Ill health from ECG changes impossible to quantify

Accessibility is all the rage in health policy these days, but ECGs have been left behind.

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We will never know how many strokes, heart attacks and deaths could have been prevented over the past four years with appropriate funding for GPs, the RACGP says. 

In its response to the post-implementation review of changes to ECG items – the changes that famously took away the rebate for GP interpretation of an ECG and restricted them to trace-only items – the college again called for a restoration of GP MBS items.  

“As a result of this funding cut, 2.2 million fewer ECG services were provided to patients from 2020 to 2022,” RACGP president Dr Nicole Higgins said. 

“Coronary heart disease is the leading cause of death in Australia. Timely diagnosis and management of heart conditions is key to saving lives.  

“We’ll never know how many patients with heart issues have missed out, who’s health has got worse, and the lives lost that we could have saved in the four years since this funding was cut.” 

In terms of hard numbers, the spend on the now-deleted GP MBS item 11700 (ECG trace and report) was $82.9 million in 2019-20; last year, the spend on the GP trace-only item 11707 was $16.8 million.  

It represents a 70% reduction in ECG services provided by GPs and other doctors.  

Dr Higgins said that rural and regional patients were likely to have been particularly affected due to the maldistribution of specialists outside of major cities.  

Despite the noise it has generated, the draft report stays relatively silent on the issue of GP rebates.  

Its only recommendations were to update the wording of items 11707 and 11714 (trace and clinical note). 

Crucially, the wording of 11714 would be changed from “specialist or consultant physician” to “medical practitioner”, allowing GPs to access the item.  

“We agree that it is important to incentivise clinical decision-making and autonomy, and that interpretation of ECG traces should not be limited by medical specialty,” the college submission said.  

“The reinstatement of adequate provision and funding within the MBS for GPs to provide both tracing and interpretation of ECG results is essential in the management of care for patients experiencing or at risk of cardiac complications.”  

The RACGP, like the AMA before it, urged the government to take decisive action on the matter; this is the second time the decision has been reviewed since it was implemented in 2020.  

“The 1 August 2020 ECG MBS amendments continue to compromise patient access to timely diagnosis and management of heart conditions,” it said.  

“The restoration of ECG tracing and reporting item numbers is critical to rectify this.”