EXPLANATORY STATEMENT HS/4/1998
SUBJECT: HEALTH INSURANCE ACT 1973
DETERMINATION UNTIER SUBSECTION 3C(1) TO PROVIDE MEDICARE BENEFITS FOR PERCUTANEOUS TRACHEOSTOMY
Subsection 3C(1) of the Health Insurance Act (the Act) provides that the Minister may, by writing, determine that a health service not already included in the general medical services table (the table) is to be treated as if it were included in the table. Such a determination shall specify a fee in respect of the health service and shall be subject to the provisions of the Act and Regulations as if it were a health service included in the table.
The table, which is prescribed by Regulations under section 4 and section 133 of the Act, contains item numbers for descriptions of and fees in respect of medical services which are, among other things, recognised for the purposes of the payment of Medicare benefits.
A restructure of head and neck surgery services in the table, including a revision of items covering tracheostomy, was introduced from 1 July 1998. The new structure was designed to reflect changes in clinical practice in this area and to recognise the emergence of head and neck surgery as a specialty area of medicine. The review of these services was undertaken in consultation with the Australian Society of Otolaryngology Head and Neck Surgery, the Royal Australian College of Surgeons and the Australian Medical Association under the auspices of the Medicare Benefits Consultative Committee (MBCC).
The Australian and New Zealand Intensive Care Society (ANZICS) subsequently advised that the revised items for tracheostomy did not cater for the percutaneous technique performed in the main by intensivists for the purpose of long term mechanical ventilation of intensive care patients. The previous item covering all tracheostomies regardless of the approach had been changed to specify the open approach, with amendment to a further item to cater for the direct stab or dilatation technique using a Minitrach or similar device. However, ANZICS advised that neither item accurately described the percutaneous procedure which was performed using a dilatation or trachea splitting technique.
At a subsequent MBCC meeting, it was agreed that the percutaneous procedure described by ANZICS is not adequately covered by existing items in the table.
This Determination will provide for the payment of Medicare benefits for percutaneous tracheostomy pending its inclusion in the table at the next amendments to the health insurance regulations.