Medicare Benefits Schedule (MBS) Review Advisory Committee: Open Consultation - Sport and Exercise Medicine Physician access to Group A4 MBS items

Overview

This review seeks input from consumers, medical practitioners, and allied health professionals on the following questions:

In February 2023, the Australasian College of Sport and Exercise Physicians (ACSEP) asked the Medicare Benefits Schedule Review Advisory Committee (MRAC) to consider reclassifying Sport and Exercise Medicine Physicians (SEMPs) as consultant physicians with access to consultant equivalent MBS items.

The ACSEP claimed the schedule of fees under Group A4 MBS items more appropriately to reflect the repeated and longer timed preventative treatments that SEMPs provide for a range of chronic conditions. This lack of access to appropriate MBS item numbers combined with complex cases has led to high out-of-pocket costs for consumers.

Sport and Exercise Medicine Physicians (SEMPs) are specialist doctors whose scope of practice focuses on the diagnosis and treatment of musculoskeletal injuries and the prescription of exercise in the management and prevention of chronic diseases.

The MBS Review Advisory Committee (the MRAC), comprised of practising clinicians, academics, health system experts, and consumers, is currently reviewing the ACSEP review proposal. The review will ensure the MBS aligns with current and evidence-based clinical use of sport and exercise medicine and does not pose inappropriate barriers to patients wishing to access SEMP services.

Read more about the MBS Continuous Review and the MBS Review Advisory Committee. 

Background

Consultant physicians traditionally perform more “cognitively complex” attendances (for example, spend more time with patients on treatment approaches and undertake fewer procedures). By contrast, specialists such as SEMPs have traditionally been more procedurally focused (for example, perform or assist with operations). The MBS Review Taskforce found the current distinction between initial and subsequent attendance MBS items [for consultant physicians and specialists] does not accurately reflect current clinical practice (MBS Review Taskforce Report from the Specialist and Consultant Physician Consultation Clinical Committee June 2020).

Group A4 MBS items provide higher rates of benefits for consultations. They include MBS item 110 for an initial attendance (fee of $168.60) and
MBS item 116 for a subsequent attendance (fee of $84.35). Consultant physicians have access to Group A4 MBS items.

Group A3 MBS items include MBS item 104 for an initial attendance
(fee of $95.60) and MBS item 105 for a subsequent attendance (fee of $48.05). Specialists such as SEMPs have access to Group A3 MBS items.

• The difference between initial attendance items 104 and 110 is $73.00 and between subsequent attendance items 105 and 116 is $36.30.

Table 1: Group A3 and Group A4 MBS items

Why your views matter

Your feedback will help the MRAC decision making process regarding Sport and Exercise Medicine Physicians access to consultant physician group A4 Medicare item numbers.

The Department of Health and Aged Care is conducting a survey: Open Consultation - Sport and Exercise Medicine Physician access to A4 MBS items. The survey is to:

• engage the views of the public, medical practitioners, and stakeholders on the services provided by Sport and Exercise Medicine Physicians, and
• ensure that any decision on Sport and Exercise Medicine Physicians access to the Medicare Benefits Schedule (MBS) is clear, robust and
  well-informed, and will benefit the public.

What happens next

Feedback from this survey will help inform MRAC recommendations. Individual submissions will not be identifiable.

Read more about the MBS Continuous Review, the MBS Review Advisory Committee and other current and completed reviews.