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Using to deliver more services in community health Peter Larter Grampians MBS Industry Advisor August 2011-June 2012. Agenda. Introduction to Medicare. Team Care Arrangements – processes and latest evidence. Recent updates to the MBS.
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Using to deliver more services in community healthPeter LarterGrampians MBS Industry Advisor August 2011-June 2012
Agenda • Introduction to Medicare • Team Care Arrangements – processes and latest evidence • Recent updates to the MBS • Diabetesprevention focus in general practice: opportunities for CHS’? « Questions and discussion »
What does an item number look like? Hint: To search for individual items, google “MBS online” Item number Item name • Medicare benefit • 100% of fee for GP services • 100% of schedule fee for nursing services • 85% of schedule fee for allied health • Dental benefit: only one amount is listed Schedule fee Click here for explanatory notes: “The Rules”
Bulk billing and private billing • ‘Bulk bill’ – patient assigns the Medicare rebate to the GP • ‘Privately bill’ 1 – patient pays full amount up front, and can either • Go to Medicare office to collect the benefit • Have the benefit deposited into their bank account • ‘Privately bill’ 2 – patient pays the ‘gap’ up front and Medicare sends a cheque for the provider to the patient to forward
Population health analysis • What are the key population health needs in your community? Could services delivered through the MBS help to address them? • MBS Project will be using population health analyses of the PCPs, MBS and other data to help identify regional priorities • It’s not just about ‘allied health’…
Health assessments (disability, refugee, 75+, Aboriginal..) Speech pathology Podiatry Occupational therapy Telehealth Visiting specialist services Diabetes education Physiotherapy Chiropractic services Aboriginal health workers Midwifery and Nurse Practitioners Dietetics Osteopathy Dental services Psychology / counselling
Evolution of the MBS **Vic DHS MBS Flipchart published**
Eligible for 8 x allied health group services per calendar year Eligible for 5 x allied health rebates per calendar year • Diabetes educators • Exercise physiologists • Dieticians Diabetes mellitus • Aboriginal health workers • Diabetes educators • Audiologists • Exercise physiologists • Dieticians • Mental health • Ots • Physiotherapy • Podiatry • Chiropractic • Osteopathy • Speech pathology GP Management Plan Team Care Arrangements Collaboration with at least 2 other providers Eligible for $4,250 of MBS dental benefits over 2 consecutive calendar years • Dental • specialist • Dentist • Dental prosthetist
“Multidisciplinary Team Care Arrangements in the management of patients with chronic disease in Australian general practice” Harris, Mark et al. 2011. Medical Journal of Australia. 94(5). • 1752 people with chronic disease • 22.7% had been put on a TCA • More likely: women, >2 chronic illnesses, metropolitan • Patients who had a TCA self-assessed their quality of care to be higher than those who did not
“Multidisciplinary Team Care Arrangements in the management of patients with chronic disease in Australian general practice” Harris, Mark et al. 2011. Medical Journal of Australia. 94(5). • Of patients who had had a TCA, the following groups rated care highest • 2 or more conditions • Low educational attainment • Went to a practice in the intervention group
“Multidisciplinary care plans for diabetes: how are they used?” Shortus, Timothy D. et al. 2007. Medical Journal of Australia. 187(2). • GPs use care plans to organise clinical care and help patients access allied health providers. • GPs rarely discuss care plans with other providers. • Conclusion: Care plans could improve with the inclusion of more patient-centred (eg: life) goals & activities
Executive understanding, decisions and support • Is your Board/CEO aware of the MBS opportunities/risks and how their use may support organisational strategy? • What are the negotiables and non-negotiables in using MBS? • Profit/loss • Billing • Salaried/private/% split • Service integration and practice protocols
Executive understanding,decisions and support • Legal and reporting issues • Compliance with Health Insurance Act 1973 (Cw) • Not claiming MBS for services funded through other sources e.g. Integrated Care Branch, DH • Capital requirements • Space • MBS billing software / online billing • Information management – referrals, MBS reporting
Developing collaborative relationships (GP engagement +)
Eligible for 8 x allied health group services per calendar year Eligible for 5 x allied health rebates per calendar year • Diabetes educators • Exercise physiologists • Dieticians Diabetes mellitus • Aboriginal health workers • Diabetes educators • Audiologists • Exercise physiologists • Dieticians • Mental health • Ots • Physiotherapy • Podiatry • Chiropractic • Osteopathy • Speech pathology GP Management Plan Team Care Arrangements Collaboration with at least 2 other providers Eligible for $4,250 of MBS dental benefits over 2 consecutive calendar years • Dental • specialist • Dentist • Dental prosthetist
The number of general practice care plans (Victoria) is increasing Note: 2010-11 stats are for July 10 to March 11, extrapolated to June 11 Source: Medicare Australia.
Governance • Key worker / project officer • Project planning, implementation & monitoring • Inter-agency porject reference group? • Internal working group? • Consultation mechanisms • Communication plan
Resources available • MBS Industry Advisor • Divisions of general practice • Medicare Australia website • DH website google “MBS Project”
Recruitment • Existing staff – extend hours • Existing private providers in the region - partnership • Recruit from outside the region – visiting providers or ‘renting rooms’ or new staff • More to come from presentations
Monitoring • Financial viability - budgeting • Clinical governance • What are clients saying? • Integrating with other clinical governance and monitoring activities
