Funding cut leading to ‘totally preventable’ strokes, heart attacks, GPs say

GPs say vulnerable people are being priced out of important heart health checks to detect potentially fatal cardiac problems, as a result of losing their ability to bill Medicare for the tests four years ago.

There were 2.2 million fewer than expected electrocardiograms completed between 2020 and 2022, after the federal government revised Medicare billing rules to restrict item numbers for interpreting the test to specialists.

Dr Ken McCroary, from Macarthur General Practice in Campbelltown, demonstrates an ECG. McCroary is reading the tests for free because of changes to billing rules.Credit: James Brickwood

A departmental advisory committee is reviewing the impact of the decision. The Royal Australian College of General Practitioners and the Australian Medical Association have made submissions to the review, calling for it to be reversed.

Coronary heart disease is the leading cause of death in Australia.

“We’ll never know how many patients with heart issues have missed out, whose health has got worse, and the lives lost that we could have saved in the four years since this funding was cut,” said college president Dr Nicole Higgins.

A draft report, published by the Medicare Benefits Schedule review advisory committee in April, concluded it was difficult to say whether the changes to rebates led to the decline in tests performed, as there were significant disruptions to health services in the two-year period for which data has been finalised, caused by the COVID-19 pandemic.

Regardless, the working group considered that the difference in fees between GPs and specialists may be viewed as inequitable, concluding the schedule should provide a rebate to whoever determined an ECG trace was required.

It found it was “possible” that the schedule item changes had disincentivised GPs from performing appropriate ECGs, particularly in rural and remote areas.

“The working group considered that the reduction in services performed in rural and remote areas may mean patients are travelling elsewhere to have their ECGs, or that there are less opportunistic ECGs being performed,” according to the April report. However, it was unable to say this for certain, due to the aforementioned data issues.

Dr Ken McCroary, a GP in Campbelltown, said it was clear to him that the change meant fewer people were being tested.

He said he completed additional ECGs during the pandemic, due to concerns about pericarditis and certain COVID-19 vaccines, and the overall decline was the result of an overwhelming number of people who may have previously had an ECG at a GP not being able to afford to see a specialist.

“I am doing ECGs for free, as I have for the last four years, because otherwise my patients will not get care,” he said.

“If I send them to the specialist in the same building, they will get turned away because they don’t have $500 for an appointment.”

McCroary said vulnerable people, particularly those in aged care, were having “100 per cent preventable strokes” because GPs could not afford to perform the tests.

The advisory committee will provide its final recommendations to federal Health Minister Mark Butler when it completes its review, which is expected late this year.

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