Associate Professor Nick Stephenson

Associate Professor Nick Stephenson

SUBMISSION FEEDBACK

Pleaseprovidecommentson allor anyof thefollowing,particularlyinrelationtoeachOptionoutlinedintheConsultationRegulationImpactStatement:

•Theappropriatenessandfeasibilityof theproposals.

•Whethertheproposedchangeswilladdresscurrentconcernswiththeregulationsinthe diagnosticimagingsector.

•Potentialcostsassociatedwitheachoption.

•Potentialbenefitsassociatedwitheachoption.

•Potentialworkforceimpacts.

•Impactson patientaccesstoappropriateimaging.

•Ruralandremoteaccessfor patients.

•Timerequiredtoimplementthepotentialchanges.

•Impacton bothsmallerdiagnosticimagingpracticesandlargerpractices.

•Any othercomments,questionsandconcernsthatrelatetotheproposedoptions. In addition,you maywishtorespondtoquestionslistedagainstspecificOptions. Submissionsshouldincludesubstantiatingevidence,wherepossible.

Option1 – No regulatorychangesorderegulation(referto page23 of theRIS)

Features:

•Thecurrentsupervisionrequirementsremainunchanged.

•Thepersonundertheprofessionalsupervisionof theradiologistwouldrequiretheappropriate qualifications,credentials,or trainingtoprovidetheservice.

•ThecurrentsubstitutionrulesintheHealthInsuranceAct1973 remain.

•Ruralandremoteexemptions.

Option2 – Minorchangesincludingclarificationof currentrequirements(referto page24-26 of theRIS

Features

•Amendmentstothecurrentsupervisionrequirementstoclarifythecircumstancesunderwhicha radiologistand/orspecialistor consultantphysicianmustprovidesupervisionandhow the supervisionmustbeprovided.

-Professionalsupervisionwouldrequire:themedicalpractitionerbeavailabletoobserveand guidetheconductanddiagnosticqualityandsafetyof theexaminationandifnecessaryin accordancewithacceptedmedicalpractice,attendthepatientpersonally,withinareasonable periodof time.

•Thepersonalattendancerequirementof musculoskeletalultrasoundwouldbeamendedtoalign withallotherultrasounditems.

•Thepersonundertheprofessionalsupervisionof theradiologistwouldrequiretheappropriate qualifications,credentials,or trainingtoprovidetheservice.

•ThecurrentsubstitutionrulesintheHealthInsuranceAct1973 remain.

•Ruralandremoteexemptions.

•Specifiedqualificationrequirementsfor ultrasoundproviders.

•Definitionof diagnosticultrasound

MusculoskeletalUltrasound(referto page25-26 of theRIS)

Questions:

•Aretheprinciplesasoutlinedsatisfactorytoclarifytherequirements?

•Whatreasons,ifany,aretherefor thepersonalattendancerequirementsfor musculoskeletal ultrasoundtoremain?

•Wouldaminimumsetof guidelinesfor ‘acceptedmedicalpractice’permodalitybeappropriate?

•Whatsavingsareanticipatedtoberealisedfromremovingthepersonalattendancerequirements for musculoskeletalultrasoundservices?

•Whatadditionalcostsareanticipatedtobeincurredby requiringamedicalpractitioner(eg radiologist)tobeincloseproximitytoattendon apatientpersonallywithinareasonableperiod of timeincircumstanceswherethisisnotcurrentlythesituation?

•Whatothercosts(ifany)mightbeassociatedwiththeproposedchanges?

•Whatarethepotentialconsequencesof theproposedchanges?

Option3 – Practicebasedapproach(referto page27-34 of theRIS)

Features

•Amendmentstothecurrentsupervisionrequirementstoclarifythecircumstancesunderwhicha radiologistand/orspecialistor consultantphysicianmustprovidesupervisionandhow the supervisionmustbeprovided.

-Professionalsupervisionwouldrequire:themedicalpractitionerbeavailabletoobserveand guidetheconductanddiagnosticqualityandsafetyof theexaminationandifnecessaryinaccordancewithacceptedmedicalpractice,attendthepatientpersonally,withinareasonable periodof time.

•Thepersonalattendancerequirementof musculoskeletalultrasoundwouldbeamendedtoalign withallotherultrasounditems.

•Thepersonundertheprofessionalsupervisionof theradiologistwouldrequiretheappropriate qualifications,credentials,or trainingtoprovidetheservice.

•ComputedTomographyserviceswouldonlybeabletobeprovidedinacomprehensivepractice, withtheexceptionof CTof thecoronaryarteries(items57360 and57361).

•Supervisionwouldbetailoredtothetypeof diagnosticimagingpractice.

•A comprehensivepracticewouldrequirearadiologisttobeavailableduringagreedoperating hours.

•Wherearadiologistison siteduringordinaryoperatinghours, theradiologistwouldbeallowed todeterminethesupervisionrequirementsfor thepracticeandhavetheflexibilitytoimplement andsuperviseefficientandeffectiveprocesses.

•Wherearadiologistison siteduringordinaryoperatinghours, theradiologistwouldbeallowed to substitutearequestedservicefor amoreappropriateservice,withouttheneedfor consultation withtherequester,ifthesubstitutedservicehasalowerMBS feethantherequestedservice.

•ThecurrentsubstitutionrulesintheHealthInsuranceAct1973 remain.

•WherearadiologistisNOTon siteduringordinaryoperatinghours, aradiologistmustbeon site for theperformanceof thefollowingservices:

oMammography;

oTheadministrationof contrast;and

oImageguidedinterventionprocedures/surgicalinterventions.

•Thereportingandsupervisingradiologistwouldnothavetobethesameperson,butpractices wouldberequiredtomaintainrecordswhichindicatethenameof alltheradiologistsinvolvedin theservice.

•Ruralandremoteexemptions.

•Specifiedqualificationrequirementsfor ultrasoundproviders.

•Definitionof diagnosticultrasound.

A Comprehensivepractice(referto page28-29 of theRIS)

Questions:

•Arethereanyothertypesof practiceswhichhavenotbeenidentified?

•Aretherecomprehensivepracticesthatdo notcurrentlyhavearadiologistonsite?

•Whatarethecostsof employingaradiologistonsiteduringordinaryoperatinghours?

•Whatarethecostsof non-comprehensivepracticesexpandingtobecomecomprehensive practices?

•Arethereenoughradiologistfor thistooccur?Whatarethebarriers?

•Is thereanyrolefor standaloneCTand,ifso, how wouldcurrentsafetyandqualityconcernsbe addressed?Whatwillbetheimpactof thischangeon providersandpatients?

•Whatothercosts(ifany)mightbeassociatedwiththeproposedchanges?

•Whatarethepotentialconsequencesof theproposedchanges?

Non-radiologistspecialistpractice(referto page30-31 of theRIS)

Question

•Arethereanyotherservicescurrentlyperformedby non-radiologyspecialists?

ADDITIONALISSUES FORCONSULTATION

1. Ruraland remoteexemptions(referto page31-32 of theRIS)

Theintentionof havingruralexemptionsistoensurepatientshaveaccesstoserviceswithout compromisingon quality.However,currentarrangementsfor ruralexemptionsvaryfor eachof the modalities,creatingconfusionduetoaninconsistentapproach.Thecurrentapproachisalsodifficult toadminister.

Questions

•Doesthecurrentrulemeetitsgoalof increasingaccessfor patientswithoutcomprisingon quality?

•Shouldexemptionsbegeographically/distancebasedratherthanlookingatpopulationbaseand localavailabilityof specialistservices?

•Arethereanyothermechanismsthatprovideincentivesfor localservicesprovisioninrural

Australia?

•Whatistheroleof tele-radiology?Shoulditbetheonlyservice,or anadjunctthelocalservice provision?

•Shouldtheexemptionnotbeavailablefor certaintypesof services?

2. Implementingany changesand therelativeroleof regulationand theDiagnosticImaging

AccreditationScheme(DIAS) (referto page33-34 of theRIS)

Therelativeroleof regulationandaccreditationinenhancingthequalityframeworkfor MBS funded

diagnosticimagingserviceswillbedeterminedfollowingfeedbackreceivedfromstakeholdersunder thisconsultationprocess.

Questions

•WouldchangestosupervisionbebetterplacedintheDIAS or remainintheregulations?

•How wouldapracticebasedsupervisionapproachbeincorporatedintoregulation?

•Is itnecessarytohaveamodalitybasedapproachintheregulations(asaminimum)anda practicebasedapproachinaccreditation?

3. Any additionalproposals,suggestionsorcomments?