Four Corners story on spinal surgery and billing

This week we worked with associations and societies and government representatives in responding to the ABC Four Corners story on spinal surgeries and billing.

This week we saw another disappointing and misleading story about Medicare billing. Producers of the story did not provide an opportunity for the AMA or other peak specialist groups or colleges to comment before going to air.

We know many members of the profession have been distressed by yet another story of this nature, following last year’s stories on Medicare fraud. In tackling this story, the AMA made the strategic decision not to amplify and therefore extend coverage of the Four Corners story once it had gone to air.

Instead, we worked quickly and responsibly to ensure that any response from the government and the Department of Health and Aged Care was measured and rational. This was in the context of calls from some groups, including insurers and consumers, for further reviews, compliance activities and suspension of certain procedures.

As always, a lot of work happens behind the scenes at the AMA.

Your President, Professor Steve Robson, worked closely with colleges and societies on the response to the story and on an appropriate strategy. Collectively we contested the allegations made by Four Corners with key people in government offices and the department, ensuring we did not see a knee jerk reaction.

The allegations made on Four Corners appear to have been seen for what they are — an unjustified attack on the profession by insurer groups. The government has reasonably asked for an update on the TGA Review of Spinal Cord Stimulators, while the department is likely to focus on consulting with relevant medical groups to discuss the operation of relevant MBS items to make sure they are
fit-for-purpose, particularly as many were changed following the MBS Review.

As you know, last year the federal government looked forensically at the issue of Medicare compliance through both a departmental review and the Independent Review of Medicare Compliance, which found compliance issues are overwhelmingly innocent mistakes caused by the complexity of the system. We were heavily involved in these reviews and continue to work with the government to encourage efforts to reduce the level of complexity involved in interpreting MBS items.

We believe that in relation to the Synapse/Kirontech report, it would have been better for insurers to work with the Department of Health and Aged Care to look at the data, and have it properly assessed against MBS requirements — in consultation with clinicians who understand what is involved in a procedure.

As noted above, the clinical effectiveness and appropriate use of these devices is already being looked at by the Therapeutic Goods Administration, which is conducting a post market review of spinal cord stimulators.

More information about the review can be found on the TGA website

Finally, the AMA is acutely aware of the issues facing our private non-GP specialists and the challenges facing the private health sector. We continue to work with key hospital groups on viability issues, and with government on the issues facing our members interacting with private health insurance. You would have seen in recent days the AMA has been prominently covered in the Australian and other media regarding the cost pressures facing doctors and patients alike when it comes to private health insurance. In coming days, you will see further comment from the AMA on these important issues. You can continue to follow the AMA’s coverage on these topics via Rounds, or on Twitter, LinkedIn or Facebook.

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