Atlas 2018 - General recommendations

Several overarching themes have emerged from the Atlas series: the need for regular public reporting, access to more complete and informative data, quality improvement strategies for the use of tests, and better information for consumers to allow informed decision‑making.

Atlas recommendations

In particular, the Atlas series highlights the importance of making best possible use of current data systems to explore and understand patterns of care. This will enable us to assess whether spending on care best matches need, and whether we are making the best use of our investment in health care. The recommendations below outline how these improvements could be achieved.

Public reporting, audit and feedback to clinicians, and improving data and accountability

  • 6a. The Australian Government Department of Health to consider ways in which regular public reports can be produced on appropriateness of, and variation in, healthcare use across Australia using MBS and PBS data. This work would complement current work on clinical quality registries and the Australian Health Performance Framework, but would specifically focus on ensuring that the MBS and PBS data:
  • i. Are collected and presented in a way that is clinically meaningful, to ensure that appropriate care is being provided and to prompt action if required
  • ii. Can be used to provide assurance that Australians are obtaining the expected value from investment in these programs.
  • 6b. The MBS Review Taskforce to advise on how the data collected by the MBS in key clinical priority areas could enable production of clinically meaningful public reports on appropriateness of, and variation in, healthcare use. Among the issues the MBS Review Taskforce should consider are:
  • i. Where possible, alignment of descriptors with evidence-based criteria
  • ii. Instances in which descriptors should specify reasons for provision of service
  • iii. Approaches to ensuring that coning and data suppression because of provider confidentiality do not prevent appropriate assessment of use of services at a local level.
  •  Episode coning in the MBS means that, when more than three tests are requested by a GP per patient attendance, benefits are paid only for the three tests with the highest fees. If a GP requests a test with three other more expensive tests, it is ‘coned out’ and may not be included in the MBS dataset.
  • 6c. The MBS to regularly review claims for reimbursement of MBS services to ensure that they meet the identified evidence-based criteria. Information on use and ordering of tests across Australia, including on intervals for repeat testing, should be documented, and fed back to referrers and providers.
  • 6d. The Australian Government Department of Health and the Australian Institute of Health and Welfare to ensure that reports on variation in care can include a better picture of patterns of care received by Aboriginal and Torres Strait Islander Australians.
  • 6e. State and territory health departments to agree on, and implement, consistent policies on coding of admissions so that reliable information is available nationally on procedures that can be undertaken as either a day patient or an outpatient. This would enable a more complete picture of care provided in Australia
  • 6f. The Commission to examine the potential to include indicators about the appropriateness of care, and equity of access and outcomes for people from rural and remote regions and for Aboriginal and Torres Strait Islander people in the indicators it recommends for the Australian Health Performance Framework
  • 6g. The Commission to use linked data in future work to investigate appropriateness and effectiveness of care – for example, to examine:
  • i. The relationship between investigations and clinically relevant outcomes (for example, colonoscopy use and the incidence of bowel cancer)
  • ii. The extent to which appropriate preventive care is being used (for example, for people with cardiac disease)
  • iii. Whether care aligns with guidelines and clinical care standards.

Improving use of testing for diagnosis and management

  • 6h. State and territory health departments, relevant colleges, specialist societies and Primary Health Networks to collaborate to develop evidence-based structured referral pathways for consultation and patient review that may lead to further investigations such as colonoscopy, cardiac testing and thyroid ultrasound. Such referral pathways could provide referrers with guidance on inclusion and exclusion criteria, services provided and their location, and any specific service requirements to support referral management. Standardising the format of referrals by providing templates or forms (where available) can be included in the referral pathway and may serve multiple purposes:
  • i. Educating referrers
  • ii. Providing a basis for suggesting more appropriate care or management
  • iii. Rejecting inappropriate referrals
  • iv. Populating care pathways within Primary Health Networks
  • v. Ensuring that reimbursement met MBS requirements.
  • 6i. The Australian Government Department of Health to work with state and territory health departments, clinical colleges, software providers and researchers to investigate ways in which decision support software used in health care can facilitate appropriate testing and testing intervals for commonly requested tests – for example, thyroid function testing in primary care.
  • 6j. The Australian Government Department of Health to investigate methods to improve access for clinicians and consumers to previous test results, to prevent any adverse effects on patients and waste associated with unnecessary repeat tests. In addition to My Health Record, other methods to ensure access to previous test results funded by Medicare should be investigated.

Providing information to enable patients to make more informed decisions

  • 6k. Clinicians to ensure that all patients are offered copies of their test results, and that discussions with patients about the diagnostic significance of these results and how they affect management are documented in clinical notes.
  • 6l. Clinical colleges to actively promote the practice of shared decision making and to prioritise training and continuing development programs in this area. This should include use of the Commission’s risk communication online module, with feedback to the Commission on ways in which the module could be improved in future revisions.