Medical Benefits Schedule Research Articles

Screening for depression in young Indigenous people: building on a unique community initiative.

Gurriny Yealamucka Health Service Aboriginal Corporation (GYHSAC) is an Indigenous community-controlled health organisation providing comprehensive primary care to the people of Yarrabah in far north Queensland, Australia. GYHSAC conducts an annual Young Person's Health Check (YPC) for people aged 15-25 years based on the Medical Benefits Schedule Item 715. However, the YPC is constantly evolving to meet the needs of the community, and in 2016, in response to concerns about psychological risk among Indigenous youth, GYHSAC teamed up with James Cook University to trial an adapted PHQ-9 depression screening tool (aPHQ-9) as part of the YPC. This study describes the 2016 YPC event, reports the prevalence of depressive symptoms, examines local issues related to the use of the screening tool and proposes recommendations for future health screening. Experienced health professionals conducted the aPHQ-9 assessment in a private area of the clinic. One-in-five young people were found to have moderate-severe symptoms or self-harm ideation in the previous 2 weeks; they were referred to the mental health service. The aPHQ-9 screening process was found to be straightforward and well accepted by staff and youth. Importantly, it provided valuable 'space' to facilitate communication on sensitive issues and was a conduit for speedy referral and follow up by trained staff. Based on our experience, we recommend dedicated depression screening in future routine community health checks for young people and adults.

Diagnosis and management of irritable bowel syndrome: a guide for the generalist.

Irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs) are so prevalent they cannot reasonably have their diagnoses and management based within specialty care. However, delayed diagnosis, lengthy wait times for specialist review, overinvestigation and lack of clear diagnostic communication are common. The intrusive symptoms of IBS and other FGIDs impair patient functioning and reduce quality of life, and come with significant costs to individual patients and the health care system, which could be reduced with timely diagnosis and effective management. IBS, in particular, is no longer a diagnosis of exclusion, and there are now effective dietary and psychological therapies that may be accessed without specialist referral. The faecal calprotectin test is widely available, yet not on the Medical Benefits Schedule, and a normal test result reliably discriminates between people with IBS and patients who warrant specialist referral.

Faecal calprotectin: current usage and perceived beneficial effects of third-party funding on rates of colonoscopy by Australian gastroenterologists.

Studies have suggested a diagnostic role for faecal calprotectin (FC) in patients with gastroenterological disorders. To investigate Australian gastroenterologists' (GE) views on FC use and to elicit factors that affect physicians' choices. Electronic surveys were sent out to 405 consultants and 34 registrars in Australia. Respondents who answered <50% of the survey were excluded. In all, 140 participants provided a >50% response; 73% reported using FC in their clinical practice. Factors cited by non-users in restricting their FC use included cost (24%), availability (47%) and familiarity (18%). Even among users, 69% cited funding as a major deciding factor; 98 and 86% of FC users believed that the test is a reliable method of differentiating between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) and assessing for mucosal healing in IBD respectively. Of non-users, 78 and 58%, respectively, would use FC to differentiate IBD from IBS and assess for mucosal healing in IBD, if FC testing was Medical Benefits Schedule (MBS) listed. Both users (79%) and non-users (68%) reported that use of FC to defer or avoid colonoscopies was likely if the test was MBS funded. Australian GE endorse the use of FC to discriminate between IBD and IBS, to check for mucosal healing in IBD and to reduce colonoscopy rates. Absence of MBS funding is an important factor contributing to the lack of usage of FC, in addition to the lack of familiarity with FC testing and availability.

Acceptability of digital anal cancer screening examinations in HIV‐positive homosexual men

Anal cancer is more common in HIV-positive homosexual men than in HIV-negative homosexual men and the general population. Earlier diagnosis leads to improved prognosis. We aimed to determine if regular anal inspection and digital examination of asymptomatic homosexual men attending for routine HIV care were acceptable and to record the rate of referral for diagnosis of potentially malignant anal lesions. We offered anal examinations to consecutive homosexual men with HIV infection aged ≥ 35 years during their routine HIV clinic visits, aiming to complete three examinations over a 12-month period. Acceptability questionnaires were completed at baseline and after each examination and doctors recorded examination findings and all resulting interventions. Hospital referral outcomes were collected and interventions were costed using the Australian Medical Benefits Schedule. Of 142 men who were offered enrolment in the study, 102 [72%; 95% confidence interval (CI) 64-79%] participated. Following the initial anal examinations, four men were referred to surgeons. Cancer was excluded in three men (3%; 95% CI 1-8%) and one was diagnosed with anal squamous cell carcinoma (SCC). Three men had anoscopy performed at the time and two were referred for colonoscopy. Ninety-eight per cent (95% CI 93-100%) of respondents said that they would probably have the examination next time. The intervention was estimated to cost approximately Australian $16 per examination. Regular anal digital examinations are an acceptable and inexpensive addition to the routine care of homosexual men with HIV infection.

Quantifying under-reporting of pathology tests in Medical Benefits Schedule claims data

We investigated the completeness of recording of pathology tests in Australian Medical Benefits Schedule (MBS) claims data, using the example of the prostate-specific antigen (PSA) test. With some exceptions, MBS claims data records only the three most expensive pathology items in an episode of care, and this practice ('episode coning') means that pathology tests can be under-recorded. The analysis used MBS data for male participants in the 45 and Up Study. The number and cost of items in each episode of care were used to determine whether an episode contained a PSA screening test (Item 66655), or could have lacked a record of this item because of episode coning. MBS data for 1070392 episodes involving a request for a pathology test for 118074 men were analysed. Of these episodes, 11% contained a request for a PSA test; a further 7.5% may have been missing a PSA request that was not recorded because of episode coning. It is important to consider under-reporting of pathology tests as a result of episode coning when interpreting MBS claims data. Episode coning creates uncertainty about whether a person has received any given pathology test. The extent of this uncertainty can be estimated by determining the proportion of episodes in which the test may have been performed but was not recorded due to episode coning.

The science and promise of somatic microarrays

Microarrays have answered the call for a faster, automatable whole genome screen of high resolution; however, with the exception of genomic arrays for the investigation of some congenital indications, they have been slow to slip into the mainstream of diagnostic pathological application in Australia. There are several reasons for this, not the least being the low Medical benefits Schedule rebate. Microarrays provide a top-down approach to genetic diagnosis, generating global information that can form the basis for more focussed genetic testing. Unfortunately the ‘averaging effect’ of this technology means that the sensitivity may be reduced when the cancer cells are admixed with non-malignant cells. Therefore diseases in which the cells bear surface markers that facilitate enrichment prior to analysis are good candidates for this type of investigation. Increased abnormality rates were evident when mi-croarray data was compared with karyotyping and FISH for two such diseases (myeloma and CLL). For unenriched samples, or where clonal evolution is a confounder, out of the box software may struggle with somatic microarray analysis, but oftentimes visual calls can be confirmed by targeted techniques.

Chronic disease management items in general practice: a population‐based study of variation in claims by claimant characteristics

To describe how Medical Benefits Schedule (MBS) chronic disease (CD) item claims vary by sociodemographic and health characteristics in people with heart disease, asthma or diabetes. A cross-sectional analysis of linked unit-level MBS and survey data from the first 102,934 participants enrolled in the 45 and Up Study, a large-scale cohort study in New South Wales, who completed the baseline survey between January 2006 and July 2008. Claim for any general practitioner CD item within 18 months before enrolment, ascertained from MBS records. The proportion of individuals making claims for MBS CD items was 18.5% for asthma, 22.3% for heart disease, and 44.9% for diabetes. Associations between participant characteristics and a claim for a CD item showed similar patterns across the three diseases. For heart disease and asthma, people most likely to claim a CD item were women, older, of low income and education levels, with multiple chronic conditions, fair or poor self-rated health, obesity and low physical activity levels. The pattern of claims was slightly different for participants with diabetes in that there was no significant association with number of chronic conditions, smoking or physical activity. Many individuals with self-reported CD do not claim CD items. People with diabetes and individuals with greatest need based on health, socioeconomic and lifestyle risk factors are the most likely to claim CD items.

Why has the Nurse Practitioner been granted Prescribing Privileges?

On 1 November 2010, legislation pertaining to nurse practitioners and midwives and their access to the Medical Benefits Schedule and the Pharmaceutical Benefits Scheme was enacted. Nurse practitioners hoped that the change in legislation would create more opportunity for non-medical health professionals to gain prescribing rights, but change in practice is slower than anticipated.

HPV DNA testing: Potential clinical applications

Human papillomavirus (HPV) is a common viral infection of squamous epithelial tissues. The medical community has only recently recognised the importance of HPV, which consists of many genotypes and is associated with a diverse spectrum of clinical manifestations. Genital HPV infections are the commonest viral sexually transmitted infections, with the majority being transient and asymptomatic. In a small number of women, chronic carriage of oncogenic or high-risk (HR) genotypes over years results in severe dysplasia (the precursor lesion of cervical cancer) and ultimately carcinogenesis via cofactors (in complex pathways not totally understood). Whilst low-risk (LR) HPVs genotypes (6, 11) are the primary cause of anogenital warts, certain HR genotypes (especially 16, 18) are now firmly established as the aetiological agent for cervical cancer and with relative risks (RR) of several hundred-fold. The addition of HR HPV DNA testing offers the following clinical applications: • Primary screening, using HPV DNA alone or in combination with the Pap in women ≥30 years. Longitudinal studies show HPV DNA testing has a higher sensitivity for predicting prevalent high-grade dysplasias than cytology. Further, the negative predictive value (NPV) approaches 100 per cent; superior to Pap smears alone. Ultimately, combined HPV DNA and Pap cytology could result in increasing the screening interval for those with normal Paps and negative DNA, making the combination cost-effective. • Triage of women with minimally abnormal (borderline, equivocal, inconclusive) Pap smears, to discriminate those truly HPV related and requiring follow-up. • Post ablative therapy for dysplasia, monitoring women for evidence of persistent disease and/or as a test of cure. Various HPV DNA detection systems exist: • Hybrid Capture 2, a DNA-RNA hybrid signal amplification assay with an analytical sensitivity of 5000 HPV copies (and this approaches the clinical sensitivity of the assay). • Polymerase chain reaction, with amplification of HPV target DNA, with sensitivities of 1–10 copies. In Australia, HPV DNA assays have largely been research tools and reimbursable by the medical benefits schedule for management of women post ablation for dysplasia. In the USA, HPV DNA assays have recently been approved for use in screening women ≥30 years, in conjunction with Pap cytology, plus for management of abnormal smears.

Supporting Mental Health in the Community: New Systems for General Practice

General practitioners (GPs) manage nearly one-third of Australians seeking help for mental health problems, and frequently express their need for consultant psychiatric support in this work. The introduction of new Medical Benefits Schedule Item Numbers 291 and 293 to provide "one-off" psychiatric assessments on referral from GPs offered the potential for providing this support, and a single point-of-entry scheme was organised to provide ease of access to appointments. The aims were to establish a single point of entry for psychiatrist assessment using Item 291, to evaluate the take-up rates of Item 291 in South Australia (SA) through this service and to evaluate the acceptability to GPs and psychiatrists of a psychiatric primary care consultation-liaison (c-l) model. Results were: 26 psychiatrists joined the project; 64 GPs referred 78 patients for assessment, providing 24% of the Australian take-up rate for Item 291, for 8% of the population; evaluation showed high approval ratings from GPs who particularly appreciated the single contact point; and positive evaluation by psychiatrists of the primary care c-l model. The conclusions were that a single contact point provided ease of access to psychiatrists for GPs; GP and psychiatrist groups evaluated Item 291 very positively; and consumer and carer evaluation are essential for further primary care c-l development.

Use of red blood cell transfusions in surgery.

Limited blood supplies necessitate the rational use of blood products. The aim of the present study was to provide a basis for audits of red cell usage in surgery by benchmarking common practice. Application of the data to the construction of a maximum surgical blood order schedule may be relevant for centres that perform a serological crossmatch or who collect autologous units. Data on surgical procedures identified by Commonwealth Medical Benefits Schedule item numbers, were collected retrospectively from theatre and blood bank records at the Royal Melbourne and Melbourne Private hospitals from May 1997 to April 1998. The percentage of procedures for which red cells were transfused, and the mean, median and range of units transfused for procedures with >/= 30% transfusion likelihood were identified. Over 12 months, 266 surgical procedure codes were itemized >/= 10 times each, contributing 12 300 data entries. Only 38 procedures demonstrated an incidence of transfusion of at least 30%. Most frequently transfused procedures included spinal fusion, total hip replacement, mandible/maxilla resection, prostatectomy and bladder excision. The number of common surgical procedures in which there is a 30% or greater likelihood that red cell transfusions will be given is limited. This benchmarking of common red cell usage is a first step in the process of determination of transfusion appropriateness.

General practitioner attitudes to case conferences: how can we increase participation and effectiveness?

To identify general practitioners' views on the barriers to using case conferencing (as outlined in the Medical Benefits Schedule (MBS) Enhanced Primary Care package) and to develop a set of principles to encourage greater GP participation in case conferences. Qualitative study, involving semistructured questions administered to focus groups of GPs, conducted between April and July 2001 as part of a broader study of case coordination in palliative care. 29 GPs from urban, regional, and rural areas of Queensland. Many of the GPs' work practices militated against participation in traditionally structured case conferences. GPs thought the range of MBS item numbers should be expanded to cover alternative methods of liaison (eg, phone consultations with other service providers). The onerous bureaucratic processes required to claim reimbursement were an additional disincentive. GPs would probably be more likely to participate in case conferences if they were initiated by specialist services and arranged more flexibly to suit GP work schedules.

The medical benefits schedule new items

The Enhanced Primary Care Package (EPC) was announced in the 1999/2000 Commonwealth budget. One initiative of the package was the introduction of new Medicare Benefits Schedule items on 1 November ...

Introducing ICD-10-AM in Australian hospitals.

The introduction of casemix funding systems has focused attention on the reliability and validity of coded health data. Defining and classifying medical and health related terms are the core activities of the National Centre for Classification in Health (NCCH), which has recently published the Australian modification of the International statistical classification of diseases and health related problems, 10th revision (ICD-10-AM). An important feature is a classification of procedures (MBS-E) based on the Commonwealth Medical Benefits Schedule. Clinicians have made major contributions to the new classification through a network of 21 Clinical Coding and Classification Groups, which advise the NCCH. Major advantages of ICD-10-AM for clinicians include the ability to update the classification within Australia with continued clinical consultation, the familiarity of the procedure codes based on MBS, and the possibility of having one classification for use in public and private healthcare facilities.

Restrictions on ‘multiple biochemical analyses’ profiling decreases usage of biochemistry test requests

One hundred and forty two thousand near-consecutive pathology episodes in a private practice laboratory were reviewed. During this period, a new government Medical Benefits Schedule (Pathology Services Table) was introduced which restricted the usage of the 'Multiple Biochemistry Analyses' (MBA) test profile. We found that requesting practitioners, when deprived of the use of the MBA profile, altered their biochemical requesting patterns and that usage of other permitted biochemical profiles increased. However, the overall use of biochemical tests decreased over the survey period, and the cost to the community of biochemical tests performed was lowered.

Medical Benefits Schedule

Medical Benefits Schedule

The Public Funding of Abortion Services: Comparative Developments in the United States and Australia

Attempts by anti-abortionists to eliminate public funding for abortion services were recently made in Australia and in the US; these attempts were successful in the US and unsuccessful in Australia. The attempts to restrict funding for abortion were described and 3 possible explanations of why the outcomes differed in these countries were offered. In the US legislation passed in 1965 created Medicaid a joint federal and state health program to provide health care for the poor. In 1973 the Supreme Court ruling in the Roe v. Wade case decriminalized abortion and declared that women had a right to abortion. It was generally interpreted that Medicaid should pay for medically indicated abortions. Most states complied with this interpretation till the mid 1970s. Between 1976-1981 a series of amendments referred to as Hyde Amendments were passed by Congress. These amendments gradually restricted the use of public funds for abortion services to cases where the life of the mother was endangered or to cases involving rape or incest. In 1980 the Supreme Court ruled that states participating in Medicaid programs were not required to pay for medically required abortions. These restrictions place great hardships on poor women who seek abortions in the US. In Australia the federal government administers a national health insurance scheme and also subsidizes private health companies. Abortions are included in the medical benefits schedule. In 1979 an effort was made in Parliament to restrict funding for pregnancy termination. The effort was defeated by a 65 to 47 vote. These differences in outcome may reflect 1) a rebound effect in the US due to the abrupt way in which abortion was legalized in 1972 compared to the gradual liberalization of abortion law in Australia or 2) the fact that the restriction of abortion funds in the US affected only the lower socioeconomic class while in Australia a restriction on funding would have affected a broad spectrum of the society. On the other hand these differences in outcome may simply be a product of differing legislative procedures and further efforts in Australia to restrict funding may be forthcoming and successful.

The cost of health care and health insurance in Australia: some problems associated with the fee-for-service system.

This paper reviews the health care system and the supporting health insurance framework in Australia. The importance of the health insurance mechanism is stressed in relation to the maintenance and growth of private fee-for-service medicine. The Medical Benefits Schedule, which is the negotiated basis for medical fees under insurance, is examined for the logic implicit in the fee structure. The high rewards for procedural medicine relative to consulting are suggested as part of the basis of the rapid growth in hospital admissions. It is also argued that the refund schedule has helped to determine the nature of the medical specialist manpower pool. Other problems associated with the complex nature of the refund schedule, such as fraud and wasteful over-servicing, are identified and discussed. It is asserted that the health insurance system and refund schedule are partly determining the nature of medical service provision and inducing inequities in the financing and delivery of medical care in Australia.