MBS Primary Care Items – Chronic Disease Management August 2010

1. ISO 9001 Lic QEC22546 SAI Global MBS Primary Care Items – Chronic Disease Management August 2010

2. CDM Item Numbers

3. Associated items

4. What is a GP Management Plan? • GP Management Plan (GPMP), Item 721, • GP Management Plans are for patients with a chronic or terminal condition who will benefit from a structured approach to management of their care needs. • GPs can provide a GPMP without having to collaborate with other providers

5. What is a Team Care Arrangement? • Team Care Arrangements (TCA), Item 723, • A TCA is for management of patients with a chronic condition and complex care needs and who require ongoing care from a multidisciplinary team of at least 3 health or care providers including their GP. • Requires collaboration between all providers, based on two way communication (oral or written) • Patients with a GPMP and TCA are eligible for the 5 allied health visits per year

6. Can a GPMP & TCA be claimed at the same time? • Yes • However, the TCA includes collaborating with the participating providers to discuss potential services they will provide to achieve management goals, • Documenting the goals and the treatment/services they have agreed to provide, patient actions and a review date. • A GPMP and TCA can both be claimed on the same day where all the components of each service are finalised on the same day

7. Review of GPMP and/or TCA – Item 732 • May be conducted by any GP from the Practice, or new GP if the patient has changed practices • Review of current GP Management Plan involves: • reviewing the patient’s GPMP • documenting any changes and • setting the next review date • Review of a current Team Care Arrangement involves: • collaborating with the participating providers on progress against treatment/services and • documenting any changes to the TCA • Can be supported by Practice Nurse (PN), Aboriginal Health Worker (AHW) or other health professional

8. Contribution to, or review of, a multidisciplinary care plan prepared by an another provider - Item 729 • Available to patients in the community • Both private and public pts on discharge from hospital • Not available to care recipients in a RACF

9. Contribution to a Care Plan prepared by an Aged Care Facility -Item 731 • Involves the GP • collaborating with Providers preparing or reviewing the plan • including their contribution with the patient’s records • Can be supported by PN, AHW or other health professional • Recommended frequency is once every six months, or earlier if clinically required

10. Who can Assist? • GPs can be assisted by a Practice Nurse, Aboriginal Health Worker or other health professional in their practice but the GP must still see the patient to confirm all components of the GPMP& TCA • Plans can now be reviewed by same GP or a GP from the same practice • GPs can choose the most appropriate review for the circumstances of the patient • - GPMP Review if reviewing alone • - TCA Review if reviewing with team input

11. MBS Item 10997 • Monitoring & support by a Practice Nurse or registered Aboriginal Health Worker, on behalf of a GP • Patients must have a chronic condition and: • have a current GPMP, TCA or Multidisciplinary Care Plan in place • A maximum of 5 services can be claimed per patient per calendar year • The item may be used to provide: • - Checks on clinical progress • - Monitoring medication compliance • - Self management advice • - Collection of information to support GP reviews of Care Plans • Can be claimed (in certain circumstances) at the same time as items 721, 723 • Patient does not need to see GP to claim

12. Allied Health Rebateable Services • Where a GPMP and TCA, or a GP contribution to a care plan prepared by an aged care facility has been completed, patients are eligible for referral to eligible allied health services. • Does not need a new GPMP or TCA (or both) in subsequent years in order for patients to be eligible each year for the allied health items, (but must be “current’ i.e. regular reviews). • Following a review of the GPMP and/or TCA, the GP may identify that the patient requires additional allied health services, and complete new Allied Health referral forms. • Capped at 5 per calendar year Jan-Dec.

13. Allied Health Providers • Can choose to bulk bill or private bill • A written report to GP is required after the first and last service, or more often if clinically necessary • Patient must choose to use either MBS claim or private insurance (i.e. cannot ‘top up’) • Allied Health Services funded by other Commonwealth or State programs are NOT eligible for Medicare Rebates, except where a subsection 19(2) exemption has been granted

14. Eligible Allied Health Provider items 10950 - 10970 Aboriginal Health Workers Audiologist Chiropractor Dietitian Diabetes Educators Occupational Therapist Osteopath Physiotherapist Podiatrist Speech pathologist Exercise physiologist Mental health workers*

15. Group Allied Health Services • For patients with Type 2 Diabetes • Who have GPMP in place • RACF patients in which GP has contributed to multidisciplinary care plan (item 731). • Provides access to one assessment and up to 8 group services • Provided by Diabetes Educator, Dietitian or Exercise Physiologist.

16. Dental services • Dental practitioners need to be registered with Medicare • Dental referral form • Claim for GPMP/TCA must have already been processed • Dental practitioners may set own fee

17. PIPs and SIPs • Practice Incentive Program (PIP) • For accredited practices to support ‘best practice’ methods • Service Incentive Payment (SIP) • e.g. Diabetes Annual Cycle of Care, • Asthma Cycle of Care

18. SIPs vs Chronic Disease items for Diabetes & Asthma • Diabetes Annual Cycle of Care • SIP item numbers can still be used with a GPMP +/-TCA • Asthma Cycle of Care • SIP item or GPMP must be chosen unless patient has another chronic condition • HOWEVER • These SIP items cannot be used with a GPMP/TCA Review and should not be claimed within 3 months

19. Minimum requirement for Diabetes Annual Cycle of Care

20. Minimum Requirements for Asthma Cycle of Care • At least 2 asthma related consultations within 12 months • One of these to have been planned (review consult) • Document diagnosis and assessment of level of asthma control and severity of Asthma • Review of use and access to asthma related medications and devices • Provision of a written Asthma Action Plan • Provision of asthma self management education • Review of written Asthma Action Plan

21. Medication Management Reviews • Practice Identifies Patient: • Based on Clinical need, considering known risk factors that predispose people to medication related adverse events. • GP Generates Referral • Use templates in clinical software program • Send referral to community pharmacy of patient’s choice • 3. GP Receives Pharmacist’s Report • Discuss with reviewing pharmacist • 4. GP Prepares Plan (claim 900) • GP develops Management Plan based on report • Copy to pharmacy • Offer copy to patient

22. Case ConferenceItems

23. Joan – Case Study A 56 year old female type II diabetic, Joan, has recently moved to your area to be nearer to her family. She would like to renew her prescriptions. Joan has been a diabetic for the past 6 years. She has been taking tablets for the past 2 years. Joan is moderately obese with a history of diabetes & high cholesterol for the past 6 yrs. Joan does not take her own BSL. Joan likes to get her prescriptions with all her repeats “filled” at the same time. This saves her having to go back to the doctor or the chemist unless she feels unwell. Joan does not have a set exercise regime because she does enough running around when she visits the grandchildren or when doing the housework What MBS items are available to Joan? What type of activity (consults & items) would you recommend for Joan?

27. Further information • Department of Health & Ageing • www.health.gov.au/mbsprimarycareitems • MBS Online • www.mbsonline.gov.au/ • Templates available • Your medical software program • www.nevdgp.org.au (IM resources) • www.monashdivision.com.au/resources/templates.htm

28. Any questions? General Practice NSW 76-80 Clarence Street, Sydney Ph: (02) 9239 2900 Fx: (02) 9239 2999 Web: www.gpnsw.com.au Email: jerrybacich@gpnsw.com.au