Deleting ECG item numbers in primary care – whose idea was it?

27th July 2020, Dr Chee L Khoo

GP: the brains behind ECGs

Just pause and think for just one minute. Over the last 12 months, how many atrial fibrillations have you picked up incidentally on ECG? How many silent old acute myocardial infarct have you seen on ECG in a patient with diabetes? How many ST and T wave changes have you seen on ECG which suggest ischaemia which requires further investigations? And how many of those have turned out to be the real thing – critical atherosclerotic cardiovascular disease? How many rhythm and conduction abnormalities have you picked up in young people that demand further electro-physiological studies? We probably don’t know how many of those may have gone on to develop into sudden acute death?

We do many preventative procedures in primary care every day. We check lipids, glucose and BP and many more in the pursuit of detecting disease early and preventing complications. Mortality from cardiovascular diseases have reduced largely from these efforts in primary care over the decades. One of the most rewarding investigations in general practice is the humble electrocardiograph (ECG). All of us can vividly and easily remember patients whom we have picked up the odd abnormality from the “routine” ECG. The humble ECG has helped reduced mortality and morbidity from CV events, strokes, falls and fractures.

Performing an ECG is NOT a money spinner in general practice, is it? Sure, ECG machines have reduced in price over the years but it is time consuming to do an ECG. It is not one of those items on which one can over-service. An annual ECG is often recommended in patients with high risks. It is just GOOD medicine. From the 1st August, Medicare will delete Items 11700, 11701 and 11702 pertaining to performing an ECG tracing +/- reporting. They will be replaced by items which can only be claimed by specialists or physicians. See the full document here.

According to the powers to be, items 11700, 11701 and 11702 are considered to be “low value care” items. The new items are introduced in their replacement are meant to “promote high value clinical use”. Seriously, it that what they think GPs do? Removing those items from general practice not only devalues the role of GPs, it will deskill generations of GPs very rapidly. Just like delisting cortisone injections from primary care, pretty much all ECGs will be referred out from hereon. As part of accreditation, we will still need to have an ECG machine but most will only do that in “emergencies” and opportunistic ECGs will rarely be done. It will be hugely more costly to the health system.

General practice is increasingly being dumbed down and we need to collectively fight against this. My good friend, Dr John Goswell from the Hunter region has written a detailed letter to the federal health minister. Please take 2 mins of your time to print a similar letter to Greg Hunt as well as the appropriate letter to your local federal member (see below). All you have to do is to put your practice stamp at the top and sign the letter. Your practice can then fax it off.

Choose your local member below and fax them a letter of objection. We need GP power! I can’t do this on my own. Circulate this post as widely as possible.

together we stand