fifine cahill, department of health and ageing:nurse practitioners and the medicare benefits...
DESCRIPTION
Fifine Cahill, Assistant Secretary Primary Care, Diagnostics and Radiation Oncology Branch Medical Benefits Division, Department of Health and Ageing delivered this presentation at the 2013 Developing the Role of the Nurse Practitioner conference. The event is designed for organisations and managers looking to better understand, utilise and grow the role of the nurse practitioner in their health service. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/nursepractitionersconferenceTRANSCRIPT
NURSE PRACTITIONERS AND THE
MEDICARE BENEFITS SCHEDULE
(MBS)
MEDICARE REBATES AND RULES
Fifine Cahill
Assistant Secretary
Primary Care, Diagnostics and Radiation
Oncology Branch
Department of Health and Ageing
Overview
• Expanding Medicare Support for Nurse
Practitioners Measure
• Understanding the frameworks in place
• Current figures
• Looking towards the future
Expanding Medicare Support for
Nurse Practitioners Measure
• $36.6 million over four years was allocated in
the 2009-10 Budget.
• Representatives of professional groups were
members of the expert advisory group that
helped to develop the Measure.
• Medicare Benefits Schedule (MBS) nurse
practitioner items introduced on 1 November
2010
The measure was introduced to:
• Improve the flexibility and capacity of the
primary care health workforce;
• Advance the position of nurse
practitioners in private practice; and
• Provide a sustainable model of practice.
An eligible nurse practitioner can:
• treat their own patients;
• provide Medicare rebateable primary care
services within their scope of practice under:
- four time tiered attendance items;
- six telehealth items; and
- ten specific pathology items.
• www.mbsonline.gov.au
Within their scope of practice, nurse
practitioners may also:
• refer patients to specialists and
consultant physicians;
• prescribe medicines under the
Pharmaceutical Benefits Scheme;
• request pathology and diagnostic
imaging services.
To access Medicare arrangements,
an eligible nurse practitioner must:
• have a Medicare provider number;
• be working in a private practice;
• have professional indemnity insurance;
and
• have collaborative arrangements in place
with a medical practitioner.
• Medicare benefits are only payable for
nurse practitioner services provided
under a collaborative arrangement with
specified medical practitioners.
• Collaborative arrangements are
covered under the Health Insurance
Regulations 1975
Collaborative arrangements – nurse
practitioners
A collaborative arrangement between
a nurse practitioner and a medical
practitioner must always provide for:
• consultation;
• referral of a patient; and
• transfer of a patient’s care.
Forms of collaboration
• through an employment relationship; or
• referral to a nurse practitioner by a medical practitioner; or
• a written agreement between a nurse practitioner and a medical practitioner; or
• an arrangement acknowledged by the medical practitioner and patient and detailed in the nurse practitioner’s written records.
An eligible nurse practitioner can
provide services at:
• Nurse practitioner’s private consulting
rooms;
• The patient’s home;
• Health clinics;
• General practices; and
• Aboriginal Medical Centres.
Referral requirements
• Referrals must be within the nurse
practitioner’s scope of practice.
• A referral made by an eligible nurse
practitioner is valid for 12 months.
Current figures
1 November 2010 to 31 January
2013
• 148 nurse practitioners;
• 144,177 general attendance
services;
• 76,188 patients.
Current figures
1 November 2010 to 31 January
2013
• 130,807 PBS prescriptions;
• 2,178 diagnostic imaging requests;
• 35,886 pathology requests.
Current figures
1 November 2010 to 31 January 2013
• $3,809,466 paid in MBS rebates;
• $3,843,230 paid in PBS prescriptions
Nurse Practitioner Services by Selected Time
Periods, 1 November 2010 to 31 January 2013
Nurse Practitioner Services by MBS Item Number,
1 November 2010 to 31 January 2013
Nurse Practitioner Services by State/Territory,
1 November 2010 to 31 January 2013
Nurse Practitioner Services by Australian Geographical
Classification – Remoteness Areas, 1 November 2010 to
31 January 2013
Looking towards the future
• Aged Care Models of Practice
Program
• Collaborative Arrangements
Nurse Practitioner - Aged Care
Models of Practice Program
• In the 2010-11 Budget, the Government
provided $18.7 million over four years
to develop, test and evaluate a range of
models of nurse practitioners in the
aged care sector.
Nurse Practitioner - Aged Care
Models of Practice Program
The program aims to:
• identify effective, economically viable and
sustainable models of practice;
• facilitate the growth of the aged care
nurse practitioner workforce; and
• improve access to primary health care for
clients of residential and community aged
care services.
Nurse Practitioner - Aged Care
Models of Practice Program
• Funded organisations include:
• Individuals/sole traders;
• Small providers;
• Peak bodies;
• Medicare Locals;
• Consortiums; and
• Universities
Nurse Practitioner - Aged Care
Models of Practice Program
Models tested include nurse practitioners
working in:
• Private practice;
• Residential Aged Care Facilities;
• General practice;
• Specialist medical practice.
Nurse Practitioner - Aged Care Models
of Practice Program
• Projects are funded in all states and
territories.
• Projects are underway in rural, regional
and remote areas.
• Includes organisations providing
Aboriginal and Torres Strait Islander and
culturally specific care.
Nurse Practitioner - Aged Care
Models of Practice Program
National Evaluation:
• Undertaken by the University of Canberra.
• Evaluator collecting data on the cost,
financial viability and economic
sustainability of each model.
• Results of the evaluation, including best
practice models, available in 2015.
Collaborative arrangements –
midwives
• More Choice for Women – Expanding
Medicare Support for Midwives measure
introduced 1 November 2010.
• The inclusion of legislative requirements
for collaborative arrangements was
central to the introduction of the
midwifery and nurse practitioner
measures.
Collaborative arrangements –
midwives
• Collaboration between providers is
pivotal to ensuring safe, high quality
care and to enable the seamless
escalation of care if clinically required.
• Midwives report ongoing difficulties in
establishing collaborative arrangements
with individual medical practitioners.
Collaborative arrangements –
midwives
• The Commonwealth agreed to vary the
secondary legislation on collaborative
arrangements to enable agreements
between midwives and hospitals and
health services.
Collaborative arrangements –
midwives
• Collaboration will continue to be
fundamental to midwifery care under
Medicare and Midwives will continue to
be required to collaborate with doctors.
• The proposed change will be to the way
collaborative arrangements are
demonstrated.
Collaborative arrangements –
midwives
• There will still need to be pathways in
place for consultation, referral and
transfer of care to a medical practitioner,
where required.
• Stakeholder consultation is underway to
effect this change.
Questions and comments?