MBS rebates for a number of female-focused diagnostic imaging items sit below those of similarly complex male-focused items.
The AMA is calling for measures to improve gender equity for rebates for diagnostic imaging.
The AMA has released its submission to the reviews of Diagnostic Breast Imaging Services and Diagnostic Imaging Ultrasound Services.
Under the current Medicare Benefits Schedule, fees for a number of female-focused items sit below those of similarly complex male-focused diagnostic items.
“The current structure of ultrasound and breast imaging MBS items creates inequity of access for women in comparison to the broader population seeking general medical imaging, an issue exacerbated by years of no and under-indexation of the MBS,” reads the AMA’s submission.
“Adjustments to service provision should be implemented through amended requirements and remuneration in line with comparable services.”
The association acknowledged that it was challenging to directly compare procedures between the sexes, for example for ultrasounds, when a specialist or consultants may be needed to perform urological and vascular ultrasounds in comparison to a sonographer, thereby influencing costs.
“Additionally, the complexity and duration of the scans can vary, making a straightforward comparison difficult,” noted the association.
“As a broad indication, the number of images to be interpreted is a reasonable starting point for determining the complexity of an item.”
The association said it was important to reimburse procedural items in line with complexity and time, including breast imaging services, to ensure healthcare providers were not disincentivised from offering necessary services.
“Fee relativity should reflect a fair allocation of resources based on service complexity rather than gender-specific conditions,” it said.
The group also called for the removal of the seven-day delay rule – denoting a maximum of two vascular ultrasound studies in a seven-day period.
“This is an issue for patients when an extra appointment is required for a new referral, taking time from GPs who often perform this task as unpaid administrative work,” it said.
“Removal of the rule would enable better access for women travelling greater distances to the regional centres where services are provided.
“These changes would also alleviate the unintended consequences of the rule for rendering requested services, where some women are forced to spend additional time and money seeing their GP for renewed referrals due to time constraints.”
The association worked through the review’s proposed item changes individually and whether they may achieve the desired outcome, namely improve equity of services.
Fees for MBS item 55048, for a scrotal ultrasound, and item 55706, for a 17 to 22-week gestational ultrasounds, were skewed, according to the association.
Despite the scrotal ultrasound requiring less images to be taken and reviewed, and taking less time to perform, it garners a $122.80 rebate compared to a $112.15 for the gestational ultrasound.
“The AMA supports amending the fee relativity for these items to ensure it is reflective of the complexity and time required to perform the scans,” reads the submission.
The association also supported looking into a new MBS item specifically for ultrasounds for endometriosis, which are currently captured in item 55065 which covers a broad range of pelvic ultrasounds.
Conversely, in the name of simplifying the MBS and avoiding condition-specific items, the AMA supported combining urological ultrasound items 55600 and 55603, and vascular ultrasound items 55282 and 55706.
Similarly, in the case of some overlapping pregnancy items, the association approved streamlining, and more funding where necessary.
“The AMA supports amendments to MBS items to ensure monochorionic multiple pregnancy scans receive subsidisation in line with their potential complexity and length of consultations and scans required,” it said.
“The AMA questions whether a financial discrepancy should exist between some of these items.
“Particularly, between items 55740 and 55741, given there is little difference in the substantive service.”
Related
It also called for an increase to obstetric and gynaecological ultrasound rebates to ensure appointments were not deferred or missed, and noted that there were issues beyond the scope of the review that furthered inequity within the MBS.
“It is important to note there are issues in other parts of the MBS that should be amended to improve equity,” said the AMA.
“We hope this review represents the first in a series of consultations on gendered disparities in the MBS.
“We provide examples of other issues we recommend for review at the end of this submission.”
