Medicare says amending items related to vitamin B12 and urine testing will increase efficiency.
Both the AMA and Royal College of Pathologists of Australasia have warned the Department of Health and Aged Care against proposed changes to vitamin B12 testing and urine examination items which would restrict patient access.
The changes, which were announced in this year’s May budget with a July 2025 start date, will ostensibly “clarify” appropriate testing pathways in an effort to reduce unnecessary testing.
In reality, DoHAC has proposed to cut rebates for some B12 testing items and to apply further eligibility restrictions on urine testing items.
While the government’s proposals do not appear to be available online at present, they have most certainly made the rounds of stakeholders like the RCPA and AMA.
According to the RCPA submission, the draft changes include lowering the rebate for some MBS B12 testing items and implementing an 11-month minimum testing interval for the quantification of vitamin B12 markers.
“The fee for the proposed active B12 MBS item number has been either halved to $23.60 or rendered $0 when included with a total B12,” the pathology college said.
These fee reductions, it said, were unjustified if the purpose of the changes was to reduce unnecessary testing rather than cut spending.
“Appropriate referral is the only way to reduce unnecessary testing,” the RCPA said.
The AMA, for its part, raised concerns that DoHAC’s proposal would put an additional burden on general practice.
It also challenged department claims that the proposal had broad support in the pathology sector, stating that it simply “does not believe this is the case”.
Like the pathology college, AMA opposed any lowering of rebates or move to block doctors from issuing additional testing when they deem it appropriate.
“It is appropriate that education efforts be enhanced for both requesters and consumers to promote appropriate testing practices,” the medical association said.
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“However, strategies intended to reduce inappropriate requests for vitamin B12 testing requests must be proportionate and not inhibit practitioners’ clinical judgement.”
RACGP quality care chair Professor Mark Morgan largely agreed with the AMA and RCPA, and raised the fact that medical science has moved on since the original recommendations for changes to the testing items were raised by an MBS review committee.
“Frequency criteria seems a clunky way to reduce MBS spending because it is often not clear to the patient, requesting clinician or pathology provider if the test has been done before,” he told The Medical Republic.
“Perhaps the nirvana of an effective and interactive My Health Record will make this easier to determine in the future.”
For urine testing item 69333, the proposal is to limit asymptomatic testing to specific patient groups.
The main concerns of the RCPA were that there is limited evidence that urine testing is being overused in community settings and that restrictions on testing will lead to more antibiotic prescribing.
Services Australia data does not show any significant increase in the total number of times item 69333 was claimed in the past decade; if anything, it has decreased slightly after hitting a high point in 2019.
Restrictions to 69333 would also likely have an impact on pathology lab logistics, given that the majority of request forms do not include clinical detail.
“The proposed changes rely on labs contacting all test requesters to clarify clinical reasoning,” the RCPA said.
“Noting the volume of these tests, this would mean laboratories needing to contact thousands of doctors each day.
“Even if this was feasible for laboratories (here we remind the Department of the acute workforce shortages our sector faces), referring doctors are highly unlikely to have the capacity to discuss each case.”
In practice, this would create significant delays on the pathology lab end.
