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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

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

Peter Larter

Primary Healthcare Team

overview
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
new mbs item numbers
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

slide10

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

relevance to ch clients
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’
opportunities principles
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
opportunities barriers
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
some examples from the field
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
what things stop gps referring into working with ch 1
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

what can ch and divisions do
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
contact details
Contact details

Peter Larter

Primary Health Branch

DHS Central Office

(03) 9096 0291

peter.larter@dhs.vic.gov.au