Medicare changes to sleep studies

Medicare has recently changed access to sleep studies.

First, a bit of background. As almost all Australian adults would know, when you go to see the doctor in this country most of the costs are paid for by the federal government through Medicare. The exception is when services are provided in a public hospital. (Then the state government pays).

Medicare spends a lot of time calculating just what the right amount is to pay a doctor for any service ‘item’ which they provide you. The relevant service is given an ‘item number’ and the doctor makes a claim to Medicare, after every interaction with a patient, for payment related to the relevant ‘item number’.

Since sleep studies were invented there has been only one item number for a sleep study performed in a sleep centre. For the last decade there has been another item number for a sleep study performed at home. With each of these item numbers it was pretty-much the case that if your sleep specialist felt that you needed a sleep study then she or he could request one.

All of that changed on November 1st. Sleep medicine specialists and GPs are still coming to terms with what the changes mean. These changes have been made predominantly to ensure that only patients who really need a test end up getting one. (Medicare is pretty certain that previously some sleep studies were being done on people who didn’t really need the test, which is part of the reason for the change).

So, we now have no less than seven different item numbers for adult sleep studies. Some of these studies can be performed on direct referral from a GP if an individual is judged to be ‘high risk’ based on some screening questionnaires. Most of these item numbers stipulate that a patient needs to see a sleep physician or respiratory physician before the test can be ordered. And when that patient does see a sleep physician, at some point the physician is very likely to have to refer to a reference list to try to figure out exactly which item number applies to the investigation that he or she may wish to perform.

Please be patient with us!

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