MBS review is a chance for change

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As the health industry reacts to the latest funding cuts, restructure plans and election promises, it’s easy to lose sight of something as important as the The Medicare Benefits Schedule (MBS) Review.

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The MBS Review, which started 12 months ago, aims to define how our health system operates for years to come and goes well beyond just defining MBS items and setting prices. The taskforce has to consider the broader picture, looking at best practice, appropriateness, overall value and a range of other systemic issues.
It’s an opportunity to change the system and put the patient at the forefront.
That is why four peak bodies – Breast Surgeons of Australia and New Zealand, Breast Cancer Network Australia, The Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association – have approached the Federal Health Minister urging her to commission a pilot study which would look at how to improve the effectiveness of breast cancer imaging from a patient’s perspective.
Breast cancer is now the most common cancer affecting Australian women, with a 1 in 8 lifetime risk of developing the disease, and high-quality, affordable, diagnostic imaging is simply crucial in detecting, treating and monitoring this condition.
Consulting surgeon and leading breast cancer researcher Professor Christobel Saunders knows through long experience how vital imaging is.
“To get a really good surgical outcome what we need to know is exactly where the tumour is, how many tumours there are and what size they are so we can guide treatment,” she said.
“But still for a percentage of women the current imaging we have (covered by the MBS) is not good enough,” she said.
The pilot study proposed would not only help improve the rates for early diagnosis and treatment of breast cancer patients, but it would also provide insight and benefits that could be applied to virtually any patient group.
Simply put, the concept is to detail the patient’s journey, identify the hurdles they face and devise ways of eliminating or minimising these problems.
Patients diagnosed with breast cancer encounter many different diagnostic imaging services – mammography, breast tomosynthesis, diagnostic ultrasound, ultrasound-guided biopsy or fine needle aspiration, and MRI – and I have seen that the journey is often unnecessarily confusing, expensive and distressing due to the complexity and illogicality of the current Medicare funding and rules.
Consider some specific examples:

• Most women with breast cancer symptoms are referred for a diagnostic mammogram. This has an inadequate rebate of $76.10 and one of the lowest bulk billing rates of all imaging procedures (around 50%) so patients immediately face a significant financial hurdle. Every day patients are paying gaps of $100 or more even in ‘bulk billing’ practices. Confronted with costs that high, how many women delay their treatment or simply cross their fingers and hope for the best?


• The result of a mammogram and ultrasound may indicate the need for an ultrasound-guided core biopsy or fine needle aspiration (FNA). However, more and more women referred for a diagnostic breast ultrasound are attending practices that do not have a radiologist on site, due to loopholes in the professional supervision rules. If a core biopsy or FNA is required, the woman may be asked to attend a different practice for the service, and she would often have the diagnostic ultrasound unnecessarily repeated.


• A diagnostic ultrasound can often indicate that a core biopsy or FNA should be conducted. However, Medicare will not fund a core biopsy or FNA on the same day as a diagnostic ultrasound, so patients eager to progress their diagnosis and possible treatment face unnecessary frustration and delays, which are compounded if the patient has had to travel a long distance for the service which is often the case for people living in regional and remote areas.


• According to Breast Surgeons of Australia and New Zealand, from the total number of new breast cancer patients some 10-15% are thought to benefit in clinical decision-making by the additional diagnostic information obtained from a breast MRI, but these services are not funded by Medicare. If they can afford it, these patients pay around $600 for an MRI because to date MSAC has not approved the use of breast MRI for specific limited indications – the MBS is not being kept in line with clinically recommended, cost- effective practice.

The four groups urging the pilot study have knowledge and experience of the current system and have offered to assist the MBS Review working groups in any way. They are also encouraging the involvement of consumers and other groups involved in breast cancer to ensure the study is comprehensive and effective.
The need for this pilot study is even greater if the next round of cuts currently proposed by Government is taken into account.
With the Federal Government planning to slash $100 million a year from patient rebates for diagnostic imaging, costs for many breast cancer patients will rise even further. People, who were relying on the bulk- billing system, may be facing out of pocket costs of $300, as well as ‘up-front’ fees of more than $500, just to be diagnosed.
Experience has shown, time and again, that cost is a huge barrier to treatment. It is inevitable that faced with these expenses, many people will simply walk away for the system. Instead of early diagnosis and treatment, their condition will worsen – this is terrible for them and it’s also bad for the health system as these people will eventually require more intense and much more expensive treatment.
The MBS Review, which is scheduled to make ongoing recommendations to the Minister, is a rare opportunity to provide sick and worried people with a less challenging journey through the health system by improving the efficiency of services as well as improving the quality of care.
To learn more about how radiology is leading the fight against breast cancer, please visit www.youtube.com/watch?v=8SCNANOuzvA
Dr Christian Wriedt, ADIA President.

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“...I have seen that the journey is often unnecessarily confusing, expensive and distressing due to the complexity and illogicality of the current Medicare funding and rules.”

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Dr Christian Wriedt
President of the Australian
Diagnostic Imaging Association
ADIA represents medical imaging practices throughout Australia, both in the community and in hospitals, and promotes ongoing development of quality practice standards so doctors and their patients can have certainty of quality, access and delivery of medical imaging services.
Visit our website www.adia.asn.au