NEUROMODULATION SOCIETY SAYS OPIOID CRISIS SET TO SOAR UNDER PHI CHANGES

[vc_row][vc_column][vc_column_text]Neuromodulation Society of Australia and New Zealand (NSANZ) is concerned Australian patients will be forced to upgrade, or miss-out pain management treatments with devices, under the PHI policy changes.

 “We are calling for the Government to make good on their promise, and guarantee that all existing procedures for pain management, including devices, be made available in Bronze, Silver and Gold policies,” said Dr Richard Sullivan, Pain Medicine Specialist Physician and NSANZ President, Melbourne.

“Australian strong opioid-related deaths now exceed heroin deaths by two-and-a-half-times, and estimates suggest more than a quarter of chronic pain patients are misusing prescription strong opioids.

“These numbers will increase should patients be denied access to chronic pain procedures they currently have under their existing policies,” said Dr Sullivan.

Mum-of-four, Kelly, 46, Wollongong, has been living with chronic pain for almost three decades, pain that significantly worsened following complications during surgery for a herniated disc.

“Chronic pain doesn’t just affect you, it really affects your entire family as well. I have three kids, and have just adopted my niece, and I was living on opioid patches unable to move off the couch.

“My pain management device gave me a new lease on life. I’ve gone back to work, I can run around with the kids, I can even sit and stand by myself without kids having to pull me out of the chair.

“Without my device for chronic pain, I wouldn’t have been able to work and would have lost my house.

“If my insurance didn’t cover my chronic pain device, there’s no way I would have been able to afford it. I can’t imagine what the consequences would be if other people were denied access to life-changing treatment for their chronic pain,” said Kelly.

The Medical Technology Association of Australia (MTAA) has been supportive of the Government efforts to simplify and make transparent private health insurance policies but remains concerned of the unintended consequences.

“It’s disappointing that consumers that need access to life saving and life changing medical devices will in most cases need a gold level policy to do so,” Ian Burgess CEO of the MTAA said.[/vc_column_text][/vc_column][/vc_row]

AOA URGES RECONSIDERATION OF PHI REFORM

[vc_row][vc_column][vc_column_text]AOA President Dr David Martin said the reform process to date does not appear to be consumer focused, “Rather than focus on the consumer, the real nuts and bolts of the reform is on exclusions, where it seems to be more about what insurers are prepared to provide within certain actuarial constraints, rather than what patients with private health cover require.

“Many private patients without “Gold” insurance will only discover they were inadequately insured when they reached the stage where surgery was the required treatment. AOA members frequently report experience of patients disappointed to learn their health insurance doesn’t cover treatment by joint replacement of their disabling arthritis (when all non-operative measures exhausted). The current system seems to be going to perpetuate this confusing situation.

Bizarrely the new system covers podiatry services at lower tiers including surgery and joint replacement and prostheses insertion even though these health providers are neither specialist surgeons nor have a system of monitoring outcomes like the National Joint Replacement Registry. The NJRR has already saved about AUD$600 million over last ten years by encouraging wise prosthesis choice.

“Insurance is meant to protect people against unaffordable financial risk, but with the present model the opposite is occurring. Patients with non-Gold insurance will only be covered for cheaper medical problems and be excluded from resource intensive problems like spinal fusion and joint replacement. Joint replacement surgery is potentially a very cost-effective intervention with good improvement in quality of life sustained over decades. Patients who can’t afford to increase their cover to Gold or pay for the surgery themselves, will be forced into the public system. The result will be an enormous cost shift from the private health system to the state-run public system.”

“This makes the decision about choosing policies that rely on exclusions a major gamble,” Dr Martin said.

AOA is calling on the Government to revisit its modelling of the traffic-light classification system by putting the Australian consumer first, rather than the profit levels of Australian private health insurance companies.

“We are urging the Federal Government not to rush, or rubber stamp these reforms. It warns changes to how orthopaedic surgery is covered requires urgent and careful collaboration with the specialists who work in the field, otherwise a sub-optimal reform will occur.

“The AOA actively supports efforts to reduce policy variation and make health insurance easier for patients to understand; however, the proposed reforms will continue to leave patients open to nasty surprises about their coverage when medical treatment is required,” said Dr Martin.[/vc_column_text][/vc_column][/vc_row]

SIMPLER PRIVATE HEALTH INSURANCE POLICIES COULD LEAD TO LONGER PUBLIC WAITING LISTS

[vc_row][vc_column][vc_column_text]The Government will be hoping these changes will deliver another record low premium increase. Last year the medical technology industry delivered cuts to the price of medical technology which delivered the lowest premium increases in 17 years.

Due to delays in Parliamentary process the Minister has provided insurers with the option to transition to the new policies by April 2020 but it is anticipated the major providers will be ready on 1 April 2019.

The Minister for Health, Greg Hunt MP said upon announcing the changes that consumers, for the first time, will be provided clearer information to allow them to compare different health insurance policies and choose the cover that best suits their needs.

“These reforms will have an overall neutral to -0.3% impact on premiums compared with current policy settings,” Minister Hunt said.

These reforms, whilst welcome, do not address the fundamental issue around the overall value of private health insurance. CHF maintains its call for an independent inquiry into private health insurance.

“CHF has long argued for consumer-friendly reforms in health insurance to reduce the frustration and uncertainty so many people experience. We believe the development of these four tiers of cover offers a path to more certain and transparent arrangements,” CEO of the Consumers Health Forum, Leanne Wells said.

But plenty of stakeholders have expressed concerns consumers will have to pay more for an effective product that covers them for the things they need.

President of the Australian Society of Ophthalmologists Dr Peter Sumich says under the reforms it will be “cheaper to pay for your private cataract surgery from your own pocket and save the money you would spend on a poor insurance product”.

Chronic pain treatments will only have to be included in the most expensive Gold level cover.

“We don’t want a situation where many are forced to drop their PHI cover altogether, further exacerbating access issues across the public health system,” Carol Bennett, CEO of Pain Australia said.

The Medical Technology Association of Australia (MTAA) has been supportive of the Government efforts to simplify and make transparent private health insurance policies but remains concerned of the unintended consequences.

“It’s disappointing that consumers that need access to life saving and life changing medical devices will in most cases need a gold level policy to do so,” Ian Burgess CEO of the MTAA said.

“There is only one definite winner today – big private health insurers. The Deloitte modelling that informed this outcome assumes that private health insurance industry would maintain profit levels of 11.5%.

“We endorse AMA’s comments the Deloitte Report should be released, analysed and debated. We have simply been seeking a 12-month delay to these changes, accompanied by a 12-month information campaign, to ensure consumers can make an informed choice,” Mr Burgess said.

Stephen Duckett, a health economist at the Grattan Institute, warned that the new rules will leave thousands of consumers facing significant premium increases.

Even private health insurers now admit that some consumers will be worse off.

“There will be winners and losers but the Government’s PHI Reform process must deliver real change to improve the affordability and value of private health cover. There’s no alternative,” Dr Rachel David, CEO of Private Healthcare Australia said.[/vc_column_text][/vc_column][/vc_row]

Fully Funded MRI Licences

[vc_row][vc_column][vc_column_text]The Government and the Opposition in recent times have been making a series of announcements regarding where new MRI licences would be made available.

The Opposition got the ball rolling when in May it announced that in government it would provide for 20 new licences, 10 for public hospitals and 10 for private hospitals.

Last weekend, the Government upped the ante by announcing they would fund an additional 30 MRI licences with Minister for Health, Greg Hunt, naming the first ten localities to receive them from November this year.  This also follows on from the review Minister Hunt ordered into how MRI licences are allocated.

Up until recently, there had been a total of 5 new MRI licences since 2013, and 2 of them were announced during the election campaign.

The flurry of activity by both the Opposition and the Government can be traced back to the Senate inquiry into diagnostic imaging that reported in February of this year.

By putting the issue of MRI licences in the political and public spotlight, it was only a matter of time before both major parties started making the commitments they have.

It is also testament to the power and influence that a Senate inquiry can have in that in 5 years only 5 new licences were made available, but in the space of 5 months since the inquiry, access to 50 new licences have been announced.

The other telling point is that health remains and will be a front and centre political issue between now and the federal election.

Both sides are competing for votes and know health can be a deciding factor in how many people decide to vote.  Access to MRIs has shown itself to be the latest battleground in the ongoing health debate.

While Labor and the Government seek to outdo each other on announcing new MRI licences, the big winner is patients.

Magnetic Resonance Imaging is amazing medical device technology, and the more people that can have access to it when needed, can only be good for the community as a whole.[/vc_column_text][vc_zigzag][/vc_column][/vc_row][vc_row][vc_column width=”1/4″][vc_single_image image=”1915″][/vc_column][vc_column width=”3/4″][vc_column_text]

ABOUT THE AUTHOR

Jody Fassina is the Managing Director of Insight Strategy and has been an strategic adviser to MedTech and pharmaceutical stakeholders.[/vc_column_text][/vc_column][/vc_row]

CHRONIC PAIN CONCERNS OVER PHI REFORMS

[vc_row][vc_column][vc_column_text]On September 11 the Private Health Insurance Legislation Amendment Bill 2018 (the Bill) and two related Bills passed the Parliament.

The legislation implements a package of reforms around private health insurance, they include:

  • allowing for age-based premium discounts for hospital cover
  • allowing private health insurers to cover travel and accommodation costs for regional Australians as part of a hospital treatment
  • strengthening the powers of the Private Health Insurance Ombudsman
  • improving information provision for consumers
  • reforming the administration of second tier default benefits arrangements for hospitals
  • allowing insurers to terminate products and transfer affected policy-holders to new products
  • increasing maximum voluntary excess levels for products providing individuals an exemption from the Medicare levy surcharge and
  • removing the use of benefit limitation periods in private health insurance policies.

The Minister for Health, Greg Hunt MP, announced these reforms will make private health insurance simpler and more affordable.

“This new approach will take all existing private health insurance policies and categorise them into a four-tier system – Gold, Silver, Bronze and Basic,” Mr Hunt said.\

Following the passage of the legislation, pain groups have cautioned about potential unintended consequences of placing chronic pain in the highest category of cover.

Changes to the clinical category intended as part of the reforms could disproportionally impact patients with chronic pain and may have far reaching implications for millions of privately insured consumers who rely on existing coverage to access chronic pain management.

Advocacy group Painaustralia has urged the Commonwealth to reflect concerns its members have raised in the rules currently being drafted to give effect to the reforms in the legislation.

Painaustralia’s CEO, Carol Bennett said she welcomed the broad intention of the reforms to simplify private health insurance but cautioned against reforms that could create a situation that forced vulnerable people to drop their health insurance altogether.

“It’s important that [the legislated reforms] don’t negatively impact on people living with chronic pain who are some of the most vulnerable in our community and often unable to work,” Ms Bennett said.

These concerns were also noted by Senator Helen Polley and Senator Richard Di Natale during the second reading of the Bill, with both nothing the changes to clinical categories could adversely impact millions of consumers.

“These rules are not detailed in these bills. Those details are apparently going to come later in the form of regulation. The government claims its new gold, silver and bronze basic system will make private health insurance simpler and more affordable. It also claims that the changes will give consumers more clarity and certainty around their coverage,” Senator Polley said.

Chronic pain is the most common reason that people seek medical heal and one in five Australians live with chronic pain. Pain is also common to many chronic conditions and its impact spans the health, disability and ageing systems.[/vc_column_text][/vc_column][/vc_row]

MY HEALTH RECORD SYSTEM GETS ADDED PRIVACY PROTECTIONS

[vc_row][vc_column][vc_column_text]. The Bill will specifically:

  • remove the ability of the My Health Record System Operator to disclose health information in My Health Records to law enforcement agencies and government agencies without an order by a judicial officer or the healthcare recipient’s consent; and
  • require the System Operator to permanently delete health information stored in the National Repositories Service for a person if they have cancelled their registration with the My Health Record system – that is, they have cancelled their My Health Record.

These amendments are the result of concerns expressed by some healthcare and privacy advocates that the MHR Act permitted the release of information to law enforcement agencies and other government bodies.

On 31 July 2018 the Minister for Health announced his intention to strengthen the MHR Act to make clear that information will not be released without a court order, and that My Health Record information would be permanently deleted if someone cancels their My Health Record.

Former AMA President Prof. Kerryn Phelps reinforced the view that it would be worth a rethink in terms of the technology given how much it has changed.

“We need to think about how far technology has come and how much we’ve learnt about cybersecurity in the meantime. Then I think that we could possibly look at what data would necessarily need to be uploaded so that it could be used in a de-identified way for public health benefit. What I’m seeing in here is much less about the personal benefits of the My Health Record and a lot more about privatisation, monetisation and public health benefits. I think we would all want to see public health benefits—things like containment of epidemics and tracking flu epidemics—but I don’t think any of us wants to see the potential costs in terms of privacy,” Prof Phelps said.

Dr Linc Thurecht, Senior Research Director at the Australian Healthcare and Hospital Association while welcoming the proposed changes also identified the wider healthcare benefits of My Health Record.

“We see it as a vital part of the future health infrastructure to provide better coordinated care for individual patients and to improve safety and quality in their care. For that to happen—I’m not sure if ‘critical mass’ is quite the right phrase—the more people who are part of that, the greater the opportunity there is to reap those kinds of benefits,” Dr Thurecht said.

Ian Burgess, CEO of MTAA believes the development of My Health Record will provide a tremendous opportunity to improve data collection across the whole health system and across the patient journey.

“We believe the government should prioritise consideration of the inclusion of medical device data in the My Health Record,”

“This would allow for improved post-market surveillance. While registries can be invaluable they’re complex and expensive. Ultimately, My Health Record should be the main data infrastructure system, rather than maintaining separate data collection systems,” Mr Burgess said.

The ADHA said in a statement that it welcomes the discussion and will be contributing to the inquiry.

“The Australian Digital Health Agency has been engaged in an important national conversation around My Health Record – its benefits, privacy controls and security protections. As the system operator responsible for the expansion of this system, the ADHA welcomes this discussion,” the statement said.[/vc_column_text][/vc_column][/vc_row]

CHIEF SCIENTIST’S TERM EXTENDED

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The Australian Government has extended Dr Alan Finkel’s term as Australia’s Chief Scientist for a further two years to the end of 2020. Minister for Industry, Science and Technology, Karen Andrews announced the extension and congratulated Dr Finkel.

“I am delighted to announce Dr Finkel’s extension and look forward to working closely with him. Dr Finkel is a tireless advocate and highly respected champion for science, innovation and technology in Australian public life, with an extensive background and expertise as an entrepreneur, engineer, neuroscientist, educator and communicator,” Minister Andrews said.

“He has played a critical role and helped lead a number of major reviews into key policy areas.”

Dr Finkel commenced as Australia’s eighth Chief Scientist in January 2016. His close work with the Government was key to shaping the recent Budget decision to invest $1.9 billion in critical Australian research infrastructure capability, particularly his leadership on the 2016 National Research Infrastructure Roadmap.

Minister Andrews said Dr Finkel’s leadership had been invaluable in progressing key policy work, including through the Independent Review into the Future Security of the National Energy Market, a review into optimising STEM industry-school partnerships, and Innovation and Science Australia’s 2030 Strategic Plan.

“The Morrison Government is looking forward to working with Dr Finkel as he continues to provide robust and respected advice to Government across a range of issues and emerging trends in science and technology, including artificial intelligence, innovation metrics and precision medicine.

“As a Male Champion of Change for STEM, Dr Finkel also plays an important role in the Government’s agenda to increase the participation of women and girls in STEM education and careers,” she said.

Dr Finkel welcomed the opportunity to continue providing independent advice to Government and advancing priority missions.

“When I took up my post in 2016, I said that I had every confidence in the ambition and ability of Australians,” Dr Finkel said.

“I am delighted to recommit to my promise to back our potential today, and to build new potential through STEM education for tomorrow and into the future–including a science workforce that harnesses the capabilities of all Australians. We are committed to developing our research and innovation capacity, as a blue-chip investment with intergenerational returns.

“I look forward to working with Minister Andrews, her Parliamentary colleagues, and the many Australians who have inspired me with their visions of what this nation could be.”

Prior to becoming Chief Scientist, Dr Finkel was the Chancellor of Monash University and the President of the Australian Academy of Technology and Engineering.

For more information, including Dr Finkel’s biography and information about the role of the Chief Scientist, visit www.chiefscientist.gov.au

[/vc_column_text][/vc_column][/vc_row]

CHANGE IN CANBERRA

[vc_row][vc_column][vc_column_text]None more so than in health with the resignation of Greg Hunt as Minister and the outstanding issue of reform to PHI via the Private Health Legislation Amendment Bill.

This Bill will set in place the framework to allow for PHI policies to be categorised as gold, silver, bronze or basic.

The Bill may have a significant impact on the medical device industry as it is may reduce patient reimbursement for medical devices or require consumers to upgrade to more expensive policies, depending upon what policy they hold under the new categorisation.  It has and remains a major issue for the medical device industry.

As of this week it had not been passed by the Senate and now the live issue is that it may not pass into law with the prospect of an early election a very, very real possibility.

If an election is called within the next two weeks, then the Bill will die.  It will either have to be revived by a re-elected Liberal Government under a new Health Minister or a new Labor Government with Catherine King as Health Minister will have to pick up the whole issue of PHI reform from scratch.

As Labor has stated their policy in regard to PHI is to cap PHI increases at 2% for two years while the Productivity Commission conducts a root and branch review of the PHI industry.

Election Timing

Up until this week, the smart money was on a May 2019 election, but the chances of a September or October election are now real.

An early election is problematic for Scott Morrison both in terms of logistics and timing.

In terms of timing, there has to be the passage of a minimum of 33 days from the calling of the Federal election and election day itself.

If an election was called this Monday for instance, then the earliest the election could be held is 29th September and that is AFL Grand Final day.

So Federally, the only realistic dates for an early Federal election are 6 Oct, 13 Oct, 20 Oct and maybe 27 October.

In order to avoid an overlap with the Victorian election which will be held on 24th November the latest an election could be called for say 27th October would be on or around 24th September.

So, there is a three-week window from now until approximately the 24th September for Scott Morrison to call an early Federal election.

The new Prime Minister faces a horror scenario for an October election.  It would see him campaigning during the footy finals season, which will no doubt just annoy a lot of people.

It would also see Victorians going to a Federal and State poll within a couple of months of each other, hardly likely to make the new PM popular.

Remember too, back in 2016 Malcolm Turnbull personally contributed $1.5m to the Liberal Party to help fund the Liberals campaign – well that won’t be happening again.

All in all, the new PM faces the worst of all worlds in regard to an October election.  But he may have no choice but to go to the polls, so the people can sort out the mess that the Government has created.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_zigzag][/vc_column][/vc_row][vc_row][vc_column width=”1/4″][vc_single_image image=”1915″ img_size=”full”][/vc_column][vc_column width=”3/4″][vc_column_text]

ABOUT THE AUTHOR

Jody Fassina is the Managing Director of Insight Strategy and has been an strategic adviser to MedTech and pharmaceutical stakeholders.[/vc_column_text][/vc_column][/vc_row]

PULSELINE FACT CHECKS THE ABC CLAIMS

[vc_row][vc_column][vc_column_text]It’s incorrect to say the regulatory environment in Australia has not changed. In 2014 an extensive review of Medicines and Medical Devices Regulation was undertaken by a panel of three eminent experts that included Emeritus Professor Lloyd Sansom AO.

That Panel made 58 recommendations, with the Government supporting 56 of them. Since then a series of legislative reforms has been put in place to regulate medical devices.

The TGA is regarded as one of the most thorough of any agency around the world and has undertaken extensive reforms of medical devices. Its rigorous premarket requirements for medical devices are aligned to international best practice.

ABC has now carried several biased and misleading articles questioning the value of the medical technology industry to the Australian healthcare system.

Global advances in medical technology over the past 20 years have resulted in a 56% reduction in hospital stays, 25% decline in disability rates, 16% decline in annual mortality and increased life expectancy of approximately 3.2 years.

The story failed to recognise doctors and other healthcare professionals are the primary users of medical technology and the industry provides physicians the tools they need to improve patient care. To ensure better outcomes for patients, surgeons need training and familiarity with medical devices.

The rapid innovation which is the hallmark of the medical technology industry – and which serves to benefit patients – would not be possible without the close collaboration between physicians and companies.

Indeed, some of the most significant medical technology breakthroughs in the last 50 years have originated with physicians who saw an unmet patient need or way to improve an existing procedure and brought their idea to a manufacturer to refine and produce for a wide patient audience.

Unlike pharmaceuticals, medical devices are implanted by surgeons and need to last for years, the more familiar a doctor is with a device, the better the outcome for the patient. That’s why medical technology companies provide extensive education and training (or retraining) of surgeons.

It’s also why technicians often support surgeons in the procession of instruments used ensuring they are all in place, and with their order of use. Technicians are highly trained specialists with intimate knowledge of the medical device being implanted and the tools used during that surgery.

PulseLine will continue to take a close look at the reporting of other media outlets and will call out errors, misrepresentation and bias. [/vc_column_text][/vc_column][/vc_row]

KING TAKES RECORD TO SENATE

[vc_row][vc_column][vc_column_text]Last week the Government announced it will amend the 2012 legislation, introduced by the then Labor Government, to ensure that if users wish to cancel their record they will be able to do so permanently, with their record deleted from the system forever.

These amendments come following concerns raised by several stakeholders since the announcement of the opt-out period, including the Australian Medical Association and the Royal College of General Practitioners who both requested the Government extend the opt-out period to give Australians more time to consider their options.

Uncertainty around the security and privacy of Australians’ having their health data being stored on a central government system had dogged the Government, as more than 20,000 Australians opted-out of the system in the first day.

The Government has attempted to reassure the public their data would be secure using the My Health Record, citing the success of the 6 year pilot program, which the Government says remained secure. The Health Minister also confirmed that the amendments to the legislation will ensure no records can be released to police or Government agencies, for any purpose, without a court order.

The Government has said its amendments will help strengthen the legislation to match the existing Australian Digital Health Agency policy. However, the Opposition remains unconvinced.

Shadow Health Minister, Catherine King MP, says the Opposition remains deeply concerned about the way the Government has handled the My Health Record opt-out period, claiming it has severely undermined the public trust in the reform.

Ms King believes that while the Government has agreed to a number of changes demanded by the Opposition and doctors’ groups, including an extension of the opt-out period and a new public information campaign, more needs to be done.

The Opposition will seek crossbench support to refer the rollout to the Senate Finance and Public Administration References Committee, which could also inquire into the census failure and the sale of Medicare numbers on the darkweb.

Ms King said the inquiry will examine the Government’s decision to shift from an opt-in system to an out-out system and whether it adequately prepared for this fundamental change from Labor’s system.

“[The inquiry] will examine a range of privacy and security concerns, including the adequacy of the system’s log-in procedures and default settings. It will also consider issues raised in the public domain around domestic violence and workers’ compensation,” Ms King said.

“Labor remains of the view the Government should suspend the My Health Record rollout until this mess can be cleaned up.”

It is expected that the committee will be asked to report back on its findings before the end of the opt-out period in mid-November.[/vc_column_text][/vc_column][/vc_row]