Using to deliver more services in community health Peter Larter Grampians MBS Industry Advisor August 2011-June 2012

Agenda Introduction to Medicare « Questions and discussion » Recent updates to the MBS Team Care Arrangements – processes and latest evidence Diabetes prevention focus in general practice: opportunities for CHS’?

Feel free to ask those tricky questions…

Medicare

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 Click here for explanatory notes: “The Rules” Schedule fee

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

Determining your priorities

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’…

Dietetics Aboriginal health workers Podiatry Physiotherapy Dental services Diabetes education Occupational therapy Telehealth Speech pathology Psychology / counselling Health assessments (disability, refugee, 75+, Aboriginal..) Osteopathy Chiropractic services Visiting specialist services Midwifery and Nurse Practitioners

Evolution of the MBS Year Key New Medicare funding 2006Allied health services (5 per calendar year) through a GP care plan 2007 Dental scheme for people with a chronic disease and complex care needs Allied health group services for people with established diabetes mellitus 2008 Type 2 diabetes risk evaluation Healthy kids check Allied health, specialist and psychologist items for diagnosis and treatment of autism Allied health items for Aboriginal and Torres Strait Islander people following a health check Follow up health services by nurses & AHWs for ATSI people following a health check 2009 Increase in follow up practice nurse and Aboriginal health worker services for ASTI people following a health check 2010Nurse practitioner and midwifery services 2011Telehealth (access to specialists) Better Start for Children with a Disability **Vic DHS MBS Flipchart published**

GP Management Plan Team Care Arrangements Collaboration with at least 2 other providers Eligible for 8 x allied health group services per calendar year Eligible for 5 x allied health rebates per calendar year Eligible for $4,250 of MBS dental benefits over 2 consecutive calendar years Diabetes educators Exercise physiologists Dieticians Aboriginal health workers Diabetes educators Audiologists Exercise physiologists Dieticians Mental health Ots Physiotherapy Podiatry Chiropractic Osteopathy Speech pathology Dentist Dental prosthetist Dental specialist Diabete s mellitus

Medicare-rebateable allied health items following GPMP+TCA ProviderMBS itemMedicare Benefit Aboriginal health worker service 10950$50.95 Diabetes education10951$50.95 Audiology10952$50.95 Exercise physiology10953$50.95 Dietetics10954$50.95 Mental health worker10956$50.95 Occupational therapy10958$50.95 Physiotherapy10960$50.95 Podiatry10962$50.95 Chiropractic10964$50.95 Osteopathy10966$50.95 Psychology10968$50.95 Speech pathology10970$50.95

“Multidisciplinary Team Care Arrangements in the management of patients with chronic disease in Australian general practice” Harris, Mark et al Medical Journal of Australia. 94(5) 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 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 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

Potential service models

Service models

Developing collaborative relationships (GP engagement +)

GP Management Plan Team Care Arrangements Collaboration with at least 2 other providers Eligible for 8 x allied health group services per calendar year Eligible for 5 x allied health rebates per calendar year Eligible for $4,250 of MBS dental benefits over 2 consecutive calendar years Diabetes educators Exercise physiologists Dieticians Aboriginal health workers Diabetes educators Audiologists Exercise physiologists Dieticians Mental health Ots Physiotherapy Podiatry Chiropractic Osteopathy Speech pathology Dentist Dental prosthetist Dental specialist Diabete s mellitus

The number of general practice care plans (Victoria) is increasing Note: 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

Understanding the MBS

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

Next steps

Questions or reflections