Changes to ECG funding regulations under review

The Department of Health is currently reviewing their decision to stop paying for the interpretation of electrocardiograms (ECGs) by GPs.

Back in August of 2020, Medicare made a surprising move: it decided to remove certain Medicare item numbers, such as item 11700, which allowed Medicare benefits to be paid for GP interpretation of ECG results. Under the proposed scheme only non-GP specialists are allowed to claim Medicare benefits for ECG interpretation.

The decision means that GPs will no longer be able to access Medicare item numbers for ECG that include reporting, effectively defunding GP interpretation of ECG results. As a consequence, GPs would be forced to either refer their patient to a specialist, interpret the ECG for free or pass along the cost to patients.

The policy change followed the report of a Medicare Benefits Schedule (MBS) Review Taskforce, established back in 2015 to examine more than 5,700 items listed on the MBS.

According to Health Minister Greg Hunt, the decision was based on safety.

“This came from a medical expert panel. It came from what’s known as the Medicare taskforce, led by Prof Bruce Robinson. It’s the highest clinical advice and it was based on safety,” said Minister Hunt to ABC News Breakfast, according to a news report.

However, no further explanation has been provided about this decision, which sparked instant outrage in the medical community.

A controversial decision
According to Dr Brett Montgomery, a senior Lecturer in General Practice, University of Western Australia, the government decision does not even follow the actual recommendations of the Review Taskforce.

“…contrary to Hunt’s claim, the MBS Review Taskforce did not recommend that Medicare stop paying for GPs to interpret ECGs. On the contrary, the taskforce explicitly recommended the opposite,” said Prof Montgomery in an article for The Conversation.

Other stakeholders have expressed strong opinions on this decision. Dr Ern Chang, a GP based in Newcastle called the decision “a rude and unexpected shock” in an open letter to Minister Hunt. Bruce Willett, the Queensland chair of the Royal Australian College of GPs, said “It’s highly insulting to GPs,” arguing that it would put an unnecessary and wasteful pressure on cardiologist to interpret all ECG tests.

For rural patients, the situation might be even worse, said Regional Victorian GP Megan Belot in a news article. “Rural GPs, we are trained specifically for emergencies and to interpret ECGs and also we can appropriately escalate to our cardiology colleagues where appropriate.

“It is putting a burden on our cardiologists who are busy seeing their patients, let alone having to do excessive work for GPs forced to send cardiologists routine ECGs. It’s ridiculous.”

Dr Montgomery hoped this was all a misunderstanding, but is frustrated that the situation has persisted for so many months. “I do like to give people the benefit of the doubt and so I wanted to assume that this decision was merely an oversight based on an accidental misreading of the Cardiac Services Clinical Committee report,” he said.

However, after the publication of his article in The Conversation, Dr Montgomery also wrote a letter to Minister Hunt, back in July 2020, expressing his views. At the time of publishing this article, he has received no answer.

“I can’t explain the minister’s silence in response to my letter (and my article) and the lack of any public correction from the minister or department of their apparent errors,” Prof Montgomery said.

Review in progress
To address all these concerns, the DoH will create a 12-member panel, called the MBS ECG Review Committee, that will specifically consider the changes made to ECG Medicare items, in the context of patient access to ECG tests. The expressions of interest for joining this committee closed earlier this month. Anyone who expressed interest on joining this panel, but was not selected, will have the opportunity to share their thoughts via email to the review team.

According to the DoH, this review panel will “give consideration to the impact of the ECG changes on patient access and cover the cost of service provision.”

The decision to review these controversial changes is a step in the right direction and might help identify a positive way forward. “I welcome the fact that there will be an ECG review committee set up to review the changes to Medicare ECG rebates,” Dr Montgomery said.