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

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Working with GPs to enhance client access to
MBS-funded services
Peter Larter Primary Healthcare Team
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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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Diabetes Prevalence in Victoria 2001
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Diabetes Prevalence in Victoria 2006
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Diabetes Prevalence in selected Loddon Mallee
Shires2001-6
Loddon 2001-6
Buloke 2001-6
2001 Prevalence 400
of Population 4.7
LGA Ranking 2

Prevalence of diabetes 708
of Population 8.5
LGA Ranking 1
2001 Prevalence 159
of Population 2.2
LGA Ranking 35
   
2006 Prevalence 299
of Population 4.3
LGA Ranking 24
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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

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Care Planning Items (for clients with a chronic
disease)
Name Item Medicare Fee (100) Recommended frequency Minimum claiming period
GP Management Plan 721 124.95 2 yearly 12 Months
- Review of GPMP 723 62.50 2 yearly 12 months
Team Care Arrangements 725 98.95 6 monthly 3 months
- Review of TCA 727 62.50 6 monthly 3 months
GP Contribution to a care plan (hospital) 729 43.40 6 monthly 3 months
GP Contribution to a care plan (aged care facility) 731 43.40 6 monthly 3 months
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Uptake of new MBS items - Victoria Care Planning
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Allied Health Items (for clients with a chronic
disease complex care needs, referred through a
Team Care Arrangements)
Relvant MBS item numbers4

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
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Uptake of new MBS items - VictoriaAllied /
dental health
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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

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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 shouldnt be reported as
  state-funded services

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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

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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

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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
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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

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Contact details

• Peter Larter
• Primary Health Branch
• DHS Central Office
• [phone]
• peter.larter_at_dhs.vic.gov.au