21 July 2020

Confusion and anger over quiet ECG changes

Cardio Clinical General practice MBS Medicare

GPs have been shocked and confused at learning they will no longer be reimbursed under the MBS for interpreting ECG tests, with rebates restricted to specialists.

This means GPs will have to refer their patient on for a potentially expensive consultation with a specialist, or interpret the test for free.

The AMA and RACGP did not appear to have flagged the changes, which are set to take effect on August 1, with their members. It’s unclear whether those bodies were themselves informed.

This has prompted GPs to take to Twitter to seek clarification and express their dismay.

“How can you defund the health sector during a global health crisis?” asked Newcastle GP Dr Kathleen Wild.

Medicare has removed the ECG items 11700, 11701 and 11702 and created new items (11704, 11705 and 11707) to “reduce low-value care”, according to an announcement on the Health Department’s website.

GPs will be able to claim the 11707 item to perform a twelve-lead ECG trace only, which will be reimbursed at $19 (instead of $16.05 for item 11702).

In a letter posted on Twitter, Dr Wild pointed out the rising costs this would create, especially for people who don’t live in metropolitan Australia.

Patients might now choose to avoid getting this potentially lifesaving procedure, she said.

Geelong GP Dr Ern Chang issued an open letter to Health Minister Greg Hunt, saying the Sunday evening announcement of the changes came as a “rude and unexpected shock”.

“By removing the ability by GPs to access ECG item numbers in their practices, Medicare is doing a great disservice to patients and the profession,” he wrote. “Why?”

Dr Chang said all doctors were trained to perform and interpret ECGs, and that the test was “critical” for the day-to-day care of patients all around Australia, including those in rural and regional locations.

It was the vulnerable who would suffer, he said.

“Practices will have to bill privately to fund expensive ECG machines,” he wrote. “If patients are unable to afford the private fee, they would have to be referred to a service provider who would be able to access the item number, delaying diagnosis and treatment. This unnecessary delay is unfathomable in an advanced medical system like Australia’s.”

The decision was “poorly considered [and] done without consultation with stakeholders,” he added.

Other GPs have pointed out the risk that defunding the service will result in deskilling within general practice, and unnecessary trips to the emergency department.

Dr Wild pointed out the importance of being able to have immediate diagnostic information about a patient’s fitness to leave her surgery.

“This is not low-value care. I do not think my patients would describe my immediate attention to their risk of arrhythmia and heart disease as low-value care.”

RACGP presidential nominee Dr Karen Price noted that while the move would save the federal government money, the costs would be pushed on to the states.

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ANDREW BAIRD
Member
ANDREW BAIRD
1 year 4 months ago

As defined by Medicare, a VR GP is not a Specialist

You can apply for recognition as a medical specialist if you have either:

an Australasian specialist college fellowship
registration with the Australian Health Practitioner Regulation Agency (AHPRA) as a specialist.
If you’re basing your recognition on your AHPRA specialist registration it will expire when your AHPRA registration does.

You must be either:

a registered health professional and eligible for a Medicare provider number
have an existing provider number for locations where you’ll be practising.
For Medicare purposes, specialists include:

anaesthetists
dermatologists
emergency medical practitioners
obstetricians and gynaecologists
ophthalmologists
oral and maxillofacial surgeons
pathologists
physicians
psychiatrists
radiologists
rehabilitation medical practitioners
sports and exercise physicians
surgeons.

Andrew Baird
Guest
Andrew Baird
1 year 4 months ago
I think I’m wrong about the bulk-billing incentive payments for patients at increased risk for COVID-19. ECGs are not eligible for the COVID-19 bulk-billing incentive payments, based on the following statement that I have copied from MBSonline. It looks like 10981 and 10982 only apply to F2F and telehealth attendances. Bulk-billing incentives items: Bulk-billing incentives items are currently available for medical services for patients who are either under 16 years old, or who are a concessional beneficiary (items 10990, 10991 and 10992). Two new bulk-billing incentive items are now available where a medical service is provided to a vulnerable patient:… Read more »
Andrew Baird
Guest
Andrew Baird
1 year 4 months ago
We can and/or we will be required to bulk-bill most patients who have an indication for ECG in general practice. Most patients who require ECG in general practice have coronary heart disease, or coronary heart disease until proven otherwise (eg: indications = chest pain, acute dyspnoea, unwell diabetic, irregular pulse, hypertension, etc). Therefore most patients who have an indication for ECG are also at increased risk of COVID-19. Therefore, bulk-billing applies, (and I think this is mandatory for patients with increased risk for COVID-19), and the COVID-19 bulk-billing incentives apply (10981 (benefit = 12.95); 10982 (benefit = 19.60)). I believe… Read more »
Andrew Baird
Guest
Andrew Baird
1 year 4 months ago
Am I Specialist? I’m VR with FACRRM and FRACGP. I don’t have any other Fellowships. My AHPRA Registration indicates that I have Specialist Registration: Registration Type: Specialist Specialty: View definition of ‘Specialty’ (this links to Medical Board document, see below) General practice Medical Board of Australia Authority This revised list of specialties, fields of specialty practice and related specialist titles has been approved by the COAG Health Council on 27 March 2018 pursuant to the Health Practitioner Regulation National Law, as in force in each state and territory with approval taking effect from 1 June 2018. Specialty Fields of specialty… Read more »
Andrew Baird
Guest
Andrew Baird
1 year 4 months ago
So, have I got this right? 6 questions. 1. An ECG tracing and report by an Orthopaedic Surgeon is eligible for a Medicare benefit under item 11714, but an ECG tracing and report by a GP (VR or non-VR) isn’t eligible for a Medicare benefit under item 11714? (The benefit for 11714 is $19.55) 2. GPs used to claim for ECG trace and report with item 11700 (benefit: $24.20); now GPs can only claim for ECG trace with item 11707 (benefit: $16.15)? 3. Don’t VR GPs count as ‘Specialists’? Or does MBS regard Specialists as non-GPs? 4. Are we unhappy… Read more »
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