Workshop for nurses interested in working in General Practice General Practice Financing Session 2 u

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Workshop for nurses interested in working
in General Practice General Practice
Financing Session 2(updated 5 February 2008)
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Learning Outcomes

• The attendees will be able to describe the
  Australian Medicare system and name a number of
  relevant practice nurse item numbers.
• The attendees will be able to describe the PIP
  and it relevance to Nursing in General Practice
• The attendees will be able to describe the
  relevance of practice accreditation to Nursing in
  General Practice

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General Practice Financing

• Australia has a universal health insurance scheme
  known as Medicare
• Medicare is available to
• Eligible Australian residents, New Zealand
  citizens, holders of permanent visas, visitors
  and temporary residents from countries with
  reciprocal health care arrangements, holders of
  temporary protection visas
• General practices either bulk bill or charge a
  fee

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Medicare Billing systems

• General Practice is small business partly funded
  by the Federal Government through Medicare
  benefits to patients. Other forms of funding
  support general practice to varying degrees
• The majority of practices usually arrange
  appointment systems based on a minimum of 4-6
  patients /hour.
• Each patient visit a consultation. The content
  and length of the visit determines the amount
  billed.

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Medicare Benefits Schedule (MBS) attendance items

• The MBS contains a unique item number for each
  professional medical service or attendance. E.g.
• Consult A - Item number 3
• Consult B - Item number 23
• Consult C - Item number 36
• Consult D - Item number 44

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Department of Veteran Affairs (DVA)

• DVA funds medical services provided by GPs and
  specialists who are registered with DVA for
  eligible veterans, widowers, war widows and their
  dependants
• Eligible veterans are issued either
• A gold card which allows for a full range of
  services
• A white card that provides access to the services
  for service relate conditions.

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Practice Incentives Program (PIP)
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Practice Incentives Program (PIP)

• The Practice Incentive Program (PIP) is part of
  a blended payments approach to general practice
  funding. Payments made through the program are in
  addition to other general practice income sources
  such as patient fees and Medicare.
• The practice must be accredited or registered for
  accreditation to access the PIP

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Practice Incentives Program (PIP) Cont.

• Some levels of payment under the PIP are linked
  to the size of the practice. The Standard Whole
  Patient Equivalent (SWPE) is used to measure
  practice size.
• SWPE is a measure of practice size that is
  independent of the number of services provided
  to patients with weighting applied to age and
  sex.

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RRMAs

• The Rural Remote and Metropolitan Areas (RRMA)
  classification of a practice also impacts on
  certain initiatives provided through the PIP.
• Zone Class Abbreviation
• Metropolitan Capital cities RRMA 1
• Metropolitan Other metro centres RRMA 2
• Rural Zone Large rural centres RRMA 3
• Small rural centre RRMA 4
• Other rural areas RRMA 5
• Remote Zone Remote centre (gt 5000) RRMA 6
• Remote centre (lt5000) RRMA 7

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PIP History

• Initial Incentives included
• IM/IT-using prescribing software and send and/or
  receive clinical data via a modem
• Medical Student placement
• Rural loading to practices in rural and remote
  areas
• General Practice Immunisation Incentive Scheme
• Participation in National Prescribing Service
  activities
• After Hours-payment for ensuring patients have
  access to 24 hour care

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PIP History cont.

• Nov 1999 EPC introduced -Health Assessments
• Care Plans and Case Conferences
• 2000-The practice must be accredited or
  registered for accreditation to receive the PIP
  incentives
• November 2001-Extension of PIP to include
• Diabetes Incentive
• Asthma Incentive
• Mental Health Incentive
• Cervical Screening Incentive
• February 2002 Extension of PIP to include
• Practice Nurse Incentive (for RRMA 3-7)

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PIP History cont

• April 2006-Extension of PN incentive to all urban
  areas of workforce shortage
• November 2006
• Asthma 3 renamed Asthma Cycle of Care
• Diabetes Cycle of Care has amended eye and feet
  examinations

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General Practice Programs

• Other Programs delivered through General Practice
  Include
• Referral to Allied Health and Dental Services for
  patients on EPC plans
• More Allied Health Service (MAHS) Program
• Domiciliary or Home Medicine Review (DMMR/HMR)
• Residential Medication Management Reviews (RMMR)
• General Practice Immunisation Incentive (GPII)
  Scheme
• Australian Childhood Immunisation Register (ACIR)
• EPC items health assessments, care plans, case
  conferences, medication management reviews and
  mental health care plans

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Medicare Benefits Schedule for Practice Nurses to
provide a service on behalf of a GP include

• MBS item 10993 -immunisation provided by a
  practice nurse on behalf of a GP
• MBS item 10994 cervical smear and preventative
  checks provided by a practice nurse on behalf of
  a GP
• MBS item 10995 cervical smear and preventative
  checks for a woman between the ages of 20 and 69
  who has not had a Pap smear in the last 4 years,
  on behalf of a GP
• Note for all of these items the medical
  practitioner claims the rebate and retains
  responsibility for the health and clinical
  outcomes of the patient

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Medicare Benefits Schedule for Practice Nurses to
provide a service on behalf of a GP include

• MBS item 10996 wound management provided by a
  practice nurse on behalf of a GP
• MBS item 10997 ongoing monitoring and support
  by a practice nurse for a person with a chronic
  disease care plan, on behalf of a GP
• MBS item 10988 cervical smear provided by a
  practice nurse on behalf of a GP
• Note for all of these items the medical
  practitioner claims the rebate and retains
  responsibility for the health and clinical
  outcomes of the patient

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Medicare Benefits Schedule for Practice Nurses to
provide a service on behalf of a GP include

• MBS item 10999 Cervical smear provided by a
  practice nurse for a woman between the ages of 20
  and 69 who has not had a Pap smear in the last 4
  years, on behalf of a GP
• MBS item 16400 antenatal service provided by a
  midwife, practice nurse or registered Aboriginal
  Health Worker on behalf of a GP, specialist or
  consultant physician in RRMAs 3-7
• Note for all of these items the medical
  practitioner claims the rebate and retains
  responsibility for the health and clinical
  outcomes of the patient

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Enhanced Primary Care ProgramEPC
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Enhanced Primary Care (EPC)

• Enhanced Primary Care Initiative introduced by
  the Commonwealth Government Nov 1999
• Practices do not need to be accredited to be
  eligible to claim EPC items
• Introduced to
• Provide more preventative care for older
  Australians
• Improve coordination of care for people with
  chronic conditions and complex care needs
• To provide a framework for a multidisciplinary
  clinical approach

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Enhanced Primary Care (EPC)

• gt75 Health Assessment (Aboriginal and Torres
  Strait Islander gt55)
• Aboriginal and Torres Strait Islander Adult
  Health Check
• Aboriginal and Torres Strait Islander Child
  Health Check
• 45 year old Health Check
• Refugee Health Check
• Intellectual Disability Health Assessment
• Case Conferencing
• GP Management Plans
• Team Care Arrangements including health or care
  givers
• Dental and Allied Health Services
• Comprehensive Medical Assessments

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Practice Accreditation
Session 3
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Practice Accreditation

• Voluntary Practice based process.
• Aimed to provide a pathway for quality
  improvement.
• The Accreditation process is a review process
  based on The Royal Australian College of General
  Practitioner (RACGP) Standards for General
  Practice (3rd Ed.).
• The general practice registers for accreditation
  with 1 of 2 recognized organisations- AGPAL or
  GP Accreditation plus.
• Once registered for accreditation the practice
  can access the PIP.
• Accreditation review occurs every 3 years.