A taskforce overseeing a review into optometric Medicare items has backed 11 of 14 recommendations by an optometry committee. However, a proposal for more frequent eye exams for middle-aged Australians has been rescinded and concerns have been raised over high computerised perimetry usage.
This week the Medicare Benefits Schedule (MBS) Taskforce published its endorsed report after obtaining recommendations from the Optometry Services Clinical Committee, which reviewed 32 MBS items since being established in 2018.
This latest report does not constitute the final position on these items, which is subject to consideration by the Minister for Health and Federal Government.
The taskforce endorsed the majority of the recommendations, which included amalgamating items 10912 and 10913 and removing the same practice restriction. This will benefit patients who have a change to their visual function or new symptoms, unrelated to an earlier course of treatment.
According to Optometry Australia (OA), another notable inclusion is the amendment of items 10940 and 10941 (computerised perimetry) to allow the service to be performed by a suitably qualified person on behalf of the billing optometrist.
There were also recommendations to remove red tape and reflect current practice, including rewording the explanatory notes for all 10 contact lens prescription and fitting items to remove the requirement to deliver the lens (10921 to 10930).
This would allow for situations where a patient chooses to purchase their contact lenses from a different point of sale. However, the clinical service of contact lens fitting, patient education and trialling of the lenses prior to the finalisation of the prescription remains unchanged.
Two year eye exams denied
The taskforce, however, didn’t support the committee’s recommendation to change the frequency for comprehensive eye exams from three to two years for people aged between 50 and 64 years of age.
It found “there was no clear justification” for this increased frequency.
OA general manager of policy Ms Skye Cappuccio said while there were positives in the recommendations, the organisation was disappointed over the lack of support for this recommendation.
“We did provide a comprehensive review of the evidence and we felt that it made a strong case for this change but this evidence does not seem to have been recognised by the taskforce,” she said.
Computerised perimetry usage
The taskforce also didn’t back a proposal to create a new item for a brief consultation (not more than 15 minutes) to be co-claimed with a computerised perimetry procedure (items 10940 and 10941) for glaucoma patients.
“This recommendation was rescinded, as there was concern for misuse of computerised perimetry as a screening tool without a clear rationale,” the report noted.
Interestingly, the taskforce asked also the optometry committee to provide clarification on the usage of its computerised perimetry items. The same was also requested by the Ophthalmology MBS Taskforce, which was concerned over “possible inappropriate use” as a screening tool.
Figures show service growth for item 10940 in optometry are double the rate of comparable ophthalmology items (8% and 4% per year, respectively).
The optometry committee stated there were several factors that had contributed to the increase in usage. It attributed the rise, among other things, to optometrists being primary eyecare practitioners who use visual fields as part of a diagnostic test regime on indication as per the schedule, as well as an increasing number of therapeutic optometrists who are highly skilled at detecting, monitoring and treating a wide range of eye diseases.
Performing intravitreal injections
The taskforce’s seperate and final review into ophthalmology items, also released this week, featured another interesting finding affecting optometrists.
Despite opposition from some ophthalmologists, it recommended consideration of appropriately trained nurse practitioners and optometrists to administer intravitreal injections.
OA stated it had been advocating for pilot initiatives that enable optometrists to support ophthalmologists with intravitreal injections, as a mechanism for supporting better patient access.
“We were most pleased to see this recommendation as we believe that optometry working with ophthalmology can help support better access to treatment via intravitreal injection which can be critical to saving people’s sight,” Cappuccio said.
“We will continue to seek RANZCO’s support to work collaboratively on models of care that utilise appropriately trained optometrists in the provision of this treatment.”
According to OA, the taskforce endorsed all recommendations from the ophthalmology committee, including the establishment of two new telehealth items.
This included an item for a patient-only consult on referral from optometry only; and one for the provision of management advice via report to optometrist and patient.
OA CEO Ms Lyn Brodie added: “Optometry Australia has been advocating for the latter as an important support for optometrists and ophthalmologists to work collaboratively to ensure patients can have ready access to the care they need.”