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By Geir O'Rourke

14 Dec 2022

More than four dozen Medicare items for colorectal surgery are set to be amended or deleted from the MBS under changes stemming from the MBS Review Taskforce.

The reforms mean anal or perineal graciloplasty will no longer be funded by Medicare from July, with the Department of Health planning to remove all items covering the procedure on patient safety grounds.

Graciloplasty involves the transposition of the gracilis muscle into the anus for the treatment of intractable faecal incontinence but has fallen out of favour since the introduction of sacral neuromodulation.

“The procedure carries considerable risk of complications including pain, infection of the surgical site or issues with the electronic device,” the MBS Review Taskforce’s colorectal surgery committee wrote in its final report, published last year.

“Therefore, the service should not be funded under the MBS and should be deleted due to concerns about patient safety.”

The MBS item for insertion of an artificial bowel sphincter as a second line treatment for severe faecal incontinence would also be deleted as the procedure was “no longer considered best practice”, the department said.

This was due to the high rates of complications associated with artificial bowel sphincters, per the MBS Review Taskforce report.

Other changes include an increase in rebates for construction of a colonic reservoir and a broadening of the descriptor for rectosigmoidectomy and bowel restoration items by removing their description as “Hartmann’s procedures”.

The new wording reflected the fact that the procedure was rarely performed in the same manner as the original description by Hartmann (ie, not usually with mucous fistula), the department said.

However, the new items proposed by the taskforce for transanal total mesorectal excision (taTME), vental rectopexy and pelvic exenteration will not be added in the July round of changes.

Both the taTME and vental rectopexy items would need to be assessed by the Medical Services Advisory Committee (MSAC) before being added to the MBS, while further consultation was needed prior to moving ahead with new pelvic extenteration items, the department said.

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