Summary of the second meeting of the Private Health Ministerial Advisory Committee – Clinical Definitions Working Group, 19 April 2017

This page contains the meeting summary for the second meeting of the Private Health Ministerial Advisory Committee – Clinical Definitions Working Group, 19 April 2017

Page last updated: 09 May 2017

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Attendees

Members
Dr Andrew Singer, Chair Dr Melinda Williams, Peoplecare
Kate Munnings, Ramsay Health Care James Harrison, St.LukesHealth
Dr Brian Hanning, Australian Health Service Alliance Dean Breckenridge, Doctors’ Health Fund
Dr Roderick McRae, Australian Medical Association James Downie, Independent Hospital Pricing Authority
David McGregor, Private Health Insurance Ombudsman Katharine Barrett, nib
Dr Maurizio Damiani, Australian Orthopaedic Association Dr David Rankin, Medibank
A/Prof Alex Hunyor, Australian Society of Ophthalmologists Dr Andrew Cottrill, HCF
Will Hanham, Department of Veterans’ Affairs Prof Stephen Duffy, The Cardiac Society of Australia and New Zealand
Jo Root, Consumers Health Forum Dr Gary Speck AM, Council of Procedural Specialists
Other Attendees
Mr Philip Truskett AM, Member, Private Health Ministerial Advisory Committee  
Secretariat
Charles Maskell-Knight Susan Azmi
Josh Shanahan Carla Roots

Apologies

A/Prof Ian Norton, Gastroenterological Society of Australia; Dr David Love, Royal Australasian College of Surgeons; A/Prof Amanda Walker, Australian Commission on Safety and Quality in Health Care; and Elizabeth Foley, Australian Nursing and Midwifery Federation.

1. Welcome and apologies

  • The Chair opened the meeting and noted the apologies above.
  • The Chair welcomed Mr Philip Truskett AM, member of the Private Health Ministerial Advisory Committee.

2. Conflict of interest

  • Members did not declare any new conflicts of interest.

3. List of clinical definitions and descriptions

  • At the last Working Group meeting on 22 March 2017, members discussed the clinical definitions currently listed in the Standard Information Statement (SIS) and started developing a new list of standard clinical definitions.
  • Members continued this discussion and worked to develop a consumer-friendly clinical definition for each category. For example, ‘gastric banding and related services’ is a clinical definition currently listed in the SIS. Members agreed that ‘weight loss surgery’ is a better clinical definition that consumers would understand more easily.
  • At the previous Working Group meeting, members agreed that each clinical definition should have a brief description to assist the consumer to make an informed choice when comparing and purchasing health insurance policies.
  • Members worked through each clinical definition to develop descriptions.
  • The Working Group agreed that where appropriate, examples of the most common procedures will be given in each description to assist consumers in understanding what each clinical definition includes.
  • The Secretariat will populate the new list of clinical definitions and descriptions as per discussions at the meeting and distribute to Working Group members for final agreement.

4. List of procedures

  • The Chair gave an overview of options proposed to populate a list of procedures for each clinical definition including:
    • Medicare Benefits Schedule (MBS) item numbers;
    • Australian Classification of Health Interventions (ACHI);
    • Medical Diagnosis Categories (MDCs);
    • Adjacent Diagnosis Related Groups (ADRGs); and
    • Develop a new list.
  • The Working Group agreed that a combination of existing lists would be most appropriate to ensure all medical, surgical and subacute services are covered. For example, the list could include: MBS item number for admissions based on a procedure; MDCs/DRGs for admissions not based on a procedure; and care types for subacute services.

5. Discussion of issues

  • The Working Group continued a discussion on whether the list of standard clinical definitions should be regulated by government or private health sector-led.
  • The Working Group discussed the need for consumer testing and agreed that this is an important step in the reform process.
  • The Working Group also discussed the challenges in developing the new list which covers all services and could be used to identify both inclusions and exclusions. The current SIS, developed in 2007, only identifies the main categories of excluded services.

6. Next steps

  • The Chair will present the Working Group’s deliberations to the Private Health Ministerial Advisory Committee at its meeting on 14 June 2017.
  • The Chair noted that this was the final scheduled meeting for the Working Group and thanked members for their contribution.


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