Australian Government - Department of Health

Medical Services Advisory Committee (MSAC)

Ophthalmology Review

The primary focus of the review is to align Medicare-funded ophthalmology services with available evidence, and to ensure service delivery is targeted to the most appropriate patient groups.

Medical Services Advisory Committee consideration

MSAC considered the ophthalmology (stage one) review report in March 2012 and provided advice to the Minister for Health, the Hon Tanya Plibersek MP.

MSAC noted the review report and the proposed series of ophthalmology item deletions and amendments to item descriptors.

The ophthalmology (stage one) review report is available below.

The primary focus of the review is to align Medicare-funded ophthalmology services with available evidence, and to ensure service delivery is targeted to the most appropriate patient groups.

A review of existing MBS ophthalmology items commenced under the MBS Quality Framework in 2010, and is continuing under the Comprehensive Management Framework for the MBS (CMFM). The CMFM, announced in the 2011-12 Budget, aims to better align MBS reimbursement with evidence-based best clinical practice. Reviews will assess existing MBS items for evidence of their quality and safety to ensure that items listed on the MBS remain clinically relevant and are appropriately claimed.

The review of ophthalmology items has been progressed in an open and transparent manner, undertaken cohesively with key ophthalmic stakeholders including the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and the Australian Society of Ophthalmologists, who assisted the Department to develop the approach to reviewing the items.

Further to this role, RANZCO also nominated several specialist ophthalmologists to be part of a small clinical working group to provide expert clinical input to the review to ensure that the research questions are relevant to current Australian clinical practice, and that valid conclusions are drawn from the evidence.

The Schedule lists approximately 160 ophthalmology items. Given the large volume of ophthalmic items the review has been undertaken in two-stages. The focus of the review was narrowed to specific items which were identified through several mechanisms comprising:

A high level literature review was also undertaken to identify any ophthalmic items with significant safety or clinical concerns, however, no issues were identified.

The same review approach and methodologies comprising MBS data analysis, fit for purpose mini-HTAs, guideline concordance, and stakeholder negotiation has been applied to both stages. Further detail is below.

First-stage ophthalmology review

The first-stage review considered 61 items. Public consultation was undertaken on both the review protocol and report. Outcomes of the first-stage review will be considered by the Medical Services Advisory Committee (MSAC) and its Evaluation Sub-Committee prior to advice being formulated for government.

Ophthalmology Second Stage Review Protocol(PDF 645 KB)
Ophthalmology Second Stage Review Protocol (Word 726 KB)

Ophthalmology First Stage Review Report (PDF 3681 KB)
Ophthalmology First Stage Review Report (Word 6510 KB)

Second-stage ophthalmology review

The protocol for the second-stage review has now been finalised, following public consultation and consideration by PASC at its December 2011 meeting. The protocol outlines the methodology to guide evidence-based analysis to support the review. A further 22 items are being assessed in the second-stage of the review.

It is anticipated that evidence-collection will commence mid-2012, with a review report developed late 2012. In line with the first-stage of the review, the report will be released for public consultation with the outcomes then considered by the Medical Services Advisory Committee and its Evaluation Sub-Committee.

Protocol - Review of Medicare-funded opthamology services (second stage) (PDF 536 KB)

Updates will be available from this website as the review progresses.

Page currency, Latest update: 29 June, 2012