Key regulatory changes doctors need to know in 2019
This year, a number of significant regulatory changes will affect the way Australian doctors manage a range of patient conditions, including heart health, aged care and chronic diseases.
MedicalDirector’s Chief Medical Officer, Dr Charlotte Middleton, discusses.
1. New MBS Items for Heart Health Check
According to the Department of Health, from 1 April 2019, two new interim items (699 and 177) will be introduced to allow GPs and medical practitioners (other than a specialist or consultant physicians) to conduct a heart health check that lasts at least 20 minutes, in consulting rooms.
Eligible patients will now be able to receive a Medicare rebate for having a specific heart health check conducted by a GP.
The changes were introduced following findings that heart disease and stroke are responsible for almost 30 per cent of all deaths and 15 per cent of Australia’s total disease burden.
The Department of Health states the heart health check complements the range of MBS items that support rebates for people to discuss their risk of heart disease with their GP, including time-based consultations for preventive health, health assessments, and Chronic Disease Management items.
The following links and factsheets can offer more guidance:
- http://www.mbsonline.gov.au/…….Factsheet – Heart Health Check.pdf
2. Strengthening primary care and managing chronic conditions
The Federal Government is set to increase incentive payments of $201.5 million to General Practice focused on quality of care and increased patient rebates of $187.2 million for 176 GP services from 1 July 2019.
Five National Strategic Action Plans will also be implemented for osteoporosis, kidney disease, rare diseases, heart disease and stroke, and children’s health, along with the new heart health check described above. The Childhood Immunisation Education Campaign will also be extended, while the Government will also invest in national projects such as the Heart Kids Action Plan and the Paediatric Telecare Service.
Importantly, as part of the Strengthening primary care package, a new annual payment will be available for each person with diabetes who signs up with a specific GP. Funding is provided for about 100,000 people to sign up – about 10% of all people with diabetes in Australia.
The new item number is consistent with the recent MBS review Report on General Practice, which recommends a move toward voluntary enrolment.
The precise details of the new fee – including the annual amount and any descriptors – have not yet been released. But as recommended by the Grattan Institute, it should encourage practices to move towards a more prevention-oriented approach to chronic disease management, including using practice nurses to call patients to check up on their condition, and using remote monitoring technology.
A patient-centric model of preventive care for chronic disease management was also further highlighted in the 2018 MBS Review Taskforce Report from the General Practice and Primary Care Clinical Committee: Phase 2.
3. Greater support for rural health
Through the Stronger Rural Health Strategy, the Government is investing $62.2 million for a new rural generalist training pathway and continuing to develop new incentive arrangements to attract more rural GPs.
The National Rural Generalist Pathway is set help ensure ‘rural generalists,’ defined as country doctors with broad skills who provide GP, emergency and specialist care in hospitals and the community. The new initiative is set to ensure a national end-to-end training program for rural generalists, to ensure they are appropriately trained, remunerated and resourced – and formally recognised by the Medical Board of Australia.
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4. More flexible models of aged care
The Government is investing $926 million to support Australia’s doctors in their role in managing chronic conditions for patients, with a new funding and service model to support care coordination and more flexible models of care for older Australians.
This includes expanded incentive payments for General Practices and increased patient rebates for 176 GP services from 1 July 2019.
This builds on initiatives that include increased payments to GPs to visit aged care homes, greater access to a GP after hours, and telehealth for regional Australia.
The Department of Health states the additional investment is set supports GPs and General Practice to deliver more flexible models of care for patients, initially focusing on Australians over 70 years. The idea for this model is that patients can voluntarily enter into a new type of relationship with their GP and receive more personalised, consistent and coordinated care, including more digital services, patient follow-up and self-management.
The Aged Care Access Incentive will continue, while the expanded Practice Incentives Program Quality Improvement Incentive payment, detailed below, is also set to support practices in continuous quality improvement in patient outcomes and the delivery of best practice care.
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5. Changes to the Practice Incentives Program (ePIP)
Introduced in May 2016, the ePIP incentive offers general practices the opportunity to contribute Shared Health Summaries to the My Health Record system for their patients.
As of 1 August 2019, the number and type of incentives available within PIP will change. Four of the existing incentives will cease and a new incentive, the Practice Incentives Program Quality Improvement (PIP QI), will commence.
With an implementation date for the PIP QI of 1 August 2019, the following four Incentives will continue through to 31 July 2019 and then cease:
- Asthma Incentive
- Quality Prescribing Incentive
- Cervical Screening Incentive
- Diabetes Incentive
The seven PIP Incentives that will remain unchanged are:
- eHealth Incentive
- After Hours Incentive
- Rural Loading Incentive
- Teaching Payment
- Indigenous Health Incentive
- Procedural General Practitioner Payment
- General Practitioner Aged Care Access Incentive
According to the AMA, practices will be required to share a minimum set of aggregated data with their local PHN, such as the number of patients with diabetes age who smoke, cardiovascular risk and weight profile.
The AMA states:
“This information will be collated at the local level by the PHNs to assist in supporting improvement and understanding health needs. There is no requirement for individual patient data, and any measures from an individual practice will not be available to the Department of Health.”
The Department of Health has also published the initial list of ten measures. These include:
- Proportion of patients with diabetes with a current HbA1c result
- Proportion of patients with smoking status recorded
- Proportion of patients with a weight classification
- Proportion of patients aged 65 and over who were immunised against influenza
- Proportion of patients with diabetes who were immunised against influenza
- Proportion of patients with COPD who were immunised against influenza
- Proportion of patients with alcohol consumption status recorded
- Proportion of patients with the necessary risk factors assessed to enable CVD assessment
- Proportion of female patients with up-to-date cervical screening
- Proportion of patients with diabetes with a blood pressure result
The following links and factsheets can offer more guidance:
- https://consultations.health.gov.au/…/Approved Web Acessible FAQs.pdf