**Please note this is a December 2015 story, for more recent coverage see:
Australian Medical Association president Brian Owler says the removal of items from the Medicare Benefits Schedule could lead to higher out-of-pocket costs for patients.
Federal Health Minister Sussan Ley announced on Monday 23 tests and procedures, including ear, nose and throat surgeries and diagnostic imaging, have been recommended for removal as part of a major shake up of Medicare.
Ms Ley said in a statement the 23 items, which also include gastroenterology, obstetrics and thoratic medicine services, cost $6.8 million in the past year and were used 52,500 times.
"This first stage of work has provided recommendations about the immediate removal of lower-volume MBS items in some specific specialities where there is clinical consensus that they are ‘obsolete’ and no longer represent clinical best-practice," she said.
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"These are also items that clinical experts deem will not have adverse impacts on a patient’s access to health services if removed.
"Reasons range from more-clinically appropriate and/or efficient technologies and procedures already listed on the MBS through to patient safety, unnecessary doubling-up of item claims and decreasing usage."
However Professor Owler criticised Ms Ley for saying the items were obsolete before the consultation process had even begun.
"It is really not up to the minister to make those sorts of comments," he told SBS News.
"If she's already made up her mind there's no point in having this consultation."
Professor Owler said the removal of some of the items, like older diagnostic imaging services, "would not be too controversial", but "just because something is not used often it doesn't mean it is obsolete".
He said some patients would be left out-of-pocket as some of the items recommended for removal were part of other procedures or were used for very specific circumstances.
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"That is the AMA has been concerned about with this process all along," Professor Owler said.
"It is a cost-cutting exercise, they're looking to make savings. We are concerned patients will be left out-of-pocket."
He said there were also questions among medical professionals about how long it would take for new items to be included in the Medicare schedule.
Ms Ley said the would seek further advice before scrapping the first 23 items.
"It is important to understand that this is not by any means a comprehensive or complete list of final findings about the final makeup of the MBS," she said.
"It is also important to remember further advice from the Taskforce will not just focus on the removal of items from the MBS altogether, but also maintaining clinically-relevant MBS items, the addition of new MBS items where appropriate, and more intricate changes around the rules governing the eligibility and use of an MBS item for a particular patient cohort."
What's on the chopping block?
Imaging:
- Intravenous Pyelography: an X-ray test of the kidneys, bladder and urinary tract.
- Graham’s Test (cholecystography): an X-ray examination of the gallbladder and bile duct.
- Pelvimetry: an assessment of the female pelvis in relation to a woman’s ability to deliver a baby.
- Bronchography: an X-ray examination of the respiratory system inside the lung after they have coated in a contrast dye.
- Vasoepididymography: using a contrast dye to examine the vas deferens and epididymis in male genitalia.
- Peritoneogram (herniography): an imaging technique used to detect certain types of hernias.
- Venography: an X-ray of the veins using a dye injected using a catheter into the veins or bone marrow.
Ear, nose and throat surgeries:
- Klockoff's tests: four separate tests to measure hearing.
- Glossopharyngeal nerve (serves tongue and throat) injection with anaesthetic.
- Cryotherapy to nose: use of extreme cold to treat to nasal haemorrhage.
- Cryotherapy to turbinates: use of extreme cold to treat turbinates, which warm the air we breath.
- Division of pharyngeal adhesions: An operation to the pharynx.
- Direct examination: of postnasal space (behind nose) with or without removing tissue.
- Direct examination of Larynx, with removal of tissue.
- Direct examination of the Larynx’s sub regions.
Gastroenterology:
- Gastric hypothermia: without gastrointestinal haemorrhage using a refrigerant.
- Gastric hypothermia: with upper gastrointestinal haemorrhage using a refrigerant.
- Biliary manometry: measurement of pressure relating to bile ducts.
- Sigmoidoscopic examination: rectal examination of lower intestine and application of heat or removal of polyps, less than 45 minutes.
- Sigmoidoscopic examination: rectal examination of lower intestine and application of heat or removal of polyps, more than 45 minutes.
Obstetrics:
- Treatment of habitual miscarriage: with injections of hormones, not administered via routine checks during pregnancy.
Thoracic medicine:
- Bronchospirometry: the study of gas exchanged from each lung separately by placing a catheter in one lung’s major air passage.
