Appendix D -              Summary for consumers

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

Recommendation 1: Very remote dialysis

Item

What it does

Committee recommendation

What would be different

Why

New item –

very remote dialysis

The new item will provide funding for the delivery of dialysis by nurses, Aboriginal and Torres Strait Islander health practitioners and Aboriginal health workers in very remote areas of Australia.

 

Dialysis is the process of removing waste products and excess fluid from the body. Dialysis is necessary when the kidneys are not able to adequately filter the blood

Introduce a new MBS item (see section 4.1 of full report for detail)

At present, most Indigenous patients from very remote areas are forced to move to more urban areas for dialysis services. This has large economic and social impacts on the patient, family and health services. The proposed new MBS item would help to address this problem by funding the delivery of dialysis in communities in very remote areas.

Having dialysis funding available for services in very remote areas will provide greater access for those patients, leading to better attendance for dialysis and improved health outcomes.

 

Recommendation 2: Medical supervision of dialysis items

Item

What it does

Committee recommendation

What would be different

Why

Replace items 13100

13103

New item – single item claimable weekly for payment for care of a dialysis patient including all routine consultations

Current MBS funding is for a doctor reviewing a patient during a dialysis session.

Change the funding of in-centre dialysis supervision to better reflect the role of the nephrologist in overseeing treatment and planning of care for patients on dialysis. The new item would cover supervision of dialysis treatments occurring through the week including consultations and attendances for routine assessment of the dialysis treatment and the ongoing planning, care, and monitoring required between treatments.

The MBS benefit would be based on a week’s worth of dialysis treatment including all the other care provided by the nephrologist. This means that all in-centre dialysis patients should receive the same rebate for their care.

 

Episodes of acute care or weeks which require a high number of specialist consultations could still be claimed separately under existing consult items instead of using the weekly dialysis item.

While most providers bill the current items less than once a month, some providers bill for every dialysis session (~3 per week). This change would ensure that all patients receive the same rebate for their dialysis supervision.

 

The current item numbers only describe the care that occurs during direct contact with a patient during a dialysis session. This does not account for the fact that much of the activity involved in caring for a dialysis patient does not require or involve direct physician contact during a dialysis session. Doctors are believed to already be providing this care, the new item simply recognises this.

 

Recommendation 3: Arteriovenous shunt item 13106

Item

What it does

Committee recommendation

What would be different

Why

Remove item 13106 — Declotting of an arteriovenous shunt.

Shunts were previously used as a way to access a patient’s veins for dialysis. This was done using a plastic tube which would occasionally block with a blood clot and need to be cleaned out or ‘declotted’.

Remove this item from the MBS.

The MBS will be simpler.

 

No impact on patients as shunts are no longer used and all patients should have venous access established using either fistulas or grafts.

Arteriovenous shunts are no longer part of contemporary clinical practice. This is reflected in the extremely low volume of items claimed which are believed to be miscoding.

 

Recommendation 4: Insertion of temporary catheter item 13112

Item

What it does

Committee recommendation

What would be different

Why

Remove item 13112 —

Insertion of a temporary catheter

Establishing peritoneal dialysis by abdominal puncture and insertion of a temporary catheter.

Remove this item from the MBS.

No impact on patients. This procedure has been replaced in clinical practice by alternative procedures, such as insertion of catheters via laparoscopy (item 13109).

Item 13112 covers a procedure that is no longer part of contemporary clinical practice. This is reflected in the extremely low volume of items claimed.

 

Recommendation 5: Indwelling peritoneal catheter for dialysis items 13109 and 13110

Item

What it does

Committee recommendation

What would be different

Why

13109 and 13110

Peritoneal dialysis works by having a soft tube (catheter) placed in the belly by surgery. A sterile fluid is put into the belly through this catheter to absorb different chemicals and toxins the kidneys would normally filter into urine. After the filtering process is finished, the fluid leaves the body through the catheter.

 

These two MBS items describe the insertion (13109) and removal (13110) of an indwelling peritoneal catheter.

Change the item descriptor for item 13110 to look similar to item 13109. Both are very similar already, very minor changes made.

These descriptions will now be the same, with the only difference being whether it is for insertion and fixation, or removal of the catheter.

The discrepancies between the two item descriptors were unnecessary and confusing. Aligning the wording of the two item descriptors increases consistency across the MBS.


Recommendation 6: Paediatric–adult transition

Item

What it does

Committee recommendation

What would be different

Why

Not an MBS item

Funding of services to support the care of patients during the transition from paediatric to adult services, particularly for adolescent patients with complex kidney disease.

Better co-ordinated support for adolescents and young adults, who have poorer outcomes than other transplant recipients, including a high incidence of the transplant (graft) being rejected (late acute rejection episodes).

An ongoing and sustainable service (or funding for a service) should be created to provide support for the care of adolescent patients with complex kidney disease.

 

As this issue involves both public and private systems; both primary and acute care; and the involvement of non-medical healthcare providers such as youth workers, the Committee recommended that the issue of paediatric–adult transition of patients with complex kidney disease be referred to an appropriate government or inter-governmental body or group, such as the Council of Australian Governments, to be addressed in an appropriate and sustainable way.

Current models are funded through grants and charitable donations, which may not be sustainable and result in variable services being available across Australia. Clinicians across Australia have been searching for sustainable funding for this model for several years, and it remains an ongoing challenge.

Patients are transitioning from a paediatric system, where parents and the health care team assume great responsibility, to an adult system where they need to become responsible for their own care—a shift that can require upskilling. They also move from a youth friendly environment to an adult and often elderly focused environment, and experience the other challenges of adolescence. This leads to them disengaging and developing negative health outcomes like hospital admissions and loss of transplants. In the UK a dedicated service has been shown to prevent transplant failures which is beneficial for patients and may save $250,000 - $350,000 for each avoided failure.