Photo: University of Melbourne Indigenous Eye Health Group
By Helen Carter
The Australian Government will invest $4.8 million in retinal cameras, slitlamps and training primary care workers how to use retinal cameras.
The move supports new Medicare Benefits Schedule (MBS) items announced in the Federal Budget last night, claimable for services provided by GPs for screening patients with diabetes with a non-mydriatic retinal camera.
Optometry Australia national policy manager Skye Cappuccio said the focus of the investment in equipment and training was on supporting better access and increased rates of assessment for diabetic eye disease among Aboriginal and Torres Strait Islander patients.
‘The Department of Health informed Optometry Australia of the equipment and training measure which will be rolled out over three years from 1 July 2016,’ she said.
‘Initially an audit will be undertaken to identify where equipment would be of most benefit.
‘The department has said that Aboriginal Medical Services and GP practices will be eligible for equipment but was unable to confirm if optometry practices would be eligible in areas where this may be most appropriate to supporting access for Aboriginal and Torres Strait Islander people.
‘We believe this may support improved uptake of the new items if appropriately targeted and are particularly pleased with the emphasis on training given the importance of ensuring quality image capture.
‘We believe the emphasis on screening of patients with diabetes is of most benefit if patients can access required follow-up care from an eye-care professional, so ensuring a robust outreach scheme that provides ready access to optometrists is vital for Indigenous communities.
‘Ensuring optometrists have access to needed optometric equipment in outreach settings is important. In this sense we are most welcoming of the inclusion of slitlamps in this scheme.’
Ms Cappuccio said Optometry Australia was already in discussions with the Health Department about its position and the department had invited optometry input to the audit.
New MBS items
The two new MBS items, expected to be one that can be claimed annually by Indigenous patients and the other that can be claimed every second year by non-Indigenous patients, should drive previously unseen patients with diabetes to optometrists.
Federal Health Minister Sussan Ley said in a media release: ‘Some 370,000 Australians at risk of diabetes-related eye diseases will benefit from a $33.8 million investment to list new Medicare items subsidising sight-saving tests every two years.’
The government expects that about one-quarter of these will be Aboriginal and Torres Strait Islander people, many of whom are living in rural and remote locations.
Ms Ley said: ‘Aboriginal and Torres Strait Islander people will be eligible annually as part of the Turnbull Government’s commitment to closing the gap on health outcomes.’
The new items are targeted at reaching patients who would not regularly attend an optometrist or ophthalmologist for a comprehensive eye examination, often due to remoteness or socio-economic barriers.
It will enable GPs to promptly provide this service at the point of consultation rather than referring at-risk patients to another health practitioner for initial assessment.
The government will provide $33.8 million from 2016-2017 to 2019-2020, commencing 1 November 2016 to list the new MBS items.
Optometry Australia national CEO Genevieve Quilty said it was a real opportunity for optometrists to work more closely with GPs to help fight avoidable blindness.
‘This may provide opportunities to ensure more people with diabetes access the care they need for diabetes-related eye disease from an optometrist,’ she said.
‘Details released are limited; however, previous information suggests these items will be claimable by patients only for GP services, for retinal images taken by a health worker and assessed by someone skilled to do so, and of patients diagnosed with diabetes but not established retinopathy,’ she said.
‘The items may potentially support better access to needed optometric care if used in conjunction with appropriate referral to optometry and if access to needed optometric care is well co-ordinated and supported. Otherwise there are potential risks of false assurances without improvement in care outcomes.’
Ms Quilty said that the Department of Health had indicated that no changes to patient access to optometry MBS items were associated with this.
‘We were disappointed that the recommendation from the Medical Services Advisory Committee, which assesses all applications for new MBS items, for optometrists to also be able to bill this item was not supported by the government.
‘We have already begun preparing a position statement detailing how we believe the item can be used to support better eye-care access without compromising care.’
Optometrist and senior research fellow in Indigenous Eye Health at the University of Melbourne, Mitchell Anjou, who has lobbied for the MBS items with ophthalmologist Professor Hugh Taylor, said they were delighted with the MBS listings.
Mr Anjou told Australian Optometry: ‘This will particularly help Aboriginal and Torres Strait Islander people who are at risk of vision loss through diabetic retinopathy.
‘We think it is a real game changer for all people with diabetes both in mainstream and for Indigenous people. Up to 98 per cent of blindness from diabetic retinopathy can be prevented with early detection and timely treatment, and these new Medicare items will support development of models of care that will increase retinal screening rates for all people with diabetes,’ Mr Anjou said.
‘At present the estimates are that only 20 per cent of Aboriginal and Torres Strait Islander people receive the NHMRC recommended annual retinal review and the mainstream comparative figure is 76 per cent of people with diabetes receive a biennial retinal examination.
‘Optometry is very well positioned to help GPs providing these services through support, training and establishing appropriate referral pathways.’
Professor Taylor, the Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne, has been lobbying for the items for more than 20 years.
He told Equipment in 2015: ‘It will make a huge difference in the bush and cities too. It’s just as important for mainstream Australia. It is building [diabetic eye checks] into primary care. People will be able to have their photo taken at their GP practice, community health centre or diabetes clinic. It’s triage work for optometrists and ophthalmologists. They will see all the people who need to be seen and not those who don’t.’