Surgeons express concerns over removal of general use items from Prostheses List

MedTech News: As part of the Prostheses List Reforms, the Independent Health and Aged Care Pricing Authority (IHACPA) recently consulted in relation to appropriate pricing of ‘general use’ items that due to be removed from the Prostheses List (PL) in July 2023.

Royal Australasian College of Surgeons (RACS) co-signed a submission which was co-badged with Australian and New Zealand Society for Vascular Surgery (ANZSVS), General Surgeons Australia (GSA) and Urological Society of Australian and New Zealand (USANZ). The submission highlighted that the PL reforms should not result in reduced access and choice of items defined as general use.  

Like many other stakeholders, including Catholic Health Australia, clinicians and patient groups, RACS expressed concerns about the removal of ‘General Use’ items from the PL without a guaranteed funding model.

“When the funding of specific items is not mandatory, variability in private hospital size, market share and negotiating power may mean those items will not always be available. Decisions about whether clinicians have access to specific general use items may depend on whether hospitals and insurers have reached agreements on the funding of those items.

“Reforms should not result in a contravention of the principle that decisions about the use of particular devices are the domain of clinicians and their patients,” said RACS in the submission to IHACPA.

In elective surgery emergency situations, the availability of ‘General Use’ items such as surgical sealants, haemostatic devices and closure devices can be a matter of life and death. RACS is concerned that the lack of remuneration for such items may have the consequence of a reduced inclination by smaller private facilities to order and keep a critical stock of them. According to the submission, a lack of such items during elective surgery may result in prolonged attempts at salvage, increased blood loss, limb or organ loss, emergency interhospital transfers and potentially preventable patient deaths.

The ANZSVS and GSA also raised concerns about items scheduled for removal that are not correctly classified and a lack of recognition for the essential nature of some of the items in specialised surgery.

RACS called for a mechanism which guarantees access to all PL items which clinicians believe are best suited to their patients should be put in place.

To ensure the continued viability of all components of the private health system, RACS acknowledges that reforms should be undertaken to prevent misuse or overuse of ‘General Use’ items.

“An appropriate reform would be to increase clinicians’ focus on choosing wisely in relation to such items, and prosthetic devices more generally. In principle RACS would be willing to work with regulators to educate surgeons and other clinicians about best practice in the use of such items and even provide opinions about different general use items and other disposables and prosthetics,” RACS said in its submission.

RACS suggested independent monitoring for access and use of devices removed from the PL.

“Monitoring should be based on the views of clinicians. Should monitoring find that clinicians believe their clinical choices have been significantly impacted, then the changes should be revisited,” said RACS.

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