Health issues

Over-50s will soon be denied Medicare rebates for knee MRI scans

Oct 17, 2018

From next month, anyone over the age of 50 will be denied Medicare rebates for GP-ordered knee MRIs, sparking anger amongst older Aussies. Source: Getty

Australians over the age of 50 will be denied Medicare rebates for GP-ordered knee MRIs from November 1.

According to an exclusive report published in the Daily Telegraph, older Australians will be forced to wait months to see a specialist or pay up to $500 for a scan. The new system is set to impact 80,000 Australians when it comes into effect in just two weeks’ time.

The Department of Health first announced changes to Medicare-funded knee imaging services in May, explaining that changes were being made to ensure services are aligned with best practice. The changes came after recommendations from the Medicare Benefits Schedule Review Taskforce.

A spokeswoman for the Federal Department of Health confirmed to Starts at 60 that the new rules would impact GPs, but not specialists.

“From 1 November 2018, GPs will no longer be able to directly request knee MRIs for patients aged 50 years and over,” the spokesperson said. “These MRI services can continue to be requested for all patients by specialists.”

The Department of Health added that since the introduction of GP-requested MRIs, there has been a dramatic increase in the number of MRIs performed annually. It claimed there was strong evidence to suggest that older people with chronic knee pain and osteoarthritis are being referred for MRIs by GPs, although it’s often not the appropriate test. In fact, it said no test is required to commence treatment. The change was recommended by the independent, clinician-led Medicare Benefits Schedule Review Taskforce following an extensive period of consultation and was originally announced by the Government in the 2018-19 Budget in May 2018.

“The Taskforce noted that since the introduction of GP-requested knee MRIs under Medicare in November 2013, there had been a large increase in the number of knee MRIs performed each year, and there was strong evidence that older people with chronic knee pain and osteoarthritis were being referred for MRIs by GPs, when this is not the appropriate test – usually no test is required to commence treatment for these conditions eg with medicines,” the spokesperson explained. “This means that many older patients may be delayed in starting treatment for their chronic condition, awaiting an unnecessary test.”

If a GP suspects an acute injury, such as a meniscal tear, as part of their clinical examination of a patient aged 50 years or over, they can refer the patient to a specialist, who can determine treatment options and whether a MRI scan is required.

“The Taskforce recommended the change to reduce unnecessary MRIs and help ensure patients are receiving the right test, at the right place, at the right time,” the spokesperson said.

The recommendations made to the government were about how the MBS can be changed to improve patient safety, reduce waste and support equity of access. In regards to knee MRIs, the changes are being implemented to ensure MBS-funded knee imaging services are being provided appropriately.

The Department said patients will benefit because they will be receiving recognised best practice knee imaging services and they won’t undergo unnecessary knee MRIs or be exposed to radiation.

Under the new rules, GPs will only be able to request three knee MRIs per patient per year for those aged between 16 and 49 and won’t be able to refer over-50s.

Starts at 60 readers shared their views about the new rules. One reader wrote: “A sin to be over 50 now? Disgusting.”

Another person asked: “Is that not discrimination?” While a third added: “What? This is the age people start having problems.”

A petition has also been set up by the Australian Diagnostic Imaging Association, asking Health Minister Greg Hunt to reconsider the change. It has received more than 9,400 signatures at the time of publication and asks why over-50s are being offered second-class healthcare.

Join thousands of other Australians who have already signed the petition, to tell the Federal Government that knee #MRIs should be affordable and accessible for everyone regardless of age. Sign the petition at: https://t.co/HBUB3yXFrn #auspol #RadiologySavesLives pic.twitter.com/RiCXZD8FSL

— Australian Diagnostic Imaging Association (@AustDIAssoc) October 15, 2018

“Thanks to the government, if you hurt yourself exercising, have a fall, or any other knee trauma you will now have two options,” they wrote. “Wait to see a specialist to get an MRI referral – which will cost money, time and pain, [or] pay the full cost of the MRI yourself, which will be hundreds of dollars – without any Medicare rebate.”