Health Care Reform & Medicare Review: Impact on Aged Care

1. Health Care Reform & Medicare Review: Impact on Aged Care Phillipa Grant 25 May 2010

2. Overview • Health Care Reform • Medicare Changes • Aged Care Access Initiative 2010-2011

3. Aged Care Reforms • Commonwealth takes full responsibility for the provision & regulation of all aged and community services • Intent is to provide a platform to deliver: • Seamless transition of care for clients, allowing people to move from one level of care to another as their care needs change; • Simple access to services; • Greater integration & innovation of services; • A nationally consistent system of services, support, assessment, care & regulation across the country

4. The Government will invest an additional $98.6 million over five years to improve access to primary health care forolder Australians. • The Government will also provide flexible funding for a variety of medical and allied health services for older Australians that will be facilitated by local primary health care organisations, Medicare Locals. This will include redirection of $14.1 million over four years from the allied health component of the Aged Care Access Initiative. • The flexible funding will enable Medicare Locals to target gaps in primary health care services experienced by older Australians in aged care homes and by those supported at home through community care arrangements. • This is expected to result in an additional 190,000 primary health care services in the two years to 2013-14.

5. GP Incentives • The Australian Government will provide increased incentive payments for GPs to provide services to older Australians in aged care homes. • Incentive payment is available to GPs in practices participating in the Practice Incentives Program (PIP) • Incentive payments will increase from $1,000 to $1,500 a year for GPs when qualifying service level (QSL) of 60 attendances to older Australians in aged care homes is met. • For GPs who meet the qualifying service level of at least 140 attendances, the incentive payment will double from $1,500 to $3,500. • By 2013-14, up to 1,200 additional GPs will be receiving incentive payments for providing services to older Australians in aged care homes. • This is expected to result in around 105,000 additional GP services being provided to older Australians in the four years to 2013-14.

6. $103.1M to better support nurses working in aged care settings • $59.9M to provide incentive payments to existing aged care workers to upgrade their qualifications • $21.0M to fund an additional 600 enrolled nurse training places and 300 registered nurse scholarships over four years – for aged care nurses to upgrade their skills • $18.7M to trial new models of care to expand and improve the role of nurse practitioners in aged care • $3.5M to explore regulation of personal care workers and assistants in nursing in aged care, through the National Registration and Accreditation scheme.

7. Implications for General Practice Networks • Links through the Aged Care Access Initiative (ACAI) with expanded nursing teams. • Potential implications under a PHCO system • There may be links to the role of the nurse practitioners in aged care and PHCOs (working collaboratively with a series of practices) • Funding Opportunities? • Unknown at this stage. AGPN to consult with DoHA to identify opportunities • http://www.budget.gov.au/2010-11/content/glossy/health/html/health_overview_01.htm • or • http://www.health.gov.au/budget2010

8. Industry Reaction • Almost unanimous support from the wide range of stakeholders affected • Positive first step – clears the way for future reform • Criticisms: • Not addressing underlying problems hampering provision of quality service – funding, workforce shortages

9. Comprehensive Medical Assessment (CMA) • Health Assessment Items • Case Conferencing Items

11. Comprehensive Medical Assessment • CMA replaced by new time based health assessment items: 701 (brief), 703 (standard), 705 (long) or 707 (prolonged) • The use of these new items will not count towards the qualifying service levels for ACAI • RNs can assist with the health assessment process in accordance with accepted medical practice and under the supervision of a medical practitioner • Time taken with these assessments includes the time of a nurse • Previous Department proformas can be used with the new items

14. CMA Components • Assessment of the resident’s health and physical and psychological function must include: • Making a written summary of the CMA; • Developing a list of diagnoses and medical problems based on the medical history and examination; • Providing a copy of the summary to the RACF; • Offering the resident a copy of the summary • Recommended that new residents receive a CMA as soon as possible after admission and preferably within 6 weeks following admission to RACF

15. CMA Restrictions • Can only be claimed for eligible patients: • On admission to a RACF, provided that a CMA has not already been provided in another RACF within the previous 12 months • At twelve month intervals thereafter • Not available to residents receiving respite care • The comprehensive medical assessment may be completed over one or more visits, provided all the components of the assessment are undertaken before the item is claimed. • A Locum can conduct a comprehensive medical assessment provided the resident’s usual GP has delegated the provision of this service to the Locum. The resident’s usual GP should be given a copy of the written summary of the outcomes of the assessment.

17. Case Conferencing Items • The case conferencing items are for GPs to organise and coordinate, or to participate in, a meeting or discussion held to ensure that their patient’s multidisciplinary care needs are met through a planned and coordinated approach. • Patients with a chronic or terminal medical condition and complex care needs requiring care or services from their usual GP and at least two other health or care providers are eligible for a case conference service. • The case conferencing team must include a GP and at least two other health or community care providers, one of whom can be another medical practitioner. Each team member should provide a different kind of care or service to the patient. • It is expected that a patient would not usually require more than five case conferences in any 12 month period.

18. As of May 1… • The multidisciplinary case conference item structure has been streamlined. • Eighteen GP multidisciplinary case conference items (734-779) have been combined into six new items (735, 739, 743, 747, 750 and 758) based on the duration of the service and on whether the practitioner is coordinating or participating in the case conference. • The old item numbers have been deleted. • There will no longer be separate items according to the location of the service. • The time periods have been adjusted to more closely align with the time periods used for level B, C, and D normal consultation items.

19. Items for organising and coordinating a case conference in a residential aged care facility or a community case conference or a discharge caseconference. • Item 735: Organise and coordinate a case conference of at least 15 and less than 20 minutes. • Item 739: Organise and coordinate a case conference a case conference of at least 20 and less than 40 minutes. • Item 743: Organise and coordinate a case conference of at least 40 minutes.

20. Items for participating in a case conference in a residential aged care facility or a community case conference or a discharge case conference. • Item 747: Participate in a case conference of at least 15 and less than 20 minutes. • Item 750: Participate in a case conference of at least 20 and less than 40 minutes. • Item 758: Participate in a case conference of at least 40 minutes. • Participating in a multidisciplinary case conference does not include organising and coordinating a multidisciplinary case conference.

21. Impact on PIP… • MBS items that count towards QSLs include attendances in RACFs for contributions to Care Plans, Case Conferences, and Residential Medication Management Reviews. • Medicare Benefits Schedule items that count towards the incentive include: • 20, 35, 43, 51, 92, 93, 95, 96, 735, 739, 743, 747, 750, 758, 903, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267. • Commencing march 2012…Changes to the PIP and GPII online administration system will allow GPs to update GP Aged Care Access Incentive banking details and view GP Aged Care Access Incentive payment advices and historical data online.

22. Summary of 1 May 2010 MBS Changes • http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/FD65645DA9682F63CA2576F60002194F/$File/201005-Summary.pdf • The Changes to Medicare Primary Care Items: A FACT SHEET FOR GENERAL PRACTITIONERS • http://www.health.gov.au/internet/main/publishing.nsf/Content/63655B6F92B2927ACA25768B007EC1D7/$File/GPfactsheet.pdf • Comprehensive medical assessment for residents of residential aged care facilities • http://www.health.gov.au/internet/main/publishing.nsf/Content/AF1023BFB3229C63CA25771F00082977/$File/6461(1003)%20Medicare%20Health%20Assessments%20Factsheet%202-%20CMA%20SCREEN.pdf • MBS Health Assessments Items 701, 703, 705, 707, 715 and 10986 • http://www.health.gov.au/internet/main/publishing.nsf/Content/F9473D35963BD72CCA25771F001AF7A0/$File/6461(1003)%20Medicare%20Health%20Assessments%20Factsheet%201-%20MBS%20Assessments%20SCREEN.pdf • GP Multidisciplinary Case Conference Medicare Items • http://www.health.gov.au/internet/main/publishing.nsf/Content/E0470D26FA4BBA31CA25771B00090107/$File/CaseConfFactSheet.pdf

23. Aged Care Access Initiative 2010-2011 • 2010/2011 Guidelines are not yet available and GPQ has not had any direct guidance about their content at this point • Key Principles Revisited: • Allied health services provided on an individual or group basis are eligible. • This program applies to residents of Commonwealth funded residential aged care facilities and Multipurpose Services. • Individual allied health services may also include participation in case conferencing and care planning • Provision of generalised group training by allied health staff for staff of RACFs should not usually be provided. However, it is acceptable for allied health professionals to provide specific instruction in the needs of a particular resident to the aged care facility staff who may need to assist the resident with the provision of that service on a day to day basis.

24. Aged Care Access Initiative 2010-2011 • Allied health services funded under Medicare or through other Government sources cannot be paid for under the Aged Care Access Initiative (ACAI). ACAI funding cannot be used to cover the payment ‘gaps’ or co-payments for services funded under Medicare or services where a private health insurance rebate is claimed. • Provision of generalised group training by allied health staff for staff of RACFs should not usually be provided. However, it is acceptable for allied health professionals to provide specific instruction in the needs of a particular resident to the aged care facility staff who may need to assist the resident with the provision of that service on a day to day basis • In 2009-10 and 2010-11 there will not be a requirement to undertake a new needs assessment. However, it is expected that divisions will continue to consult with relevant stakeholders in formulating annual program plans and respond to changes in availability of allied health services in the area or the experience of providers in providing services to the resident population.

26. Aged Care Legislation • Please note: It is a requirement under the Aged Care Act, 1997 (the Act) that the individual care and support needs, including allied health care needs of residents in aged care facilities, are assessed and documented with the assistance of appropriate health professionals, on a regular, on-going basis. • Allied health services funded under the ACAI are not routinely available to residents with high care needs. Under the Act approved providers have an obligation, where an assessed need has been identified, to provide allied health services at no additional cost to the resident (Refer to Quality of Care Principles Schedule 1 Item, 3.11).

28. Part of the Fifth Community Pharmacy Agreement and will require legislation. • Medication charts in RACFs will double as prescriptions • Envisage development of a system allowing the supply of medicines and PBS claims ... from a medication chart in residential aged-care facilities. • A staged supply support allowance will enable pharmacists to dispense medications in instalments. High-care patients (particularly those with mental illness and drug dependencies) can have their prescription drugs dispensed in instalments by eligible pharmacists, based on the instructions from the patient's treating doctor.

29. Caring for Older AustraliansIssues paper • Demand for aged care services is expected to become more diverse in the future • Questions have been raised about the financial sustainability of the aged care system and its ability to supply an adequately trained workforce to respond to changing patterns of service demand. • Against this backdrop, the Australian Government has asked the Productivity Commission to develop detailed options for restructuring Australia’s aged care system to ensure it can meet the challenges facing it in coming decades. • This issues paper was released on 21 May 2010 and is intended to assist individuals and organisations in preparing a submission to the Commission. It covers a range of issues on which the Commission is seeking information and feedback. • To ensure due consideration of input prior to release of the draft report, submissions should have reached the Commission by Friday 30 July 2010. • http://www.pc.gov.au/projects/inquiry/aged-care/issues

31. Phillipa Grant • Program Coordinator – Aged Care & Chronic Disease • General Practice Queensland • pgrant@gpqld.com.au • (07) 3105 8300

32. Thank you