An old recommendation to cut GP access to a vascular MBS item has resurfaced, to the AMA’s chagrin.
The AMA is cautioning Medicare against restricting an MBS item covering renal duplex examinations to selected specialties, arguing that the removal of GP access would create a “substantial access risk”.
The service in question is MBS item 55278, which covers duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels.
Data from Services Australia indicates that it was billed around 100,000 times over the last financial year; or, for a sense of scale, roughly half the number of GP level E consults recorded that year.
GP requests count for the most services under item 55278, according to the AMA.
The proposal to axe GP access to the item has been around since at least 2020, when an MBS Review Taskforce report argued that the use of renal duplex ultrasound for diagnosis and management is specialised and that using the examination to screen for atherosclerotic renal artery stenosis represents “low value care”.
While the committee did recognise that there would be scenarios where GPs would have cause to use the item for ongoing surveillance of renal artery disease, particularly in rural areas, it still opted to recommend cutting access to GPs entirely.
Under the taskforce recommendation, item 55278 would be restricted to doctors specialising in hypertension, nephrology, vascular surgery, interventional radiology and rheumatology.
While that particular recommendation appears to have fallen by the wayside, The Medical Republic understands that it is now up for official consideration.
In a submission to the MBS Review Taskforce released earlier this week, the AMA warned that the effect of restricting item 55278 could have the opposite intended effect.
Related
“It also risks test substitution — displacing appropriate, low‑cost, no‑radiation ultrasound with computed tomography angiography, which carries higher system costs and higher radiation and contrast exposure to patients — undermining both safety and value,” the submission said.
“The AMA has previously raised these concerns and recommended retaining GP referral for renal duplex, with a focus on clinical indications rather than categorical referral barriers.”
Strengthened clinical indications included in the explanatory notes, the AMA said, would balance access and appropriateness without imposing an additional administrative burden on GPs.
“The AMA reiterates the system must continue to support doctors’ professional judgement and remains cautious about administrative requirements that seldom improve appropriateness yet often hinder timely care,” the association said.
It also recommended that, if any changes were to go through, the Department of Health, Disability and Ageing commit to a 12-month post-implementation review.
