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Working with GPs to enhance client access to MBS-funded services

Working with GPs to enhance client access to MBS-funded services. Peter Larter Primary Healthcare Team. Overview. New MBS items – what they are, why they are here Care planning and MBS Relevance to CH clients and CH services Engaging General Practice Opportunities and issues.

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Working with GPs to enhance client access to MBS-funded services

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  1. Working with GPs to enhance client access to MBS-funded services Peter Larter Primary Healthcare Team

  2. Overview • New MBS items – what they are, why they are here • Care planning and MBS • Relevance to CH clients and CH services • Engaging General Practice • Opportunities and issues

  3. Diabetes Prevalence in Victoria 2001

  4. Diabetes Prevalence in Victoria 2006

  5. Diabetes Prevalence in selected Loddon Mallee Shires2001-6 Loddon 2001-6 Buloke 2001-6

  6. New MBS item numbers • 8 categories • Health assessment • Prevention & health promotion • Care planning & case conferencing • Allied and dental health • Mental health (Better Access items) • SIPs (Service Incentive Payments) • Quality Use of Medicines • Incentives to bulk bill – under 16s and concession card holders www.health.vic.gov.au/communityhealth/gps/mbs.htm

  7. Care Planning Items (for clients with a chronic disease)

  8. Uptake of new MBS items - Victoria Care Planning

  9. Service type Allied health professional service (provided to an individual) Dental health professional service (provided to an individual) Allied health professional services (provided to a group) Client eligibility Client has a chronic medical condition[1] and complex care needs[2], is being managed by a GP under an EPC plan[3] and is not an admitted patient of a hospital Client has a dental condition that is exacerbating a chronic1 and complex2 condition, is being managed under and EPC plan3 and is not an admitted patient of a hospital Client has been diagnosed with type 2 diabetes mellitus, is being managed in the community by a GP under a GP Management Plan service (#721) or, if a resident of a Commonwealth-funded aged care facility, is being managed under a multidisciplinary care plan to which the GP has contributed (#731), and is not an admitted patient of a hospital Aboriginal Health Worker service #10950 Diabetes education service #10951 Audiology #10952 Exercise physiology #10953 Dietetics services #10954 Mental health service #10956 Occu-pational therapy #10958 Dental assessment or treatment, provided by a dental practitioner, dental specialist and/or dental prosthetist #85011-8777 Assessment for Group Services Diabetes education service – Assessment for group services #81100 Exercise physiology service – Assessment for group services #81110 Dietetics service – Assessment for group services #81120 Physio-therapy #10960 Podiatry #10962 Chiropractic service #10964 Osteopathy #10966 Psychology #10968 Speech pathology #10970 Group services Diabetes education service – Group service #81105 Exercise physiology service – Group services #81115 Dietetics service – Group service #81125 Allied Health Items (for clients with a chronic disease & complex care needs, referred through a Team Care Arrangements) Relvant MBS item numbers[4] [3] The term ‘EPC Plan’ is a generic one. Clients are considered to be managed under an EPC plan if, during the last two years, the GP has prepared an EPC plan for them and: (a) has claimed a GP Management Plan service (#721) and Team Care Arrangements (#723) service for clients living in the community; or (b) has claimed a Review of a GP Management Plan (#725) or Review of Team Care Arrangements (#727) service for clients living in the community; or (c) the client is living in a Commonwealth-funded residential aged care facility and is being managed under a care plan into which the GP has contributed (#731) [4] The item numbers can only be claimed for services provided by allied and dental health practitioners registered with Medicare Australia

  10. Uptake of new MBS items - VictoriaAllied / dental health

  11. Relevance to CH Clients • Clients • More likely to be young-middle aged adults, concession card holders, non-English speaking background • Significant psychosocial problems and high incidence of chronic disease • Less likely to be able to afford a ‘gap’

  12. Opportunities- Principles • models adopted should not result in a reduction of public allied health services. This is about ADDITIONAL services • the implementation of new multidisciplinary models of care that incorporate MBS services is relevant to all CHSs, whether or not they manage medical clinics • community Health agencies need to ensure that any new service models are compliant with s19(2) of the Health Insurance Act 1973 (Commonwealth) by seeking legal advice • MBS services shouldn’t be reported as state-funded services

  13. Opportunities & Barriers • Opportunities to enhance services • Partner with Divisions to create new referral pathways / new services eg: packages of care for patients with diabetes • Explore viability of private AH providing services in CHSs, funded/subsidized through MBS • Help fund care planning activities through MBS • Reduce waiting lists for AH services • Issues to work through • Aligning with organizational CH philosophy • Legal and HR issues • Workforce (GP shortage, AH shortage?, emerging PN role) • Which clients are most ‘suited’ to MBS services • Relationships • Understanding the MBS and Divisions

  14. Some examples from the field • Chronic Disease Management – Hepburn Health Service & Central Highlands Division GPs • Mental Health & Chronic Disease Management – Inner East CHS • Mental health – Doutta Galla CHS and Melbourne Division mental health nurses

  15. What things stop GPs referring into / working with CH?1 • GP referral does not give patient benefit • GPs lack knowledge of CHS services inc eligibility, fees • Perceived long waiting times & lack of feedback • Alternatives are better fit with GP system eg MBS rebates for private allied health, vouchers for psychology services, MAHS 1. Dr Wendy Bissinger, Deputy Chair, General Practice Divisions Victoria

  16. What can CH and Divisions do? • CEO to CEO leadership • Clinicians need to identify the benefits of GP referral and feedback for patients • Jointly plan and implement a pathway • For easily identifiable patient population • CHS to organise access & feedback • Division role to promote to GPs; CHS role to enhance responsiveness • Both to monitor

  17. Contact details Peter Larter Primary Health Branch DHS Central Office (03) 9096 0291 peter.larter@dhs.vic.gov.au

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