EXPLANATORY STATEMENT

 

Select Legislative Instrument 2006 No. 86

 

Minute No. 7 – Minister for Health and Ageing

 

Subject:       Health Insurance Act 1973

 

Health Insurance (General Medical Services Table) Amendment Regulations 2006 (No. 2)

 

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the

Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.

 

The Act provides, in part, for payments of Medicare benefits in respect of professional services rendered to eligible persons.  Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services set out in prescribed tables.

 

Subsection 4(1) of the Act provides that the regulations may prescribe a table of medical services (other than diagnostic imaging services and pathology services) that sets out items of medical services, the amount of fees applicable in respect of each item, and rules for interpretation of the table.

 

A table of general medical services is currently prescribed by the Health Insurance (General Medical Services Table) Regulations 2005 (the Principal Regulations) which commenced on 1 November 2005. 

 

The purpose of the Regulations is to amend the Principal Regulations to make changes as part of the on-going management of the General Medical Services Table, and incorporate changes in items to the table resulting from review by the Medicare Benefits Consultative Committee.  These reviews are designed to ensure that the table reflects current clinical practice and encourages best practice.

 

The Regulations would include amendments to the existing rules of interpretation and the items listed in the table.

 

The Medical Services Advisory Committee has assessed the evidence supporting the safety, effectiveness and cost-effectiveness of a number of medical technologies.  Consequently sixteen new items would be introduced for five new technologies and one item would be amended to include an existing technology.

 

Broadly, consultation on the Regulations was conducted with the Australian Medical Association, relevant professional medical craft groups and Medicare Australia.

 

Details of the Regulations are set out in the Attachment.

 

The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised. 

 

The Regulations would be a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

The Regulations would commence on 1 May 2006.

 

                                                                                                      Authority:       Subsection 133(1) of the

                                                                                                         Health Insurance Act 1973

ATTACHMENT

 

Details of the proposed Health Insurance (General Medical Services Table) Amendment Regulations 2006 (No. 2)

 

Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2006 (No. 2).

 

Regulation 2 provides for the Regulations to commence on 1 May 2006.

 

Regulation 3 provides that Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2005.

 

Schedule 1

 

Rules of Interpretation

 

Item [1] – Schedule 1, Part 2, subrule 6(1)

This item amends subrule 6 (1) to indicate that it applies to proposed new items 109, 2801, 2806, 2814, 2824, 2832, 2840, 3005, 3010, 3014, 3018, 3023 and 3028.  Rule 6 defines the meaning of “single course of treatment” in certain circumstances.

(These items are added by items [20] and [24] below)

 

Item [2] – Schedule 1, Part 2, subrule 7(1)

This item amends subrule 7 (1) to indicate that it applies to proposed new items 2801 to 2840 and 3005 to 3028.  Rule 7 defines the meaning of “professional attendance” in certain items.

(These items are added by item [24] below)

 

Item [3] – Schedule 1, Part 2, rule 8

This item amends the heading of rule 8, to insert a reference to proposed new items 2801 to 2840 and 3005 to 3028.  Rule 8 provides interpretation of a reference to “attendance on a patient” in certain items.

(see item [24] below)

 

Item [4] – Schedule 1, Part 2, subrule 8(1)

This item amends subrule 8(1) to indicate that it applies to proposed new items 2801 to 2840 and 3005 to 3028.  Rule 8 provides interpretation of a reference to “attendance on a patient” in certain items.

(see item [24] below)

 

Item [5] – Schedule 1, Part 2, subrule 9(13A)

This item introduces new subrule 9(13A) to apply to proposed new items 714 and 716.  Rule 9 sets the fee for certain items.

(These items are added by item [23] below)

 

Item [6] – Schedule 1, Part 2, subrule 44(2A)

This item introduces new subrules 44(2A) and 44(2B) to apply to proposed new items 714 and 716.  Rule 44 sets out that some items in Group A14 Health Assessments apply to only certain groups of patients. Proposed new items 714 and 716 would only apply to a patient who is a humanitarian visa holder.

(see item [23] below)

Item [7] – Schedule 1, Part 2, subrule 44(3)

This item amends subrule 44(3) to indicate that it applies to existing items 704, 706 and 710 and proposed new item 708. 

(Proposed new item 708 is added by item [22] below)

 

Item [8] – Schedule 1, Part 2, rule 46

This item amends the heading of rule 46 to distinguish this rule from new rule 48A.  Rule 46 sets out the meaning of “health assessment” for items 700, 702, 704 and 706.

(see item [22] below)

 

Item [9] – Schedule 1, Part 2, rule 46A

This item introduces new rule 46A to explain the meaning of a “child health check” and that it applies to proposed new item 708.

(see item [21] below)

 

Item [10] – Schedule 1, Part 2, rule 48A

This item introduces new rule 48A to explain the meaning of “health assessment” in items 714 and 716, and new rule 48B to explain the meaning of “humanitarian visa holder” in proposed new items 714 and 716.

(see item [22] below)

 

Item [11] – Schedule 1, Part 2, rule 58A, 58B and 58C

This item introduces new rules 58A, 58B and 58C to explain the meaning of “co-ordinate” and “case conference team” in proposed new item 880 and the application of proposed new item 880.

(Proposed new item 880 is added by item [23] below)

 

Item [12] – Schedule 1, Part 2, rules 63A and 63B

This item introduces new rules 63A and 63B to explain the application of proposed new Group A24 Palliative Care/ Pain Medicine and the application of items 14227, 14230, 14233, 14236, 14239 and 14242, respectively.

(Proposed new Group A24 is added by item [24] and proposed new items 14227, 14230,14233, 14236, 14239, and 14242 are added by item [28] below)

 

Item [13] – Schedule 1, Part 2, rules 82A and 82B

This item introduces new rules 82A and 82B to explain the application of proposed new items 10988 and 10989, respectively.

(These items are added by item [25] below)

 

Item [14] – Schedule 1, Part 2, rule 87A

This item introduces new rule 87A to explain the application of proposed new items 35404, 35406 and 35408.

(These items are added by item [33] below)

 

Item [15] – Schedule 1, Part 2, subrule 88(2A)

This item introduces new subrule 88(2A) to apply to proposed new items 2946 to 3000 and items 3032 to 3093 to indicate that each of these items is applicable not more than 5 times in a 12 month period.  Rule 88 allows for a limitation on certain items.

(These items are added by item [24] below)

 

 

Item [16] – Schedule 1, Part 2, rule 94

This item introduces new rule 94 to explain the application of items 15556, 15559 and 15562 and new rule 95 to explain the application of items 38365, 38368 and 38654.

(These items are added by items [29], [40] and [42] below).

 

Details of the proposed Amendments to Items

 

Item [17] – Schedule 1, Part 3, item 104

This item amends item 104 to preclude proposed new item 109 being claimed on the same occasion.

(Proposed new item 109 is added by item [20] below).

 

Item [18] – Schedule 1, Part 3, item 106

This item amends item 106 by inserting the term “ophthalmology” for the purpose of item 106.

 

Item [19] – Schedule 1, Part 3, item 106

This item amends item 106 to preclude proposed new item 109 being claimed on the same occasion (see item [20] below).

 

Item [20] – Schedule 1, Part 3, item 109

This item introduces new item 109 to recognise the additional complexity inherent in an eye examination of a child under the age of nine years, or a developmentally delayed child under the age of fifteen years where, in the clinical judgement of the practitioner, more comprehensive examination and assessment is required than is normally provided in an initial consultation.

 

Item 109 has been developed in consultation with the Royal Australian and New Zealand College of Ophthalmologists and relates to the introduction of item 10943 on 1 November 2005 for additional assessment by optometrists of children with significant visual dysfunction.  The different age groups and clinical requirements between item 109 and item 10943 are intentional, and reflect the clinical expertise of the different provider groups.

 

Item [21] – Schedule 1, Part 3, item 708

This item introduces new item 708 to cover the health assessment of Aboriginal and Torres Strait Islander children up to the age of 14.  It complements the existing health assessments, available to Aboriginal and Torres Strait Islander people aged 15 years and over.

 

An Aboriginal and Torres Strait Islander Child Health Check will help to ensure that Aboriginal and Torres Strait Islander children receive the optimum level of health care by encouraging prevention, early detection, diagnosis and intervention for common and treatable conditions that cause considerable morbidity and early mortality.

 

Representatives of key organisations were invited to join an Expert Advisory Group to assist in the development of the clinical content of the item.  The organisations represented on the Advisory Group included: the National Aboriginal Controlled Community Health Organisation; the Royal Australian College of General Practitioners; the Royal Australasian College of Physicians; the Divisions of Paediatrics and Child Health; the Australian Indigenous Doctors Association; and the Northern Territory Government.  A range of medical, health and community organisations were consulted on the content of the item descriptor.

 

 

 

 

Item [22] – Schedule 1, Part 3, items 714 and 716

This item introduces new items 714 and 716 to support the provision of a health assessment for patients who have been granted residency in Australia under the Humanitarian Program.

 

New items 714 and 716 for health assessments introduce new humanitarian entrants to the Australian primary health care system as soon as possible after, ideally within six months but up to 12 months of, their arrival in Australia.  The aim of the assessment is to develop a detailed history and undertake a physical examination of the patient to identify immediate and long term health care needs and to initiate treatment.  Patients can also be introduced to preventative health care in Australia, in particular immunisation, maternal and child health care and breast and cervical screening.

 

Some new arrivals have had little experience of Western health care systems and some may not know what a General Practitioner is or does.  Some may have complex and unusual conditions as a result of their area of origin or living conditions prior to arrival in Australia where communicable diseases such as tuberculosis, hepatitis, parasitic infections and human immunodeficiency virus and other sexually transmitted infections may be endemic.  Many will have been exposed to war, famine, repression, torture and/or extreme poverty.

 

The changes have been developed in consultation with the Australian Medical Association, the Royal Australian College of General Practitioners, the Rural Doctors Association of Australia, the Department of Immigration and Multicultural Affairs and the Northern Division of General Practice.

 

Item [23] – Schedule 1, Part 3, item 880

This item introduces new item 880 for the payment of Medicare benefits for a case conference provided by a consultant physician or a specialist in the specialty of Geriatric or Rehabilitation Medicine.

 

The Australian Society for Geriatric Medicine and the Australian Faculty of Rehabilitation Medicine both submitted to the Department that it was inequitable that there is not an item for case conferences in hospital as this is part of established practice.  New item 880 provides case conferences for the elderly and those with a disability who are hospital in-patients.

 

The item was developed in consultation with the Australian Medical Association, the Australian Society for Geriatric Medicine, the Australasian Faculty of Rehabilitation Medicine and Medicare Australia.

 

Item [24] – Schedule 1, Part 3, new items

This item introduces eighteen new items (items 2801, 2806, 2814, 2824, 2832, 2840, 2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996 and 3000) for attendances and case conferencing by pain medicine specialists for the management of patients in chronic and/or severe pain.

 

This item also introduces eighteen new items (3005, 3010, 3014, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, and 3093) for attendances and case conferencing by palliative medicine specialists for the management of patients with a terminal illness.

 

Currently the patients of specialists and consultant physicians who provide similar pain or palliative medicine services have different rebates available to them.  Specialist attendance rates are lower than those for consultant physician attendances.  It is considered inequitable for patients to receive different rebates for the same services from practitioners who are recognised as specialists in the same field of medicine.

 

The items have been developed in consultation with the Australian Medical Association, the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists, the Australasian Chapter of Palliative Medicine, the Royal Australian College of Physicians and Medicare Australia through the Medicare Benefits Consultative Committee process.

 

Item [25] – Schedule 3, Part 3, Miscellaneous Services

This item introduces item 10988 for immunisation services provided by a registered Aboriginal Health Worker on behalf of a medical practitioner and item 10989 for wound management services provided by a registered Aboriginal Health Worker on behalf of a medical practitioner.

 

The items will apply in the Northern Territory which is the only jurisdiction where Aboriginal Health Workers are required to be registered under state or territory law.

 

These arrangements will recognise the important role that Aboriginal Health Workers play in the direct provision of clinical care in the Northern Territory and will help to expand the delivery of primary health care to Aboriginal and Torres Strait Islander people.

 

The proposed items have been developed in consultation with the Northern Territory Department of Health and Community Services and other stakeholders in the Northern Territory.

 

Item [26] – Schedule 1, Part 3, item 10993

This item amends existing item 10993 to allow practice nurses to provide immunisation services in a wider range of locations – any location except where the person is an admitted patient of a hospital or day hospital facility.

 

The amendment recognises that practice nurses provide services in a range of locations, particularly in rural and remote communities.  It will also ensure that the Medical Benefits Scheme (MBS) items for immunisation services (items 10893 and 10993) can be used in a consistent manner by both practice nurses and registered Aboriginal Health Workers.

 

The amendment has been discussed with the Northern Territory Department of Health and Community Services, in association with development of the new MBS items for immunisation and wound management services provided by Aboriginal Health Workers.

 

Item [27] – Schedule 1, Part 3, item 13915

This item amends existing item 13915 to exclude the payment of Medicare benefits for the injection of drugs used in microwave therapy.

 

Removal of funding for microwave cancer therapy (including the intravenous administration of drugs used in the therapy) has been agreed by the Minister following a recommendation by a National Health and Medical Research Council review committee and consultation with the profession.

 

 

 

 

 

Item [28] – Schedule 1, Part 3, new items

This item introduces new items (14227, 14230, 14233, 14236, 14239 and 14242) for the intrathecal administration of baclofen for the treatment of severe chronic spasticity where oral antispastic agents have failed or caused unacceptable side effects. 

 

Item 14227 covers the refilling of the implanted infusion pump with baclofen.  Item 14230 would cover the insertion or replacement of the intrathecal or epidural spinal catheter.  Item 14233 would cover the insertion or replacement of the infusion pump.  Item 14236 would cover the implantation of the infusion pump and the insertion of the intrathecal or epidural spinal catheter.  Item 14239 would cover the removal of the infusion pump or the removal or repositioning of the intrathecal or epidural spinal catheter.  Item 14242 would cover the insertion of the reservoir and spinal catheter.

 

The introduction of these items will allow the administration of baclofen consistent with the indications approved by the Pharmaceutical Benefits Advisory Committee.  Access to these items is restricted to patients who have severe chronic spasticity and meet the Pharmaceutical Benefits Scheme criteria for the service associated with the baclofen.

 

Item [29] – Schedule 1, Part 3, new items

This item introduces five new items (15550, 15553, 15556, 15559, and 15562) to encourage the use of planning and simulation for use with three dimensional conformal radiotherapy (3D CRT).  This is a method of delivering radiotherapy that uses computer planning and treatment systems to tailor the size and shape of the dose area to the ideal target volume, with maximum exclusion of the surrounding normal tissue.  Because higher doses of radiation can be delivered to cancer cells while significantly reducing the amount of radiation received by surrounding healthy tissues, the technique should increase the rate of tumour control while decreasing side effects.

 

Item 15550 covers high quality 3D CRT simulation where there is no intravenous contrast medium used to assist in imaging the region of interest.  Item 15553 covers high quality 3D CRT simulation where a intravenous contrast medium is used to assist in imaging the region of interest.

 

Item 15556 covers high quality 3D CRT level 1 (simple) dosimetry (planning). Item 15559 covers high quality 3D CRT level 2 (intermediate) dosimetry (planning). Item 15562 covers high quality 3D CRT level 3 (complex) dosimetry (planning).

 

The items were developed in consultation with both the Australian Association of Private Radiation Oncology Practices and the Royal Australian and New Zealand College of Radiologists.  The Australian Medical Association, Medicare Australia and the Department of Veterans’ Affairs have been notified of the proposed changes.

 

Item [30] – Schedule 1, Part 3, item 16003

This item amends item 16003 to specify that it does not cover a service to which items 35404, 35406 or 35408 apply (the item had been previously amended to state that it does not cover a service associated with selective internal radiation therapy).  This item covers intracavitary administration of a therapeutic dose of yttrium 90 injection for various conditions, including cancer and synovitis.

(see item [33] below)

 

 

 

Item [31] – Schedule 1, Part 3, item 30214

This item amends item 30214 to re-instate the 85% benefit level (out-of-hospital benefit) by removing the symbol H from this item to bring it into line with associated item 30213.  The meaning of the symbol ‘(H)’ refers to an item which limits the provision to a service performed or provided in a hospital or approved day hospital facility.

 

Item 30214 provides for the 7th session of treatment of telangiectases or starburst vessel and the need for the service has to be demonstrated to the Medicare Claims Review Panel before benefits are paid (hence the low utilisation of the item).  Item 30213 covers the previous six treatments and is a mirror image of 30214, although the Panel do not review these. It has a much higher utilisation rate with a significant number provided out of hospital.  Item 30213 has retained the 85% rebate and, as it is identical to item 30214, the 85% benefit for item 30214 needs to be re-instated.

 

Item [32] – Schedule 1, Part 3, item 31200

This item amends item 31200 to restrict the claiming of skin flaps (items 45200, 45203, 45206) in association with the removal of certain tumours, cysts, ulcers or scars.

 

Item 31200 covers the surgical excision (and suture) of tumours, cysts, ulcers and scars that do not require histopathology.  At the recent Medicare Benefits Consultative Committee meeting about skin issues, it was agreed that it is not clinically necessary to perform flap repair on surgical wounds created under item 31200.  Therefore the skin flap items are now restricted with the claiming of item 31200 as direct closure by suture is the most appropriate method of completing the procedure.

 

Item [33] – Schedule 1, Part 3, new items

This item introduces item 35400 for vertebroplasty for the treatment of a painful osteoporotic vertebral compression fracture, where the patient to whom the service is provided has not had the pain arising from the vertebral compression fracture controlled by conservative medical therapy; and diagnostic imaging has confirmed that vertebroplasty will be of benefit, performed on an admitted patient in a hospital or day hospital facility.

 

This item also introduces item 35402 for vertebroplasty for the treatment of painful metastatic deposit or multiple myeloma in a vertebral body, performed on an admitted patient in a hospital or day hospital facility.

 

Vertebroplasty is a procedure used to stabilise fractured vertebrae in order to relieve pain in patients with osteoporotic vertebral compression fractures or expanding spinal cancer secondaries or multiple myeloma.  It involves the percutaneous injection of artificial bone cement and an opacifier into the marrow space of the fractured vertebra, under imaging guidance, which hardens to fill spaces and provide stability.

 

Vertebroplasty was introduced under a 3C Determination made under the Health Insurance Act 1973 to ensure that Medicare benefits were payable for vertebroplasty services under appropriate items and fees from 1 November 2005.  This was necessary as, from 1 November 2005, restrictions were applied to existing items of the Table that are currently being claimed inappropriately for vertebroplasty services.  The Determination ceases at the end of 30 April 2006.

 

This item also introduces new Medicare items (35404, 35406, & 35408) for selective internal radiation therapy following a Medical Services Advisory Committee recommendation that public funding should be supported for selective internal radiation therapy using SIR-Spheres for the treatment of hepatic metastases which are secondary to colorectal cancer and are not suitable for resection or ablation, used in combination with systemic chemotherapy using 5-fluorouracil and leucovorin.

 

Item 35404 covers the dosimetry, handling and injection of SIR-Spheres.  Item 35406 covers the trans-femoral catheterisation of the hepatic artery for the administration of SIR-Spheres.   Item 35408 covers the catheterisation of the hepatic artery via a permanently implanted hepatic port (item 35406) for the administration of SIR-Spheres.

 

The items were developed through the Medicare Benefits Consultative Committee process.

 

Item [34] – Schedule 1, Part 3, item 35616

This item amends item 35616 by adding radiofrequency electrosurgery to the list of available endometrial ablation techniques thereby expanding the treatment options available.

 

Endometrial ablation techniques aim to destroy the endometrial lining of the uterus causing a reduction or elimination of menstrual bleeding.  The Medical Services Advisory Committee has found that second generation techniques such as radiofrequency electrosurgery are as safe and effective as the first-generation techniques covered under the current item.

 

Item [35] – Schedule 1, Part 3, item 36836

This item precludes the claiming of benefits for cystoscopy on the same occasion as High-energy transurethral microwave therapy (HE-TUMT).  Cytoscopy is considered a normal part of the HE-TUMT procedure and will also align the HE-TUMT items with the Trans urethral resection of the prostate (TURP) items.

(see item [38] below)

 

Item [36] – Schedule 1, Part 3, item 36842

This item precludes cystoscopy being claimed on the same occasion as HE-TUMT.

This procedure is considered a normal part of the HE-TUMT procedure and this will also align the HE-TUMT items with the TURP items to maintain consistency in the MBS.

(see item [38] below)

 

Item [37] – Schedule 1, Part 3, item 37224

This item precludes the claiming of benefits for destruction of a prostatic lesion by diathermy or visual laser cystoscopy on the same occasion as HE-TUMT.  This procedure is considered a normal part of the HE-TUMT procedure and will align the HE-TUMT items with the TURP items to maintain consistency in the MBS.

(see item [38] below)

 

Item [38] – Schedule 1, Part 3, items 37230 and 37233

The item introduces new Medicare item 37230 for the payment of Medicare benefits for HE-TUMT, for patients with benign prostatic hypertrophy.  This item would also introduce a new Medicare item 37233 for the payment of Medicare benefits to provide HE-TUMT as a treatment option for patients if an operation to treat benign prostatic hypertrophy has been discontinued because of medical reasons.

 

HE-TUMT was recommended for public funding following a Medical Services Advisory Committee evaluation and will provide another treatment option for patients with moderate to severe symptoms of benign prostatic hypertrophy.

 

The items 37230 & 37233 were developed in consultation with the Australian Medical Association, the Urological Society of Australasia, the Australian and New Zealand Association of Urological Surgeons and Medicare Australia through the Medicare Benefits Consultative Committee process.

 

Item [39] – Schedule 1, Part 3 item 38353

This item precludes the claiming of cardiac resynchronisation therapy items on the same occasion as insertion of a cardiac pacemaker.  This change is to reflect the original intent of the item as agreed with the relevant professional craft group.

(see item [40] below)

 

Item [40] – Schedule 1, Part 3, items 38365 and 38368

This item introduces item 38365 for the insertion of the cardiac resynchronisation device and item 38368 for the insertion of the transvenous left ventricular electrode via the coronary sinus for use with the device.

 

Following a Medical Services Advisory Committee evaluation cardiac resynchronization therapy (CRT) was approved for public funding.  CRT is a proven treatment for selected patients with severe heart failure and aims to restore the synchronisation contraction of the left and right ventricles and thereby improve cardiac function.

 

Item [41] – Schedule 1, Part 3, item 38393

This item precludes the claiming of the cardiac resynchronisation therapy item on the same occasion as item 38393 for insertion or replacement of automatic defibrillator or generator.  This change is to reflect the original intent of the item as agreed with the relevant professional craft group.

(see item [40] above)

 

Item [42] – Schedule 1, Part 3, item 38654

This item introduces item 38654 for the insertion of the left ventricular electrode via thoracotomy for use with the cardiac resynchronisation device.  The proposed item would be introduced as it is sometimes not possible to place the left ventricular electrode via the coronary sinus, and it must be placed via open thoracotomy.

(see item [40] above)

 

Item [43] – Schedule 1, Part 3, item 47684

This item amends item 47684 for the treatment of spinal fracture to specify that it covers treatment with immobilisation by halo as well as calipers.

 

For each of the spinal fracture items 47684, 47687, 47690, 47693, “or halo” has been added to the descriptor.  Items were amended on 1 November 2005 to change “including immobilisation….” to “with immobilisation…” to prevent inappropriate claiming for a new procedure, vertebroplasty.  The amendment inadvertently excluded immobilisation by halo, which the profession has advised has always been claimed under these items for a small number of patients, so this is now being rectified.

 

 

Item [44] – Schedule 1, Part 3, items 47687 to 47693

This item amends items 47687 to 47693 to specify that they cover treatment with immobilisation by halo as well as calipers. (see item [41] above)

 

Item [45] – Schedule 1, Part 4, item 12

This item amends item 12 of Part 4 (non-Medicare service) by replacing the words “for hepatic metastases” with “any condition other than hepatic metastases that are secondary to colorectal cancer”.  This follows an evaluation of the procedure by the Medical Services Advisory Committee which recommended that on the strength of evidence pertaining to the treatment of patients with hepatic metastases secondary to colorectal cancer which are not suitable for resection or ablation, that interim public funding should be supported for first line treatment by administration of SIR-Spheres in combination with systemic chemotherapy using 5FU and leucovorin, with the collection of survival data.  However, as there is currently insufficient evidence pertaining to the treatment of non-resectable, non-ablatable hepatocellular carcinoma with SIR-Spheres, the Medical Services Advisory Committee recommended that public funding should not be supported at this time.

 

Item [46] – Schedule 1, Part 3, further amendments

This item introduces an amended fee for items 348, 350, 352, 501, 503, 507, 511, 515, 519, 520, 530, 532, 534, and 536. 

 

Item 348 covers a professional attendance by a consultant psychiatrist where they interview a person other than a patient at their surgery, hospital, or residential aged care facility where the attendance duration is not less than 20 minutes and less than 45 minutes and is in the course of an initial diagnostic evaluation of the patient. Item 350 covers the same services as in item 348 where the duration is not less than 45 minutes.  Item 352 covers a professional attendance by a consultant psychiatrist where they interview a person other than a patient at their surgery, hospital, or residential aged care facility where the attendance duration is not less than 20 minutes and is in the course of continuing management of the patient.

 

Fee increases for psychiatric items 348, 350 and 352 were negotiated in consultation with the Royal Australian and New Zealand College of Psychiatrists and recognise that the complexity and time involved in interview of a patient's carer can be commensurate with a consultation with a patient. These fee increases therefore correct a previous anomaly and promote more effective clinical practice.

 

Items 501 to 536 relate to professional attendances by emergency physicians in the practice of emergency medicine.  Item 501 covers medical decision making that is straightforward.  Item 503 covers medical decision making of low complexity.  Item 507 covers medical decision making of moderate complexity.  Item 511 covers medical decision making of moderate complexity including liaison with relevant health professionals and discussion with patient’s relatives.  Item 515 covers medical decision making of high complexity including liaison with relevant health professionals and discussion with the patient and the patient’s relatives.  Item 519 covers an attendance for emergency evaluation of a critically ill patient for at least 30 minutes and but less than 1 hour.  Item 520 covers the same service as item 519 but for at least 1 hour and but less than 2 hours.  Item 530 covers the same service as item 519 but for at least 2 hours and but less than 3 hours.  Item 532 covers the same service as item 519 for at least 3 hours and but less than 4 hours.  Item 534 covers the same service as item 519 for at least 4 hours and but less than 5 hours.  Item 536 covers the same service as item 519 but for at least 5 hours.

 

Fee increases for emergency medicine items 501 - 536 were negotiated with the Australian College of Emergency Medicine which comprises specialist emergency physicians, and appropriately recognise the nature of emergency medicine by aligning these items with a specialist consultation item structure based on specialist item 104, rather than a general practice item structure.  The fee increases also recognise the predominantly after hours nature of emergency medicine.