Medical procedures under the knife

The safety, efficacy and cost of some common medical procedures has been called into question
 
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02.Taking action

MBS Comprehensive Management Framework

The federal government has established the Comprehensive Management Framework (CMF), tasked with ensuring new and existing MBS items are safe, effective, represent value for money and will lead to improved health outcomes in patients.

Now - just like new drugs are put before the Pharmaceutical Benefits Advisory Committee before they can be listed on the Pharmaceutical Benefits Scheme (PBS) - new tests and procedures have to get past the Medical Services Advisory Committee to be listed on the MBS and therefore be eligible for Medicare rebates.

With more than 6000 procedures on the MBS, there’s much work ahead to identify which treatments are ineffective by contemporary standards, potentially do more harm than good, or are less cost-effective than alternatives.

This can be done by means of clinical trials, where a procedure is tested against a placebo treatment. There is also so-called comparative effectiveness research, which compares new or existing procedures to other (non-placebo) treatments. 

The results could mean revising clinical guidelines to reflect best practice or, for those where the main concern is cost, removing them from the MBS - a process called disinvestment. Vertebroplasty for osteoporotic fractures, for example, has already been removed from the MBS, though it’s still practiced.

This will undoubtedly have flow on benefits to healthcare consumers, saving them time and money, and preventing unnecessary pain or discomfort for procedures of little or no benefit.

By freeing up funding for procedures that do help, all health consumers benefit.

What you can do

With doctors not always making appropriate decisions on behalf of their patients, the onus is on patients to take some responsibility for their care – an approach advocated by the Choosing Wisely campaign, created by US physician societies in collaboration with our US sister organisation, Consumer Reports.

This isn't ideal, since many consumers aren’t particularly health-literate or may feel it’s not their place to question a doctor’s authority. But until the CMF has made significant headway on its task of assessing not only new but existing procedures for effectiveness, your best bet is to inform yourself.

• Look up the Choosing Wisely lists, either by speciality (paediatrics, ophthalmology, neurology etc) or condition. For many procedures, the information is relevant for Australians.

• Get a second opinion for any significant tests or surgical procedures.

• Don’t go looking for apparently non-invasive procedures such as CT scans and X-rays. If they’re ordered, ask if it will change the way your condition is managed, or prevent a more invasive procedure (like exploratory surgery).

• Invite a friend or relative to come with you to the doctor. They can take notes for you while you talk, and also help you make sense of what you were told.

International approaches

United Kingdom

The UK’s National Institute for Health and Care Excellence (NICE) is an independent organisation charged with assessing new drugs and treatments as they become available and providing guidelines on how a particular condition should be treated. NICE also maintains a database of clinical practices it recommends should be discontinued or not be used routinely - the "Do not do" recommendations. Practices are included due to evidence of ineffectiveness, or a lack of evidence to support its continued use.

United States

Choosing Wisely colleges and medical specialist societies have compiled lists of five things patients and doctors should question within each speciality, regarding tests, procedures and medications. Consumer-friendly resources on tests, procedures and medications have also been created by our US counterpart, Consumer Reports, in conjunction with these societies.
 

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