Using to deliver more services in community health

Peter LarterGrampians 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

Aboriginalhealth workers

Podiatry

Physiotherapy

Dental services

Diabetes education

Occupationaltherapy

Telehealth

Speech pathology

Psychology / counselling

Health assessments

(disability, refugee, 75+, Aboriginal..)

Osteopathy

Chiropractic services

Visiting specialist services

Midwifery and Nurse

Practitioners

Evolution of the MBSYear Key New Medicare funding

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

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

**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

Diabetes mellitus

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 +)

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

Diabetes mellitus

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

0

50000

100000

150000

200000

250000

300000

350000

2006-07 2007-08 2008-09 2009-10 2010-11

GPMPs

TCAs

Reviews

Note: 2010-11 stats are for July 10 to March 11, extrapolated to June 11Source: 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