Enhanced Primary Care (EPC) Introducing the new Chronic Disease Management (CDM) Medicare Items Denzil Burke Assistan

1. 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

2. ‘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

3. 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 Medicare Items

4. 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 EPC Timeline

5. 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. CDM Items Overview

6. 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). LIST OF NEW CDM ITEMS

7. SUMMARY TABLE

8. 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 721 - GP Management Plan (GPMP)

9. 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 723 – Team Care Arrangements (TCA)

10. 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 725 – Review of GPMP

11. 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 727 – Review of TCA

12. 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 729 – GP Contribution to care plans prepared or reviewed by another provider

13. 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. MBS Item 731 – GP Contribution to care plans for residents of aged care facilities

14. 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. ASSISTING GPs with CDM services

15. 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 CDM Items

16. 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 GP managed care

17. 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. SIPs and team-based care

18. 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. Advantages of CDM Items

19. Notes, descriptors, forms, Q&As etc at: www.health.gov.au, (and follow the A-Z to ‘Chronic Disease Management Medicare Items’) Useful Link