Cardiac device benefits face more cuts, while technical services remain secure in the short term

MedTech & Diagnostics News: Starting from July 2024, Cardiac Implantable Electronic Devices (CIED) listed on the Prescribed List (PL) will undergo a further 20% reduction in their benefits.

CIEDs are battery powered electronic devices used to manage heart conditions including rhythm abnormalities. Optimal device performance and longevity requires regular checks, with 1-4 scheduled services occurring each year, and others when needed due to new events or symptoms.

The cuts to cardiac device benefits follows a similar reduction implemented on July 1, 2023. The reduction will apply to the portion of the PL benefit corresponding to the device’s cost, now recalculated at 56.3% after rectifying certification costs provided by the industry. This recalculated proportion will be used to adjust the 20% reduction from July 1, 2024, factoring in the 2020/21 weighted average price of a CIED in the public hospital system.

Industry contends that PL benefit reductions for CIEDs will reduce their ability to provide technical support services for these devices. The device cost adjustments have led to the technical support services component of the CIED PL benefit representing 43.7% of the total benefit.

The Medical Services Advisory Committee (MSAC) has also finalised its assessment of cardiac technical support services provided by industry-employed technicians.

It is estimated that the total cost of follow-up cardiac technical support services to be $73.3 million in 2022 and this increased to $87 million in the most recent cost estimates provided by the MTAA.

In order not to compromise the current care of patients with CIEDs or inadvertently increase any out-of-pocket costs associated with the receipt of these services, the MSAC advised that the costs for these follow-up services be excluded from the current staged PL benefit reductions.

While there will be no immediate reductions to the technical services component of the benefit on July 1, 2024, the Department of Health will initiate public consultation in the upcoming month to determine how to implement the MSAC advice on technical support services.

MSAC reiterated its earlier advice that further consideration needs to be given to identifying alternative, evidence-based models of care for all patients with CIEDs, how these services are most appropriately funded, and how the funding of these services are transitioned out of the PL benefit amount.

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