using to deliver more services in community health peter larter grampians mbs industry advisor...
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![Page 1: Using to deliver more services in community health Peter Larter Grampians MBS Industry Advisor August 2011-June 2012](https://reader036.vdocument.in/reader036/viewer/2022062313/56649d3a5503460f94a14706/html5/thumbnails/1.jpg)
Using to deliver more services in community health
Peter LarterGrampians MBS Industry Advisor August 2011-June 2012
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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’?
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Feel free to ask those tricky questions…
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Medicare
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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
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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
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Determining your priorities
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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’…
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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
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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**
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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
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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
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“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
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“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
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“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
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Executive understanding, decisions and support
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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
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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
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Potential service models
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Service models
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Developing collaborative relationships
(GP engagement +)
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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
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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.
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Governance
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Governance
• Key worker / project officer
• Project planning, implementation & monitoring
• Inter-agency porject reference group?• Internal working group?• Consultation mechanisms• Communication plan
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Understanding the MBS
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Resources available
• MBS Industry Advisor
• Divisions of general practice
• Medicare Australia website
• DH website google “MBS Project”
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Recruitment
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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
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Monitoring
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Monitoring
• Financial viability - budgeting
• Clinical governance• What are clients saying?• Integrating with other clinical governance
and monitoring activities
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Next steps
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www.health.vic.gov.au/pch/downloads/factsheet06.pdf
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Questions or reflections