AMA Submission to the Department of Health Consultation: Spinal Surgery - Government response to MBS Review

1 Aug 2018

The review of Spinal Surgery MBS items pre-dated the MBS Review Taskforce and the AMA was represented on the review. This work was later absorbed by the MBS Review Spinal Services Clinical Committee (SSCC), who released draft recommendations for public consultation between 7 June and 21 July 2017. 

The AMA did not oppose the SSCC’s final MBS recommendations released in January 2018.  The AMA acknowledged the overall outcome of the changes would be a simplified, modern schedule for medical practitioners performing these specialised spinal services. 

Since these recommendations were released, however, additional restrictions regarding lower axial back pain were made independent of the SSCC without direct consultation of the SSCC and relevant craft groups. That is, in May 2018, Chair of the MBS Review Taskforce, announced that the Government will be making several changes to the Medicare Benefits Schedule (MBS) items for spinal surgery, to take effect on 1 November 2018 subject to the passage of legislation. 

These changes include: replacing the existing 74 items for spinal surgery with around 60 spinal surgery services; introducing new rules, including item co-claiming restrictions; and removing three obsolete items that will not be covered by the new items (items 40336, 48600 and 48603). The Government’s decision also included clarification for MBS items for spinal fusion, so that they are not claimed for the treatment of ‘uncomplicated axial chronic lower back pain’. This change has been introduced based on recommendation in the February 2018 Choosing Wisely Australia report that lumbar spinal fusion is not recommended for the treatment of this condition: http://www.choosingwisely.org.au/recommendations/fpm

The AMA received extensive feedback from members concerned about the post hoc and inappropriately restrictive change for spinal fusion and included it, amongst other policy concerns, in its submission to the Department.