Department of Health launches consultation on new funding model for cardiac support services

MedTech & Diagnostics News: The Department of Health has launched a consultation, following the recent Medical Services Advisory Committee (MSAC) advice, to determine the new funding model of cardiac technical support services provided by industry-employed technicians.

Cardiac implantable electronic devices (CIEDs) are battery-powered devices used to manage heart conditions, including rhythm abnormalities. Optimal device performance and longevity require regular checks, with 1-4 scheduled services annually and additional services as needed due to new events or symptoms.

In Australia, cardiac technical support services are provided through three different care models: public hospitals and outreach services that employ cardiac technicians, private cardiologists who employ cardiac technicians, and private cardiologists who use only industry-employed cardiac technical support.

MSAC considered that the cost of technical support services provided to privately insured patients should not be funded via the Prescribed List (PL) benefits for CIEDs.

The Department of Health received an application from the Medical Technology Association of Australia (MTAA) representing its members Medtronic, Abbott, Biotronik, MicroPort CRM, and Boston Scientific.

The Cardiac Society of Australia and New Zealand (CSANZ) Position Statement on CIEDs noted, “Industry holds an important role in facilitating the optimal device programming for each patient and in trouble shooting device-related issues. Industry provide and maintain the device programmers that are a prerequisite for CIED follow-up. Industry is also integrally involved in the provision of remote monitoring services.”

The total cost of these technical services was estimated at $73.3 million in 2022, rising to $87 million in the most recent estimates provided by the MTAA. Due to device cost adjustments, the technical support services component of the CIED PL benefit now represents 43.7% of the total benefit.

To avoid compromising patient care or increasing out-of-pocket costs for CIED services, the MSAC advised excluding these technical service costs from the staged PL benefit reductions.

The Australian Medical Association (AMA) has not supported funding the service via the MBS, fearing it would lead to out-of-pocket expenses for privately insured patients. Instead, the AMA advocated for private health insurers to continue to reimburse these services or for a revised PL benefit.

The Professional Cardiac Scientists Association (PiCSA) has urged the government to devise a funding model that safeguards both industry and non-industry workforce roles.

“Funding reform measures are necessary, but must not undermine the viability of third-party non-industry providers or bias against the direct employment of cardiac physiologists,” the organisation said.

Furthermore, PiCSA proposed that employers and the Australian government enforce registration with the Australian Accredited Clinical Physiologists (ACCP) for the cardiac device workforce. This measure, they argued, would uphold stringent quality, safety, and ethical standards in the delivery of cardiac technical support services.

International reimbursement models include a fee-for-service approach in France and Germany, a subscription model with a set fee for all services within a certain period in France and the US, and a combination of both in the Netherlands.

The Department of Health is now inviting stakeholders to provide feedback on how to implement the MSAC advice.

“We ask that you raise any matters of concern or negative implications for your organisation, you and/or your sector. We acknowledge the impact that amendments to the current funding model for these services could have on consumers, sponsors, technicians, and public and private hospitals and are interested in understanding all perspectives on this matter,” the Department stated.

The consultation is due to close on 6 September 2024.

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