Digital Biopsy Medical Benefits Schedule (MBS) Item Number...

Digital Biopsy Medical Benefits Schedule (MBS) Item Number

“Bureaucracy and red tape should not delay our efforts to bring help to those in need.”

London Nicole Breed

My Friends,

The Medical Benefits Schedule (MBS) in Australia affects medical care and medical costs to a much greater extent than most people realise. MBS does not get much coverage or publicity. Doctors like it that way. Item numbers however are a constant subject of discussion and interest amongst doctors and health care providers. This is not surprising, as the MBS determines the Medicare rebates and thus their incomes. The MBS is a jumble of some 5,700 plus items and their rebates for medical services. It has an interesting history antedating the introduction of the original Medibank introduced by the Whitlam Government. It was initially made up by surgeons for surgeons and still carries the spirit and the interest of its founders. It was designed for one thing and one thing only, too wit to maximise the financial benefit to surgeons. Without any other guidelines for the original Medibank, it was adopted as the basis for medical remuneration. It was a gravy train. It was expanded and it has been growing ever since. It has some perverse and very counter-productive health-economic incentives. It produces some very good results and some appalling results. It produces huge expenses in many areas, for no or negative health benefits to anyone but the medical profession. It expands continuously and the main source for expansion is application by doctors for other things to be added on so that they can be remunerated.

The whole idea of the growth of the MBS is to improve health care by allowing funding of new and beneficial procedures and technology, removing items which are not beneficial to health care, and remove funding for perverse and counterproductive activities. For a new item to be placed on the MBS it needs to convince the bureaucracy it improves the delivery of health, by either improving outcomes optimising the process optimising, reducing costs for equal or greater benefits. Tiresias thinks that preparation for application for an MBS Item Number and rebate for Digital Biopsy and Real Time Pathology is getting close. This will be easy to justify on all criteria. Digital biopsy will reduce the number of biopsies, and frozen sections, which will improve care and costs. In screening it will significantly improve outcomes and again, and importantly to the health bureaucracy, reduce costs. But, despite the obvious benefits, the bureaucratic process may not be as simple as common sense would suggest. Optiscan however is developing the leadership and the skill set on its board to handle this process, because, in Australia, it is critical that Digital Biopsy and real-time pathology have an MBS Item Number. Once an item number is given there will be a scramble for Optiscan’s Confocal Laser Endomicroscopes(CLE’s), for performance of Digital Biopsy and real time pathology. Most of the demand will come for cancer screening in such areas as oral, gastrointestinal screening of Barrett’s oesophagus and ulcerative colitis, cervical, and skin. Of course, replacement of frozen section biopsies and in vivo real time pathology in breast, brain, skin, head and neck surgery, and other cancer surgery, will make CLE real-time histopathology indispensable. But of course, the great incentive, and not to be too Diogenean, just as important as patient outcomes, which will drive this technological change, the incentive that Tiresias has talked about previously; remuneration to doctors. Once there is an MBS Item Number for Digital Biopsy, Optiscan will be hard pressed to supply even a fraction of this demand. Then my friends, the market will take notice and then my friends we will smile as we sip our Pina Colada’s at sunset.