Transcript Understanding the MBS for chronic disease care

Using
to deliver more services
in community health
Peter Larter
Grampians MBS Industry Advisor
August 2011-June 2012
Agenda
• Introduction to Medicare
• Team Care Arrangements – processes
and latest evidence
• Recent updates to the MBS
• Diabetes prevention focus in general
practice: opportunities for CHS’?
« Questions and discussion »
Feel free to ask those tricky questions…
Medicare
What does an item number look like?
Item
number
Schedule
fee
Item name
Hint: To search for
individual items,
google “MBS online”
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”
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’…
Health
assessments
(disability, refugee,
75+, Aboriginal..)
Speech
pathology
Physiotherapy
Chiropractic
services
Osteopathy
Dietetics
Podiatry
Diabetes
education
Occupational
therapy
Visiting
specialist
services
Midwifery and
Nurse
Practitioners
Telehealth
Aboriginal
health
workers
Dental services
Psychology /
counselling
Year
Key New Medicare funding
Evolution of the MBS
2006
Allied 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
**Vic DHS MBS Flipchart published**
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
2010
Nurse practitioner and midwifery services
2011
Telehealth (access to specialists)
Better Start for Children with a Disability
Eligible for 8 x allied
health group services
per calendar year
Diabete
s
mellitus
GP
Management
Plan
• Diabetes educators
• Exercise
physiologists
• Dieticians
Eligible for 5 x allied
health rebates per
calendar year
• Aboriginal health
workers
• Diabetes educators
• Audiologists
• Exercise
physiologists
• Dieticians
• Mental health
• Ots
• Physiotherapy
• Podiatry
• Chiropractic
• Osteopathy
• Speech pathology
Team Care
Arrangements
Collaboration
with at least 2
other providers
Eligible for $4,250 of
MBS dental benefits
over 2 consecutive
calendar years
• Dental
• Dentist
• Dental prosthetist
Medicare-rebateable allied health
items following GPMP+TCA
Provider
MBS item
Medicare Benefit
Aboriginal health worker
service
10950
$50.95
Diabetes education
10951
$50.95
Audiology
10952
$50.95
Exercise physiology
10953
$50.95
Dietetics
10954
$50.95
Mental health worker
10956
$50.95
Occupational therapy
10958
$50.95
Physiotherapy
10960
$50.95
Podiatry
10962
$50.95
Chiropractic
10964
$50.95
Osteopathy
10966
$50.95
Psychology
10968
$50.95
Speech pathology
10970
$50.95
“Multidisciplinary Team Care Arrangements
in the management of patients with chronic
disease in Australian general practice”
Harris, Mark et al. 2011. Medical Journal of Australia. 94(5).
•
1752 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. 2011. 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. 2007. 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
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 +)
Eligible for 8 x allied
health group services
per calendar year
Diabete
s
mellitus
GP
Management
Plan
• Diabetes educators
• Exercise
physiologists
• Dieticians
Eligible for 5 x allied
health rebates per
calendar year
• Aboriginal health
workers
• Diabetes educators
• Audiologists
• Exercise
physiologists
• Dieticians
• Mental health
• Ots
• Physiotherapy
• Podiatry
• Chiropractic
• Osteopathy
• Speech pathology
Team Care
Arrangements
Collaboration
with at least 2
other providers
Eligible for $4,250 of
MBS dental benefits
over 2 consecutive
calendar years
• Dental
• Dentist
• Dental prosthetist
The number of general practice
care plans (Victoria) is increasing
350000
300000
250000
200000
GPMPs
150000
TCAs
Reviews
100000
50000
0
2006-07 2007-08 2008-09 2009-10 2010-11
Note: 2010-11 stats are for July 10 to March 11, extrapolated to June 11
Source: Medicare Australia.
Governance
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
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
Monitoring
• Financial viability - budgeting
• Clinical governance
• What are clients saying?
• Integrating with other clinical governance
and monitoring activities
Next steps
www.health.vic.gov.au/pch/downloads/factsheet06.pdf
Questions or reflections