Heart charity and cardiologists call for sustained MBS funding of heart checks, despite opposing views from RACGP

This Heart Valve Disease Awareness Week (20 – 26 February), leading charity hearts4heart and cardiologists across the country are urging reform to Medicare Benefits Schedule (MBS) items for Heart Health Checks, saying current settings risk overlooking less well-known heart conditions.

The Heart Foundation has also been seeking a financial commitment from the government to ensure billing is sustained indefinitely, despite an opposing view from the Royal Australian College of General Practitioners (RACGP).

“Removing the Heart Health Check from the MBS has the potential to undo years of progress embedding CVD prevention activities in routine care. This is unacceptable given these activities are needed more than ever to curtail the wave of chronic disease we expect to see in the years ahead,” the Heart Foundation said.

Interim heart health check items (699 and 177) were introduced to the MBS on 1 April 2019, allowing patients to receive a cardiovascular disease assessment from a GP or another medical practitioner. Currently under review, the interim funding for these items was extended last year and is due to expire in June this year.

Modelling from the Heart Foundation shows over the next 5 years, 76,500 heart disease related events could be prevented with the widespread uptake of Heart Health Checks.

Concerningly, there are restrictions that prevent patients from receiving a heart health assessment if they have received a separate medical assessment service within the previous 12 months.

While the MBS Heart Health Check was an excellent initiative, hearts4heart CEO and founder Tanya Hall believes there needs to be greater synergy between health assessments to ensure that no patient falls through the gap.

“It is great to see health assessments focused on heart disease prevention, but it is not practical to have a health assessment that focuses on one disease in isolation. There are many different types of heart disease, and focusing primarily on cardiovascular disease overlooks patients at risk of other heart conditions, such as heart valve disease,” Ms Hall said.

The RACGP has a different view saying that the “items 699 and 177 represent fragmentation of MBS funding toward single disease focussed items rather than comprehensive primary care. While these item numbers have helped to focus attention on assessment of cardiovascular disease (CVD), the leading cause of death in Australia, their introduction also represents an ad-hoc, piecemeal approach to supporting risk assessment and preventive care in primary care. The savings from the removal of these items could be reinvested in longer consultations, mental health and/or chronic disease management.”

As the recommendations from the Strengthening Medicare Taskforce Report are developed and funded, Ms Hall hopes to see changes to Medicare heart health assessments that allow patients to receive more comprehensive care.

“Claiming the MBS heart check should not exclude GP’s from claiming a separate Medicare health assessment service, because patients often have co-morbidities,” said Tanya Hall.

“Our healthcare system should be holistic and focus on prevention – earlier detection and treatment once heart disease is detected saves lives, reduces healthcare costs, and improves economic productivity,” said Associate Professor Dion Stubbs, a cardiologist at Alfred Hospital.

“A simple first step to achieving this is to introduce a simple stethoscope check as a requirement in health assessments, because it can be used to check for symptoms of various heart diseases, including heart valve disease, atrial fibrillation, and heart failure.”

There were 130,853 Medicare items processed for item 699 from January to November 2022, however, many GPs are not providing the MBS Heart Health Check because auscultation isn’t included, and because it restricts them from claiming other separate Medicare health assessments.

“GPs also need MBS funding to conduct thorough follow-up appointments with patients if further tests have been warranted, to talk through their results, including things like cholesterol levels and blood pressure. These factors are important to consider when reviewing the MBS Heart Health Check,” Associate Professor Stubbs said.

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