The Medicare Review Advisory Committee has recommended to the Government that patients of appropriately qualified registered nurses should be given equal access to the CMBS rebates relating to surgical assistance as doctors currently receive.
Summary of MSASA response
The proposal has not been subjected to an appropriate level of analysis that includes detailed investigations into patient safety impact implications. The report contains numerous sweeping statements and questionable assumptions, with little quantitative data to support them. The Subcommittee appears to have accepted the claims of the nursing groups lobbying for access to CMBS
rebates at face value and without question.
We disagree with the premise that nurse surgical assistants are able to provide the same qualitative service as medical surgical assistants. They do not have the same training, skills or responsibilities as doctors and to grant the proposal is a presumption that they do, which will potentially impact adversely on patients.
We acknowledge that some nurses will continue to perform first surgical assistant duties, as they have done for many years. However we do not agree that they require access to CMBS rebates to continue to do this work. The current system does delineate between medical surgical assistants and nurse surgical assistants and maintains appropriate professional expectations of both groups.
This Sub-committee has proffered a solution that will appease the nurse lobby groups, but which by its own admission, fails to address the primary justification for change – namely an alleged (but not quantified) shortage of MSAs in rural settings. These issues should be addressed outside of a major structural change to the CMBS that will have significant unintended consequences at many levels –
including the threat to junior doctor training and the likely exacerbation of a shortage of quality theatre nurses. It will also create an unquantified and unfunded additional drain on the CMBS.
Any expansion of access to the CMBS by non-medical persons will likely be keenly observed by the Allied Health Workforce. It will be seen as an opportunity to press for further access to the CMBS beyond the nurse practitioner workforce. Given that these pressures already exist in the system, this impact is likely to be immediate for a range of AHPRA-registered health professionals.
Finally, as per our previous submission, any move to deskill the surgical assistant, or increase their subservience, would encourage insurance companies to push for bundling of surgical fees for both surgeon and assistant, and likely anaesthetists as well. It would fit nicely with their US style “managed care” agenda, which is an ever-increasing threat to Australian private medicine and surgery. Hence, Australia’s balanced private- public hospital and healthcare model, which has produced world-class health and medical treatment for decades, risks being further pushed into corporate control, with funds driving the direction of private medical services in line with investor expectations.
