FEATURE: FUNDING FOR EXERCISE-BASED THERAPIES The next most generous category of “inappropriate painkillers.” Patient X specialty. It is important to interpret Table rebate is granted to almost all medical can get sensibly prescribed opiate 1 as a “patient payment” not “practitioner specialist physicians, with the glaring painkillers if she has entered palliative payment.” SEM physicians being exception of SEM physicians (who are care for advanced cancer, but if she gets specialists who are slightly undersupplied not deemed to qualify as “physicians” incorrectly prescribed opiates for her in the market can and do typically charge under the MBS). Consultant physicians knee pain or tennis elbow, it is a disaster. similarly to the fees that are the Medicare can generally be relied upon to provide rebate amounts for other physicians, high-quality service, but in the Basically at the bottom tier for MBS meaning that most of the fee has to musculoskeletal world, you can’t be sure. practitioner rebates is a collective of be paid out of the patient’s pocket. Therapeutic Guidelines: Rheumatology all Allied Health practitioners and SEM Effectively, this might mean our (2017 version, sadly) states that both the Physicians, meaning that all of the hypothetical Patient X can’t afford to knee osteoarthritis and tennis elbow of Exercise-based practitioners are part see a SEM physician, and since there Patient X should be treated with of a group of practitioners that receive aren’t SEM physicians in public hospitals “multiple” cortisone injections (multiple relatively paltry patient rebates from either, it is an important service that may being required as the patient often gets Medicare. SEM Physicians have the not be available for Patient X due to lack worse after the initial one(s) wear off, unique distinction of being the only so you need to repeat them). The 2017 practitioners in the entire MBS whose version, I kid you not, written from a cave patients’ rebates are lower in absolute where you don’t have to read RCT results. terms than they were 10 years ago. The TG:R isn’t picky about which joint or SEM rebates are actually 20-35% lower, which tendon you have pain in, by the even off a low base, whereas the other way, it offers a blanket recommendation MBS rebates have generally been for cortisone injection for every joint minimally indexed (10% higher in and every tendon listed. It states that 10 years, obviously well below CPI). the most important factor in considering As can be seen from Table 1, even a cortisone injection is the expertise though the Australian Medical Council of the practitioner (not whether there (AMC) assessed SEM as being a fully- is RCT evidence that it beats placebo). fledged medical specialty ten years ago, patient rebates are up to 66% lower than On the third tier of MBS rebates for for Rheumatology & Rehab Medicine, Patient X is the general practitioner, which would be the closest specialties who is awarded a mid-range rebate to SEM. It is not simply a matter of being for a longer consultation which gets penalised for being a “newer” specialty. upgraded (fairly) in the event of Sexual Health and Addiction Medicine organising team care arrangements, were recognised at exactly the same time which in the scenario I painted for as SEM yet have subsequently been Patient X, seems highly justified. Like granted equity with the other physician any practitioner, there is the capacity specialties. It is hard not to reach the for GPs to be delivering harmful conclusion that SEM is penalised under treatment options, and the biggest the MBS simply for the fact that SEM failing of GPs in recent years is not is an exercise-based medical specialty “inappropriate antibiotics” but instead and not a drug-based or procedure-based VOLUME 36 • ISSUE 2 2018 37 zciweisalaiBanyzrataK/segamiytteg