of provider skill, time and risk involved. It does so by making the item descriptors clearer, which provides patients with greater billing transparency, reduces variability in item use for similar services and supports ease of auditing.

This recommendation focuses on making billing more transparent for patients and providers, and ensuring that patients have equal access to the same MBS benefits for ED attendances if they receive the same services.

Section 5: Intensive care recommendations: Recommendation 3 to Recommendation 7
Item(s) What it does Committee recommendation What would be different Why

13870, 13873, 13876

These items cover the provision of intensive care to a patient in an ICU. This includes both professional attendances by medical providers and routine procedures such as electrocardiographic (ECG) monitoring, sampling blood from arteries for testing and inserting a bladder catheter to drain urine, whether on the patient’s first day in an ICU (13870) or on subsequent days (13873).

There is a separate item that covers the management of invasive blood pressure monitoring by devices (‘catheters’ known also as ‘lines’) inserted into arteries and / or veins in or near the heart and lungs (13876), for each type of pressure monitored up to a maximum of four pressures in a day. Intensive care patients who are less well or have more complex needs typically require more monitoring due to unstable blood circulation.

Leave these items unchanged.

No changes.

There is no evidence that these items or services are being misused, and they accurately reflect modern intensive care practices. In particular, the Committee believes that the need for invasive blood pressure monitoring remains the most appropriate way of accounting for different levels of patient complexity in an ICU for the following reasons:

  • Δ It is scalable (from no invasive pressure monitoring up to four types of monitoring), simple and auditable, and it accurately reflects the overall level of professional involvement required.
  • Δ There are no appropriate alternatives, and invasive pressure monitoring is likely to be less ambiguous than alternative ways of accounting for complexity. This means that there is less risk of item misuse.

13847, 13848

‘Counterpulsation by intraaortic balloon’ uses a therapeutic device to support the function of the heart. The device alternates between: (i) creating a vacuum effect (by rapidly deflating the balloon) that pulls blood forward during contraction of the heart; and (ii) maintaining blood pressure (by inflating the balloon) in between contractions of the heart.

Remove the different fees for managing counterpulsation by intraaortic balloon on the first day (13847) and on subsequent days (13848).

The same MBS benefit would be provided on the first day and subsequent days of managing counterpulsation by intraaortic balloon.

This recommendation simplifies the MBS and enhances value for the patient and the health system because it recognises that there is no significant difference in the professional involvement required between first and subsequent days.

13851, 13854

These items cover management of a therapeutic device that helps the heart to circulate blood around the body, either on the first day of care (13851) or on subsequent days (13854). It may be used if the heart is injured and unable to adequately supply the body with blood (for example, during a severe heart attack).

Different types of device are available, including intra‐aortic balloon pumps (IABP; which are also covered under items 13847 and 13848); ventricular assist devices (which are the intended device covered under items 13851 and 13854); and extracorporeal membrane oxygenation (ECMO; a more recently developed device that supports the functions of the lungs in addition to the functions of the heart).

Consider an expedited MSAC assessment for listing new MBS items for extracorporeal life support, and revise items 13851 and 13854 to clarify that they are intended to cover ventricular assist devices (VADs).

The currently item descriptors are ambiguous. The new descriptors will clearly refer to the intended service of managing ventricular assist devices.

The MSAC will consider listing ECMO on the MBS. If it decides to list ECMO, MBS benefits will be available for ECMO and other extracorporeal life support services under a specific item.

This recommendation focuses on making the currently ambiguous item descriptors for items 13851 and 13854 clearer. It will also ensure that substantively different technologies (such as ECMO) are appropriately evaluated by the MSAC before being listed as a distinct service (item) on the MBS.

13815, 13842

Cannulation and catheterisation of arteries (13842) or veins (13815) is a procedure that involves inserting a tube (‘catheter’ or ‘cannula’) into a blood vessel. This tube allows fluids to be delivered, blood to be drawn or blood pressure to be measured.

The tube can be inserted with or without ultrasound guidance.

Ultrasound guidance allows the provider to visualise the structures beneath the skin (such as blood vessels, nerves and muscles). This helps the provider to guide the tube into position.

Revise the item descriptions for intra‐arterial cannulation (13842) and central vein catheterisation (13815) to encourage providers to use ultrasound guidance.

Item descriptors would clearly convey the expectation that ultrasound guidance should be used where clinically appropriate. This would encourage providers to deliver this service safely and effectively.

This recommendation supports the safe and effective delivery of health services and enhances value for patients and the community.

Ultrasound guidance helps providers to accurately insert catheters or cannulae into blood vessels without damaging the surrounding areas.

In modern practice, the use of ultrasound guidance is considered best practice, and it is therefore an integral component of cannulation and catheterisation. For this reason, it should not attract separate MBS benefits. However, a blanket requirement for ultrasound guidance is not appropriate, because there are circumstances where ultrasound guidance is not appropriate or necessary. For example, experienced providers may not need it, especially if they were trained before ultrasound became part of the standard of care.

TBD

Defining goals of care is a medical professional attendance service. It involves a comprehensive evaluation of the patient’s issues (medical, psychological, social and other); proactive offering of treatment alternatives (including alternatives to intensive or escalated care); and discussion of these alternatives with the patient (or surrogate decision maker), and the patient’s family, carers and other health practitioners (where appropriate).

Introduce an MBS item that covers discussion and documentation of goals of care by an Emergency Physician or Intensive Care Specialist for patients who are potentially nearing the end of their lives, where alternatives to active management may be an appropriate clinical choice, and where relevant goals of care have not yet been decided.

MBS benefits would be payable for this service, under a specific item.

This recommendation focuses on improving the quality of end‐of‐life decision‐making, with the aim of improving patient experience and enhancing value for the patient and the community. The Committee noted consumer feedback that end‐of‐life decisions are often made without providing sufficient information to patients and their families on the alternatives available to them. Patients may not realise they have alternative options, which may result in them receiving prolonged and futile treatment that they do not want. The Committee noted that in ideal circumstances, goals of care are defined with a provider who is familiar with the patient, prior to admission to hospital or an ICU. However, if this has not happened, it is important that providers support patients and their families in making informed choices before beginning intensive and potentially prolonged treatment.

Section 6: General recommendations: Recommendation 8 to Recommendation 10
Item(s) What it does Committee recommendation What would be different Why

14200

‘Gastric lavage’ is a therapeutic procedure (also known colloquially as ‘stomach pumping’) that is used to treat patients who have ingested poison. A tube is passed into the stomach, and small amounts of fluid are then passed in and out of the stomach (repeatedly) to remove the poison.

Remove this item from the MBS.

This service would no longer attract an MBS rebate.

Gastric lavage is no longer best practice. It has unclear benefits, particularly in comparison to other readily available and less invasive techniques. There is also a risk of serious complications. It is therefore considered an obsolete and unsafe practice.

TBD

Response to a ‘code blue’ or rapid response system referral is a medical professional attendance service. ‘Code blue’ calls are requests for immediate medical professional attendance for medical emergencies, such as cardiac arrest. Rapid response systems, such as the Medical Emergency Team (MET) call system, are designed to request immediate medical professional attendance to manage patients whose health is deteriorating. The aim is to intervene early in order to stabilise the patient and prevent further deterioration that results in ICU admission or cardiac arrest.

The service involves immediate attendance, where the provider assesses the patient, investigates the medical emergency and manages care. This includes performing procedures such as rapid administration of fluid and medications to maintain blood pressure and flow, as well as procedures to support the patient’s breathing.

This proposed item is for attendances in response to code blue or rapid response system requests outside of EDs or ICUs by the medical practitioner taking overall responsibility for the patient in the course of the call or code response. It is not claimable in conjunction with ED attendance or ICU daily management items by the same provider.

Consider an expedited MSAC assessment for listing an MBS item for rapid response system / code blue attendances.

MBS benefits would be payable for this service, under a specific item.

This recommendation focuses on supporting access to this best‐practice health service in order to improve patient health outcomes.



  • ΔMedical professional attendances for arrest calls and rapid response system alerts (such as MET calls) represent best‐practice standard of care and are potentially life‐ saving.
  • Δ Significant professional involvement is required when attending to such patients— over and above other referred attendances that may be covered under existing item 104—because the provider does not know the patient, the patient is in an unstable clinical condition or is critically ill, and the provider needs to attend immediately (disrupting his or her existing workflow).

13818, 13830, 13857 and 13881– 13888

These items refer to a variety of procedural services.

  • ΔItem 13818: ‘Right heart balloon catheters’ are devices inserted into the part of the heart responsible for receiving blood from the body and pumping it to the lungs. These devices measure blood flow and pressures, such as to monitor patients who have received heart surgery.
  • Δ Item 13830: ‘Intracranial pressure monitoring’ is a specialized service involving measurement of the pressure within the skull, such as to monitor patients who have experienced head trauma or surgery on the brain.
  • ΔItems 13857 and 13881: ‘airway access and mechanical ventilation’ is a therapeutic procedure involving insertion and use of devices to support a patient’s lung function (breathing).
  • ΔItem 13885 and 13888: ‘haemofiltration’ is a therapeutic procedure that supports a patient’s kidney function (for example, removal of waste products from blood, and maintenance of blood concentrations of electrolytes).

Leave these items unchanged.

No changes.

No concerns were raised regarding access to these items or the safety, obsolescence, value or misuse of these items.



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