using to deliver more services in community health peter larter grampians mbs industry advisor...
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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