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HEALTH INSURANCE (1997-98 PATHOLOGY SERVICES TABLE) REGULATIONS 1997 NO.299
EXPLANATORY STATEMENTSTATUTORY RULES 1997 No. 299
Issued by the Authority of the Minister for Health and Family Services
Health Insurance Act 1973
Health Insurance (1997-98 Pathology Services Table) Regulations
Section 133 of the Health Insurance Act 1973 ("the Act") provides that the Governor-General may make regulations prescribing matters for the purposes of the Act.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services (including pathology services) set out in the table (which includes the pathology services table).
Section 4A of the Act provides that the table of pathology services may be prescribed by the regulations. The Health Insurance (1997-98 Pathology Services Table) Regulations prescribe such a table.
The changes to the pathology services table in these regulations have been developed with the cooperation and support of the two peak pathology professional bodies, the Royal College of Pathologists of Australasia (RCPA) and the Australian Association of Pathology Practices (AAPP), through the Pathology Services Table Committee and the Pathology Consultative Committee.
The 1997-98 Pathology Services Table includes an increase in Schedule fees for forty selected items, the addition of three new items, a revision of the description of one item, and changes to the Rules of Interpretation (the Rules).
The selected fee increases are in line with the terms of the three year Agreement between the Government and the pathology profession which was announced in the 1996-97 Budget. Under the Agreement, which was negotiated with the two peak pathology professional bodies, the RCPA and the AAPP, pathology expenditure under the Medicare benefits arrangements will be managed to predetermined amounts over the period 1996-97 to 1998-99. These amounts equate to an annual growth rate for pathology expenditure of around 6 per cent.
The Agreement, which took effect from 1 July 1996, contains a series of measures to manage pathology expenditure, with adjustments being made as necessary to operate within the cap's agreed parameters. At the end of August 1997, the growth rate for expenditure on pathology for 1997-98 was running below target at 4.3 per cent with trends in processing activity indicating that this pattern is likely to continue. The adjustments to the selected items are in accordance with these provisions.
There has been an overall fee increase of around 1.7 per cent over 1996-97 expenditure, in line with the 1 November 1997 general fee increase applying to the Medicare Benefits Scheme. The funds have been allocated in a targeted manner, and forty items have been selected for a fee adjustment that:
* improves relativities between items with a high professional input, and those currently under-remunerated, and
* provides benefits to both the public and private sectors, and to those general practitioners who provide pathology services in their surgeries.
In addition, the regulations prescribe two new tests for immunocytochemical examinations, a new test for the monitoring of response to therapy in corticosteroid treated asthma in children, the removal of a restriction to a test for immunoglobulin G subclasses and amendments to the Rules of the Pathology Services Table.
Details of the regulations are set out in the Attachment.
The regulations come into effect from 1 November 1997.
ATTACHMENT A
Regulation 1 cites the regulations as the Health Insurance (1997-98 Pathology Services Table) Regulations, Regulation 2 prescribes a commencement date of 1 November 1997 for the Dew regulations.
Regulation 3 prescribes the new pathology services table for 1997-98 which sets down the pathology services eligible for Medicare benefits. Regulation 4 repeals Statutory Rules 1996 No. 232 and Statutory Rules 1997 No- 54. The selected items with a fee increase include:
* seven patient episode initiation items (items 73901, 73907, 73909, 73910, 73912, 73913 and 73915) and the specimen referred item (73921);
* fifteen microbiology items (items 69201, 69205, 69207, 69209, 69213, 69219, 69223, 69282, 69283, 29289, 29290, 69291, 69293, 69294 and 69295) that required a higher level of professional input;
* six of the more complex histopathology items (items 72817, 72823, 72824, 72825, 72830 and 72836);
* ten items from Group P9 - simple basic pathology tests (items 73801, 73802, 73803, 73904, 73805, 73807, 73808, 73809, 73810 and 73811 - the pregnancy test item 73806 has been excluded)
- item 73906 has been excluded from a fee increase because of concern over the appropriateness of pregnancy tests continuing to be on the Pathology Services Table due to the ready availability of pregnancy test kits in pharmacies; and
* one haematology item (item 65011).
The other changes to the 1997-98 Pathology Services Table are:
* two new items (13059 and 73060) provide for the immunocytochemical examination of material obtained by procedures, in particular fine needle aspiration, described in cytology items 73045, 73047, 73049 and 73051 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques
- item 73059 involves the use of 1 to 3 antibodies per specimen and item 73060 involves the use of 4 or more antibodies per specimen
- the two items are comparable to the two histopathology (immunohistochernical examination) items 72846 and 72847 in Group PS (Tissue Pathology) and have the same Schedule fee levels, 530.00 and 540.00 respectively;
* new item 71095 provides for the quantitation of serum or plasma eosinophil cationic protein (ECP), or both-t6 a maximum of three assays in one year, for the monitoring of response to therapy in cortitosterold treated asthma, in a child less than 12 years
- the ECP test is a marker of airway inflammation, and its clinical use is to monitor preventative treatment, most commonly inhaled corticosterold therapy,
- the ECP test would complement pulmonary function, tests, which are considered unreliable in young children with severe asthma;
* a restriction, which limited the payment of Medicare benefits for the quantitation of all four immunoglobulin G subclasses, to two tests in a twelve month period, has been removed from item 71073
- an annual restriction was put in place to prevent inappropriate ordering, however, it can be difficult to stabilise a child with immunoglobulin G subclass deficiencies, and repeated testing may be required to determine the appropriate dosage of the drug, and the frequency of immunoglobulin infusions,
* in the Rules, subrule 4 (2) (a) is amended to include a reference to "INR" (International Normalised Ratio) in the estimation of prothrombin time
- the result for prothrombin time is expressed as a ratio. A correction factor (International Sensitivity Index) is applied to the prothrombin ratio and the result issued as an INR. This reference is generally accepted and understood within the pathology community;
* subrule 4 (2) (a) is amended to permit the ordering of an unlimited number of prothrombin tests for patients undergoing coagulant therapy to be performed over a six month period
- currently only six tests can be requested at one time. The proposed change would reduce the need for consultations required only for the purpose of updating pathology requests;
* a new subrule 4. (2) (g) is added to permit the ordering in one request of up to six tests performed within six months, for the quantitative estimation of albumin and calcium in relation to therapy of a patient with Vitamin D, its metabolites or its analogues
- this will cover the monitoring of patients undergoing treatment with calcitriol for osteoporosis, reducing the small but significant risk of hypercalcaemia; and
* due to the addition of a new subrule, minor changes in subrule 4. (2) lettering.