Transcript The Department of Health and Ageing

Enhanced Primary Care (EPC)
Introducing the new
Chronic Disease Management (CDM)
Medicare Items
Denzil Burke
Assistant Director, GP Programs Branch
Commonwealth Department of Health and Ageing
EPC Medicare Items
• ‘Have made a significant contribution to improving
management of patients with chronic & complex
conditions in general practice.’
• ‘While uptake variable and quality not optimal, there
has been a fundamental shift in general practice:
there is now a structured approach to
multidisciplinary care.’
-
independent evaluation of the EPC items, July 2003
• EPC items are an initial step, not a solution in itself for chronic disease
management, or for all challenges facing general practice
EPC Medicare Items
CONTEXT:
• Health Assessments for Older Australians & ATSI people $43.9 million MBS benefits paid 2004-05
• Care Planning - $63.5 million 2004-05
• Case Conferencing - $2.9 million 2004-05
• Medication Management Review - $3.2 million 2004-05
EPC Timeline
• Nov 1999 – EPC health assessments, care planning & case
conferencing items
• Nov 2001- Home Medicines Review, PIP incentives for
asthma, cervical screening & diabetes
• Nov 2002 – PIP incentive for mental health care
• May 2003 - EPC MBS items refunded in 2003-04 Budget
• May 2004 – MBS ATSI Adult Health Check item
• July 2004 – MBS Allied Health & Dental Services items; Aged
care Comprehensive Medical Assessment item
• Nov 2004 – Aged Care medication review item
• July 2005 – MBS Chronic Disease Management (CDM) items
CDM Items Overview
• Six new CDM items July 05 (old items cease Nov 05)
• Items stem from the Red Tape Review and were
developed at the request of, and in close
consultation with GP groups.
• New CDM items for care planning at 2 levels:
– GP managed care: GP Management Plans (GPMP) &
reviews for patients with chronic conditions
– Team based care: Team Care Arrangements (TCA) &
reviews for those with chronic and complex conditions
(usually will include GPMP).
• New items are simpler, more flexible and can be
used for patients with a wide range of chronic
conditions.
LIST OF NEW CDM ITEMS
•
•
•
•
•
MBS Item 721 - preparation of a GP Management Plan (GPMP)
MBS Item 723 - coordination of Team Care Arrangements (TCA)
MBS Item 725 - review of a GP Management Plan
MBS Item 727 - coordination of a review of Team Care Arrangements
MBS Item 729 - contribution to a multidisciplinary care plan being
prepared or reviewed by another health or care provider
• MBS Item 731 - contribution to a multidisciplinary care plan being
prepared or reviewed by another health or care provider for residents of
aged care facilities
• Most items also available for patients being discharged from hospital
(with items 721 & 723 only for private patients).
SUMMARY TABLE
721
Medicare
Fee
(100%)
$120
Recommended Minimum
Claiming
frequency
Period*
12 months*
2 yearly
723
$95
2 yearly
12 months*
725
$60
6 monthly
3 months*
727
$60
6 monthly
3 months*
729
$41.65
6 monthly
3 months*
731
$41.65
6 monthly
3 months*
Name
Item No
Preparation of a GP
Management Plan
Preparation of Team Care
Arrangements
Review of a GP
Management Plan
Coordination of Review of
Team Care Arrangements
Contribution to a
multidisciplinary care plan
Contribution to a
multidisciplinary care plan
by an Aged Care Facility
*CDM services can also be provided more frequently in’ exceptional circumstances’ - where there has been a
significant change in the patient’s clinical condition or care circumstances (such as development of comorbidities or complications, deteriorating condition, illness/death of carer etc), that require a new GP
Management Plan, Team Care Arrangements or review service.
MBS Item 721 - GP Management Plan
(GPMP)
• Available for patients with a chronic (or terminal) medical condition.
• Recommended frequency is once every two years or less if clinically
required.
• GPMPs involve the GP (can be assisted by Practice Nurse) assessing the
patient, identifying needs, agreeing management goals, identifying
patient actions, treatment and ongoing management and documenting
this in the GPMP.
• GPMPs allow GPs to prepare care plans for eligible patients where the
involvement of other health or care providers is not required.
MBS Item 723 – Team Care
Arrangements (TCA)
• Available for patients with a chronic (or terminal) medical condition
and complex needs requiring ongoing care from a multidisciplinary
team of their GP and at least two other health or care providers.
• Recommended frequency is once every two years or less if clinically
required.
• TCA involves a GP (can be assisted by Practice Nurse),
discussing/agreeing with the patient which providers should be
involved, what information can be shared, collaborating with the
participating providers on required treatment/services and
documenting this in the patient’s TCA.
• A TCA can be provided without a GPMP, but a patient must have both
a GPMP and a TCA to access allied health and dental care (MBS Items
19050 to 10977).
MBS Item 725 – Review of GPMP
• This is for patients who have a current GPMP and require a review of
their GPMP.
• Recommended frequency is once every six months or less if clinically
required.
• A review of a GPMP involves the GP (can be assisted by a Practice
Nurse), reviewing the patient’s GPMP, documenting any relevant
changes and setting the next review date.
MBS Item 727 – Review of TCA
• This is for patients who have a current TCA and require a review of
their TCA.
• Recommended frequency is once every six months or less if clinically
required.
• A review of TCA involves the GP (can be assisted by a Practice Nurse),
discussing/confirming with the patient which providers should be
involved, what information can be shared, collaborating with the
participating providers on progress against treatment/service goals
and documenting any changes to the patient’s TCA.
• This item should also be used for team-based reviews of active EPC
care plans.
MBS Item 729 – GP Contribution to
care plans prepared or reviewed by
another provider
• This provides a rebate for GPs to contribute to a multidisciplinary care
plan being prepared or reviewed by another provider (eg hospital
staff, allied health).
• Recommended frequency is once every six months or less if clinically
required.
• Contributing to a care plan involves the GP, confirming the patient’s
agreement for the GP to contribute to the plan, collaborating with the
person preparing or reviewing the plan and including the GP’s
contribution in the patient’s records.
MBS Item 731 – GP Contribution to
care plans for residents of aged care
facilities
• This is for patients in residential aged care facilities and is otherwise
similar to identical to Item 729.
• Where a GP has contributed to a care plan for an aged care resident, the
resident can access the MBS allied health and dental care services items.
ASSISTING GPs with CDM services
• PNs and/or AHWs can assist GPs in providing CDM services but this is not
mandatory.
• Assistance could include:
- information collection
- aspects of patient assessment
- identification of patient needs
- making arrangements for services.
• GP must see the patient and review and confirm all assessments and
elements of the plan.
SIPs and CDM Items
• SIPs for asthma, diabetes and mental health continue to be available to
GPs.
• The new CDM items do not change access to or usage of the SIPs.
• Where the work involved in providing both a SIP and a CDM item for the
same patient at the same time overlap, common sense limits on how both
items can be used apply, for GP managed care and for team care.
SIPs and GP managed care
• GPMPs and the SIPs for asthma or mental health overlap – both involve
assess/plan and review steps and GPs should choose which service to use.
• Not appropriate to provide both a GPMP and SIP for asthma or mental
health within same twelve months.
• A GPMP and a diabetes SIP can be claimed for the same patient - these
services are complementary.
• A review of the GP Management Plan and the SIP should not be claimed at
the same time (ie within three months) as the work involved in both
services overlaps.
SIPs and team-based care
• A GP can provide a GPMP and TCA and a SIP as these patients have
complex needs that cannot be addressed by the SIP alone.
• This has been the case for EPC multidisciplinary care planning and
SIPs.
• It is not appropriate, however, to both review the CDM item and claim
the SIP at the same time as the work involved in both services
overlaps.
Advantages of CDM Items
• Easier to use with simpler MBS requirements.
• Expanded role for practice nurses/AHWs.
• GPMP widely accessible for patients with chronic conditions (broadly
defined) – patients who were not previously eligible for care planning.
• GPs can prepare care plans without having to collaborate, but MBS
funds collaboration where required.
• More flexibility in claiming frequency.
• Access to allied health & dental services maintained for patients with
GPMP & TCA.
• GPs can prepare (for private patients) or contribute (public & private)
to discharge plans, including for aged care residents.
• New items will support the use of templates & best practice models.
Useful Link
• Notes, descriptors, forms, Q&As etc at: www.health.gov.au, (and follow
the A-Z to ‘Chronic Disease Management Medicare Items’)