Authors' objectives: Following amendments to the fee for several cataract items listed on the Medicare Benefits Schedule (MBS), a review of existing MBS ophthalmology was commenced under the MBS Quality Framework. This review is continuing under the Comprehensive Management Framework for the MBS. The primary focus of reviews of existing items is to ensure that the MBS supports and encourages evidence-based, cost-effective clinical practice and to identify and evaluate current MBS services that present potential safety and quality issues. Given the large number of ophthalmology MBS items, this review is being undertaken in two stages. Information presented in this summary and the review report only relates to the first-stage of the review. The secondstage of the review is expected to commence late 2011. The review of ophthalmology items will inform recommendations aimed at aligning the use of Medicare-funded ophthalmology services with available evidence. The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) has played a crucial role in assisting the Department to develop the approach to reviewing existing items in light of contemporary evidence regarding their appropriate use in clinical practice. Further to this role, RANZCO also nominated several specialist ophthalmologists to be part of a small Clinical Working Group (CWG) to provide expert clinical input to the review to ensure that the research questions are relevant to current Australian clinical practice, and that valid conclusions are drawn from the evidence. The Department would like to thank both RANZCO and the CWG members for the vital assistance provided in undertaking this review.

Authors' recommendations: Reviews are expected to result in primary and supplementary review outcomes as shown below: Primary review outcomes Where an evaluation suggests that an item under review is supported by the evidence, the likely recommendation will be that the MBS listing will be retained in its current form. However, should an evaluation suggest that listed MBS items or services are inconsistent with contemporary evidence in relation to its clinical use or effectiveness, direct amendments to the MBS may be recommended. These may include one or more of the following changes: • addition or removal of MBS items; • changes to the Schedule fee; • refinement of MBS item descriptors to better target patient groups, clinical indicators and/or promote the use of optimal clinical pathways; and/or • potential for interim-listing pending the collection of item-specific data. Potential amendments to the MBS arising from reviews will be undertaken through consultation with the relevant stakeholder groups. Supplementary review outcomes In addition to primary review outcomes relating to MBS reimbursement, reviews may indicate the need for secondary investment strategies aimed at bridging the divide between current evidence, including clinical guidelines and current clinical practice. To achieve this, a number of strategies may be implemented following the evaluation of individual items or services. These may include, but are not limited to, the following: • development or revision of clinical practice guidelines for evaluated services where there is an identified need; • strengthening or targeting of auditing/compliance activities; • education and training initiatives for practitioners and/or consumers; • exploring incentive-based initiatives to promote improved clinical practices or linking education and training programs to access incentives; and • the development of research opportunities where gaps in effective service provision are evident. The identification of mechanisms to support evidence-based best practice will complement and reinforce any primary outcome MBS amendments to help improve health outcomes for patients, whilst ensuring the most efficient use of limited resources.

Project Status: Completed

Year Published: 2011

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/65A4239557E05A98CA2579260078E8ED/$File/MBS%20Ophthalm%20Services%20review_final%20report_public%20consult%20v6.pdf

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)