Authors' objectives: As part of the 2009 Budget, the Australian Government announced that joint injection items 50124 and 50125 would be removed from the Medicare Benefits Schedule (MBS) on 1 November 2009 as they were considered, in most cases, minor and routine in nature, and could be delivered as part of a standard consultation. From 1 November 2009, any practitioner administering the service could continue to perform the service under the relevant attendance item for the relevant medical speciality, or the relevant imaging items for diagnostic imaging specialists. Practitioners with previously rendering this service under MBS arrangements included consultant physicians (including rheumatologists), general practitioners and radiologists undertaking image guided joint injections on referral. At present, the consultant physician attendance items are not time-based. Rheumatologists argued that they do not render other procedural services that may compensate for the longer time required to perform more complex joint aspirations or injections. General Practitioners who undertake joint injections may be remunerated for the time taken by moving from a Level B consultation item to a Level C or D, provided that all requirements of the relevant item are met. Radiologists also undertake image guided joint injections on referral from a medical practitioner. The higher MBS fee for radiological items provides for the additional time, complexity and equipment associated with administering the service. The department met with the ARA on several occasions to discuss the impact of the removal of these two items from the MBS on people suffering from severe arthritis. The ARA also advised that the procedure is not necessarily simple or routine in all patient groups, as rheumatologists often deal with more complex joint aspirations and injections, such as for small joints. In March 2010, the Minister of Health and Ageing agreed that the MBS Quality Framework new listing process be used as a way of analysing the merits of claims made by the ARA. This was the first application to be assessed under the MBS Quality Framework new listing process. The MBS Quality Framework trialled methodologies for the assessment of services that had not historically been evaluated by MSAC (i.e. consultation, consultation-related and allied health services). In December 2010 the Minister for Health and Ageing decided to seek MSAC's advice on the outcomes of assessments conducted under the MBS Quality Framework. In many instances these types of services do not have the level of published peer-reviewed evidence that MSAC would expect to appraise under its terms of reference. Applicants were therefore asked to provide published scientific/academic literature where possible, and where there was an absence of such documentation, applicants were encouraged to provide other sources of evidence, such as grey literature, websites of specialty organisations or projects related to the application, clinical expert opinion and research reports. The assessment of the evidence base with respect to the safety, effectiveness and cost-effectiveness for this application was through a "rapid review" and not a formal systematic review. Modifications were made to the methodology with respect to the search strategy, inclusion criteria, assessment of study quality and data analysis. This rapid review was an evidence-based assessment derived from a simple systematic search of studies published in the peer reviewed literature.

Authors' recommendations: After considering the strength of the available evidence in relation to the application for a new MBS item for diagnostic joint aspiration and intra articular steroid injection by consultant physicians, MSAC agreed that there was insufficient evidence to identify the characteristics of patients or providers for whom the procedure would be more time consuming or complex and could not be performed as part of an attendance. If evidence supporting the need for specific MBS items were to become available, MSAC considered that such services should be defined in terms of patient characteristics rather than provider type.

Project Status: Completed

Year Published: 2011

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1176-public

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee (MSAC)