Shall we give GPs education about when to claim an item? Nah, just make the claiming process needlessly complex instead.
Decision support and education about when to claim certain cardiac imaging items would likely do the trick to decrease inappropriate imaging and have the significant added benefit of not making the MBS even more confusing, the AMA says.
In a submission to the second consultation paper from the post implementation review of Medicare funded cardiac imaging items the AMA said it “remained concerned” that complex planned item structures and prescriptive claiming requirements would impede good clinical care.
While the consultation paper itself does not appear to be publicly available, the AMA submission covers potential changes to myocardial perfusion study (MPS) items and broader structural reforms which would expand GP requesting pathways for computed tomography of the coronary arteries (CTCA) and related credentialling requirements.
It appears the Department of Health, Disability and Ageing is looking at adjusting MPS items to fix unintended access barriers arising from broad application of the stress echo caveat, separation of metropolitan and rural/remote structures and rigid frequency restrictions.
The AMA response gives some vital clues as to what the department is considering.
“The AMA also encourages the department to consider whether separate GP‑requested and specialist‑requested MPS item numbers remain necessary where the clinical indication and the Medicare benefit are effectively the same, noting this split can add avoidable complexity for referrers and providers, including in regional and rural settings where GPs coordinate most cardiac care,” the AMA said.
“Any simplification should preserve appropriate safeguards for low‑value use while removing administrative distinctions not reflecting clinical reality.”
Instead, the AMA recommended implementing decision support and education on the appropriate role of stress echo, MPS and CTCA, “consistent with previous advice that education can improve appropriateness without relying solely on restrictive claiming rules”.
The AMA gave “in principle” support to a DoHDA proposal to introduce structured GP-requested CTCA access, noting that the department’s rationale was that non-GP specialist-only pathways delay diagnosis and disproportionately affect rural Australians.
Related
At multiple points throughout the submission, the AMA stressed that the department should prioritise writing simple, clear explanatory notes designed to prevent unintentional misuse in the first place, rather than focussing on identifying inappropriate claiming after the fact.
“Stakeholder experience outlined in the department’s paper demonstrate revised structures were confusing and administratively complex; reforms should not solve one problem by inventing another,” the association said.
“The AMA recommends implementation support that’s practical for clinicians: consolidated guidance, plain-language explanatory notes, and examples that reduce interpretive disputes and support consistent claiming.
“We also recommend evaluation frameworks that include patient outcomes and appropriateness of care, not only utilisation or service volumes.
“The AMA has previously expressed concern where reviews lacked outcome measures and focussed disproportionately on counts rather than good clinical practice.”
