2007/8 Budget Highlights

For a summary of highlights from the Australian (Federal and State/Territory) and New Zealand health sector budgets for 2007/8 click here.

Expansion of MRI

College Position

The DEC had a significant role in advising the College Council on strategic and economic impacts of options proposed for expansion of MRI.

The RANZCR is:

• Committed to open, more equitable, quality assured access to Medicare funded MRI services for both patients and providers;
  
• Opposed to the use of licenses to control the diffusion of new technology. Australia is still lagging other countries in access to MRI technology that is now widely accepted as a standard, safer, component of diagnostic imaging services for an increasing range of clinical applications.
  
• Fundamentally opposed to any form of tendering process and price control;
  
• Opposed to the magnitude of the rebate cuts unilaterally imposed by the Government in August 2004 to fund a limited expansion of 20 MRI units;
  
• Committed to ensuring that those without a Medicare eligible MRI unit are not further disadvantaged by redirection of funding from other modalities to fund further site restricted expansion of MRI;
  
• Committed to keep working with the Government to achieve the total removal of site restricted access to MRI.
  

The following documents detail the College's response to the Government's position on the expansion of MRI and the very compelling case put by the College for open access to MRI.

• College Response to the Minister's MRI Proposal - December 2003
  
• Statement to Fellows about Expansion of Access to Medicare Funded MRI – June 2004
• Submission to Health Minister Tony Abbott on MRI Open Access – October 2005

MRI Licences

The College is disappointed that the Government is continuing to control the diffusion of this vital technology. The College has communicated its concerns to the Minister in writing.

The College considers that site restrictions for MRI will remain a significant obstacle to the appropriate use of diagnostic imaging technology in Australia.

Funding has been approved for a total of 115 MRI units, however not all licences have been allocated or made. A full list of currently eligible, operational units can be found at
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/haf-docs-mrilist.htm

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MBS Rebate Increases

November 2004

MBS rebates for Radiology items (except MRI) covered by the Radiology Quality and Outlays MoU were increased by 3% from 1 November 2004. The College and the ADIA jointly submitted to the Government that these increases were affordable under the capped Radiology MoU due to continuing lower than expected demand for imaging services.

Similar increases occurred in MBS rebates for Nuclear Medicine items.

June 2004

MBS rebates for non-MRI items covered by the Radiology MoU were increased from 1 June 2004. These were the first rebate increases in Radiology items since November 1998 and the College argued strongly that the equivalent of an ‘across the board’ increase of approximately 3.5% should be targeted as follows to areas where patient affordability and industry viability had been impacted by ad hoc adjustments under the former agreement:

• Ultrasound and Mammography – 6%
  
• Diagnostic Radiology – 3%
  
• CT – 2.2%

In the particular case of mammography items, while these items had been quarantined from earlier cuts, the higher percentage increase recognised that these items were relatively poorly remunerated and that situation had been aggravated by the inability to increase rebates during the previous agreement. Similar considerations applied to ultrasound items.

Other MBS Related Issues

MBS Fraud Reporting
The HIC has implemented new channels to make it easier for members of the medical profession to report concerns in relation to possible fraud or abuse of Medicare and the PBS. A business hours hotline has been established 1800 202 011. An online reporting facility can be accessed on the Medicare Australia website alternatively or reporting forms can be downloaded from the web click here and can be sent to the PRB Compliance Program, PO Box 9822 in each capital city or fax: 02 6124 7744.

Private Hospital Patients
An admitted patient in a private hospital must have a valid request form for a diagnostic imaging service to be performed under Medicare. The request must be signed, dated and provided by the requesting practitioner prior to beginning the relevant service. A note written in the patient's clinical record is not a valid request for the purposes of Medicare - a practitioner who has rendered a diagnostic imaging service must retain the request form for a period of 18 months from the day on which the service was rendered.

Exemptions from the written request requirements for R-type (Requested) diagnostic imaging services are listed in section DID.4 (p445-447) of the Medicare Benefits Schedule Book, 1 November 2004.

Reporting by Overseas Doctors
In the explanatory notes included in the Diagnostic Imaging Services Section (Category 5) of the 1 November 2005 Medicare Benefits Schedule (MBS), section DIC.1 provides the following interpretation about reports provided by practitioners located outside Australia:

"Under the Act, Medicare benefits are only payable for services rendered in Australia. Where a service consists of a number of components, such as a diagnostic imaging service, all components need to be rendered in Australia in order to qualify for Medicare benefits. For diagnostic imaging services, this means that all elements of the service, including the preparation of the report on the procedure, would need to be rendered in Australia."

The College was not consulted about the inclusion of this interpretation. The MBS book is not a legal document and in cases of discrepancy the Legislation is the source document for payment of Medicare benefits. Radiology providers need to ensure that they comply with the requirements of the relevant Legislation, namely the Health Insurance Act (Cth) 1973, the Health Insurance Regulations (Cth 1975) and the Health Insurance (Diagnostic Imaging Services Table) Regulations (Cth) 2005.

In the case of reporting by overseas doctors the College believes different interpretations of the Legislation can be drawn. The College is of the view that the Legislation does allow an interpretation to the effect that overseas reporting by a providing practitioner will not invalidate a claim for Medicare benefits. This matter is presently the subject of discussion between the College and Medicare Australia and unfortunately has not been determined by any agreed interpretation or Court decision. Until such time as the matter is finally determined practitioners should obtain and act on their own advice with respect to this practice.

Proposed changes to MBS item descriptors for CT – Imaging of Coronary Arteries
The Department of Health and Ageing (DHA) has advised its intention to change the item descriptors of a number of CT items from 1 May 2006 to clarify that CT of the coronary arteries is not currently eligible for a Medicare rebate as it is a new application that has not been evaluated by MSAC. The College submitted an application to MSAC in January 2006 for assessment of CT Coronary Angiograms. As at July 2007 the final outcome of this submission was still awaited.