demystifying the mbs primary care item numbers a workshop for gps, practice nurses and practice managers st george di

1. Demystifying the MBS Primary Care Item Numbers Information for this presentation is taken from http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare_ Liz Meadley Primary Care Solutions

2. Learning Outcomes At the completion of this workshop the participants will be able to: Utilise the Medicare item numbers as revised by Medicare from 1st Jan ’10 and implemented on 1st May ‘10 Adapt a case study based on the Medicare item numbers to the general practice environment. Use a case study to illustrate the value of a systems approach to identify at risk patients

3. Changes to Item Numbers Changes to be introduced 1st May 2010 Changes include: Medicare Fee increases Item descriptors for general attendance items Attendance items out of consulting rooms After hours attendance items Prolonged attendance items Health Assessment items Chronic Disease Management items GP multidisciplinary Case Conference item numbers

4. Increase in Medicare Fees

5. Increase in Medicare Fees

6. Increase in Medicare Fees Fees for level C & D general attendance increased

7. Increase in Medicare Fees Fees for level C & D general attendance increased

8. Changes to time based Item Descriptors To fulfil the requirement of the item descriptor GPs can bill the items where they undertake all or some of the tasks set out in the descriptor. This should be reflect in the patient records. This aims to support GPs to provide preventive care.

9. Changes to time based descriptors The new descriptor for level B, C and D items will apply to the following groups

10. Increase in Medicare Fees Non-urgent after-hours items 5040 and 5060 have increased

11. Changes to Attendance items provided out of Consulting Rooms Medicare Items for non-urgent after-hours home visits and consultations at an institution will be combined. Services to residential aged care facilitates will remain unchanged.

12. Changes to Attendance items provided out of Consulting Rooms Standard consultation

13. Changes to non-urgent after-hours services for home visits and consultations at an institution other than a Aged Care Facility

14. Urgent after-hours

15. Health Assessment Items The following are now classified under 4 new time based item numbers (instead of 10): Healthy Kids Check; 45-49 Health Assessment; Type 2 Diabetes Risk Evaluation; Older Persons Health Assessment; Comprehensive Medical Assessment for permanent residents of an aged care facility; Health Assessment for person with an intellectual disability; Health Assessment for a person under the Government humanitarian program;

16. Health Assessment Items cont. Aboriginal and Torres Strait Islander:- The 3 items previously available are now collapsed into one Health Assessment Item ( Item 715). The following assessment will be undertaken under the new item number: - Aboriginal and Torres Strait Islander child health assessment; Aboriginal and Torres Strait Islander adult health assessment; and Aboriginal and Torres Strait Islander older persons health assessment.

17. Aboriginal & Torres Strait islander Health assessment – Item 715 has no designated time or complexity requirements; has no distinction between assessments provided in or out of consulting rooms; and The time taken to complete the health assessment will be at the GP’s discretion; Not available to people who are in-patients of a hospital or care recipient in a Residential Aged care facility; This item can be re-claimed after 9 months.

18. Health Assessment Target Groups GPs may select one of the MBS Health assessment items to provide Health Assessment services to a member of any of the target groups listed below.

19. Health Assessments The time period includes the time taken by the doctor and the practice nurse. You will still be required to identify the type of Health Assessment being provided to the patient, by endorsing your account/receipt or Bulk Bill assignment of benefit voucher including the item number applicable of which there are four time based item numbers. Ask the PN to give examples Ask the PN to give examples

20. Chronic Disease Management Two CDM items for the review of CDM plans (items 725 and 727) are now combined into one item number (732). 732 can be used to either review a GPMP or to coordinate a review of a TCA. 732 - Fee $66.80 732 Descriptor – Review a GPMP or Coordinate a review of TCA/Multidisciplinary Care Plan/Multidisciplinary Discharge Plan Can a GP claim item 732 twice on the same day? Yes, providing an item 732 for reviewing a GPMP and another 732 for reviewing a TCA are both delivered on the same day as per MBS item descriptors and explanatory notes.

21. Chronic Disease Management The multidisciplinary case conference item structure has been streamlined. 18 GP multidisciplinary case conference items ( 734 - 779) have been combined into 6 based on the duration of the service and on whether the GP is coordinating or participating in the case conference. There will no longer be separate items according to location of the service. The time periods have been adjusted to more closely align with the time periods for level B, C and D normal consultations

22. Changes to Case Conference Item Numbers

23. The new PIP Indigenous Health Incentive Is a key part of the Council of Australian Governments (COAG) National partnership Agreement on closing the gap: Tackling Indigenous Chronic Disease Supports General Practice and Indigenous health services to provide better health care for Indigenous Australians, including best practice management of chronic disease; Targets Aboriginal and Torres Strait Islander patients aged 15 years and over with a chronic disease. www.medicareaustralia.gov.au PIP Indigenous Health Incentive

24. PIP Indigenous Health Incentive cont. To take part in the incentive your practice should be; Participating in the PIP; Agree to seek consent to register Aboriginal and Torres Strait Islander patients at risk of chronic disease; Establish and use a remainder system to ensure follow-up; Agree to undertake cultural awareness training; Agree to annotate PBS scripts for PBS Co-payment measure. www.medicareaustralia.gov..au

25. PIP Indigenous Health Incentive cont. What payments are available under the PIP Incentive? A one off sign on payment of $1000 to practices that agree to undertake specified activities to improve provision of care Patient registration payment of $250 for each eligible patient annually Outcome payments (tier 1) of $100 for each registered patient for providing target level of acre in a calendar year Outcomes payment (tier 2) of $150 for providing majority of care in a calendar year with a minimum of 5 MBS items www.medicareaustralia.gov.au

26. PIP Indigenous Health Incentive cont. PBS Co-payment measure commencing on 1 July 2010; Offers co-payment relief to participating patients. You will be required to annotate PBS prescriptions for eligible patients Eligible patients holding concession cards will receive their PBS medicines without co-payment. Non –concession patients will pay the current concession rate. www.medicareaustralia.gov.au

27. PIP Indigenous Health Incentive cont. For more information about the PIP Indigenous Health Incentive call: Medicare Australia PIP Team : 1800222032 Indigenous Access Line : 1800556955 Go to www.medicareaustralia.gov.au/pip Email: pip@medicareaustralia.gov.au www.medicareaustralia.gov.au

28. Case Study Joan

29. Joan – a Diabetic Case Study Joan is a 66 year old female type II diabetic and has recently moved to your area to be nearer to her family. She would like to renew her prescriptions. Joan has her current tablet packets with her. She states she has been very happy with her current medication & would just like some repeats please! Joan likes to get her prescriptions with all her repeats “filled” at the same time. This saves her having to go back to the doctor or the chemist unless she feels unwell. Joan has been diabetic for past 9 Yrs and has been taking tablets for the past 2 years. Joan is moderately obese, BMI 30, BP 140/85, P 90 regular. Joan does not take her own BSL. Medications: Metformin 500 mg bd Simvastatin 40 mg daily Glibenclamide 5 mg bd Ramipril 5 mg daily Ezetimibe 10 mg daily Joan does not have a set exercise regime because she does enough running around when she visits the grandchildren & while doing the housework.

30. Case Study 2 Allan’s Story

31. Allan is a 44 year old man who presents to the practice for the 1st time on the recommendation of his wife who is a regular patient. Allen has been a smoker for 20 years and now wants to give up! He is overweight and on examination his BP is 160/94, P 88, BMI 38. Allen likes his couple of beers a night after a hard day at the office. Please develop a preventive pathway for Allen indicating number of visits and relevant MBS item numbers.

32. Resources Item descriptors and explanatory notes are available at www.mbsonline.com.au Fact sheets will be available at www.health.gov.au/mbsprimarycareitems

33. Thank You Liz Meadley Primary care Solutions lizm50@bigpond.com Mobile: 0458232322