Practice Incentives Program: Accessing the Indigenous health incentives. January 2015

Transcription

1 Practice Incentives Program: Accessing the Indigenous health incentives January 2015

2 What is the Practice Incentives Program? The Practice Incentives Program (PIP) aims to encourage continuing improvements in general practice through financial incentives to support quality care and improve access and health outcomes for patients. Administered by Medicare Australia on behalf of the Australian Government Department of Health (DoH), PIP payments are in addition to other income earned by general practitioners and the practice, such as patient payments and Medicare rebates. There are currently 11 PIP initiatives.

3 Payments The PIP Indigenous Health Incentive (IHI) has three components, or levels of payments: A practice sign-on payment; The patient registration payment; and The outcomes payment. A rural loading ranging from per cent, depending on the remoteness of the practice, is also applied to the payments of practices located in Rural, Remote and Metropolitan Areas (RRMA) 3 7.

4 Sign on payment $1000 per practice A one-off payment to practices that agree to undertake specified activities to improve the provision of care to their Aboriginal and/or Torres Strait Islander (ATSI) patients with a chronic disease, including registering eligible ATSI patients for the PIP IHI and/or the Pharmaceutical Benefits Scheme (PBS) Co-payment Measure (also known as the Closing the Gap initiative) with the Department of Human Services (DHS); This payment is made to practices in the next quarterly PIP payment following sign-on.

5 Sign on payment To sign-on for the PIP IHI, practices are also required to: Create and use a system to make sure their chronic disease ATSI patients aged 15 years and over are followed up (such as recalls and registers); Undertake cultural awareness training within 12 months of joining the incentive, unless exempt; and Use the Closing the Gap (CTG) annotation on eligible PBS prescriptions.

6 Patient registration payment $250 per eligible patient per calendar year A payment to practices for each ATSI patient aged 15 years and over, who is a usual patient of the practice and who is registered with the practice for the management of a chronic disease. This payment is made once per patient, per calendar year.

7 Patient registration payment To receive the patient registration payment, each patient will: Have had, or have been offered, an ATSI health assessment (MBS item 715); Have a current Medicare card; and Have provided informed consent to be registered for the PIP IHI by completing the patient consent part of the patient registration form. The practice will be responsible for sending this form to DHS via fax or completed patient registration online via Health Professional Online Services (HPOS).

8 Outcomes payment Tier 1: Chronic disease management $100 per eligible patient per calendar year: A payment to practices for each registered patient where a target level of care is provided by the practice in a calendar year. Tier 2: Total patient care $150 per eligible patient per calendar year: A payment to practices for providing the majority of care for a registered patient in a calendar year.

9 Tier 1 requirements Prepare a General Practitioner Management Plan (GPMP) (MBS item 721) or coordinate the development of Team Care Arrangement (TCA) (MBS item 723) for the patient in a calendar year; and Undertake at least one review of the GPMP or the TCA (MBS item 732) during the calendar year; or Undertake two reviews of the patient s GPMP or TCA (MBS item 732) during the calendar year; or Contribute to a review of a Multidisciplinary Care Plan (MDCP) for a patient in a Residential Aged Care Facility (RACF) (MBS item 731) twice during the calendar year. Note: The recommended frequency for preparing a GPMP or coordinating a TCA, allowing for variation in patients needs, is once every two years, with regular reviews (recommended six monthly).

10 Tier 2 requirements Where a practice provides the majority of eligible MBS services for patient (with a minimum of any five eligible MBS services) during a calendar year. This may include the services provided to qualify for the Tier 1 outcomes payment. If two or more practices provide the same number of eligible MBS services for a patient in a calendar year, a Tier 2 outcomes payment will be made to each practice. Eligible MBS items, for the purposes of this incentive, are those items commonly used in general practice which include, but are not limited to, attendances by general practitioners (items 1-51, 193, 195, 197, 199, 601, 602, 603, , ) and chronic disease management items.

11 Identification of Aboriginal and/or Torres Strait Islander patients For practices to register patients for the PIP IHI and the PBS Co-payment Measure, patients must self identify to the general practitioner or practice staff as being of ATSI origin. Patients don t need to provide evidence to support this. General practitioners or practice staff should ask all patients if they identify as being ATSI origin. The national standard identification question is Are you of Aboriginal or Torres Strait Islander origin?.

12 Identification of Aboriginal and/or Torres Strait Islander patients Self identification is voluntary, but practices need to make sure patients can make an informed choice about their decision to self identify. A patient has the right to choose whether to reveal their ethnic origin. Their answer should be recorded as stated in their patient record. Practices should respect the patient s choice to self identify. The Royal Australian College of General Practitioners (RACGP) Standards for general practices (fourth edition) state practices need to work towards the routine recording of patients cultural background, including self identified ATSI Australians, to help appropriately tailor care to patients.

13 Cultural awareness training To meet this requirement, at least two staff members from the practice (one must be a general practitioner) must complete cultural awareness training within 12 months of the practice signing on to the incentive. For the purpose of the PIP IHI, appropriate training is any endorsed by a professional medical college, such as: Those offering Continuing Professional Development (CPD) points; or Those endorsed by the National Aboriginal Community Controlled Health Organisation (NACCHO) or one of its state or territory affiliates. Practices must be able to provide evidence that training has been completed or that exemptions apply.

14 Cultural awareness training exemptions Exemptions are possible where: Appropriate training has been completed up to 12 months before the practice signs on for the incentive; A practice is under the management of an Aboriginal Board of Directors or a committee made up mainly of Aboriginal community representatives; There are only two staff members at a practice, it is sufficient for only one staff member to complete appropriate cultural awareness training or be considered to be exempt; A staff member is qualified as an Aboriginal Health Worker (AHW); or The only general practitioner at the practice is on a temporary contract with a tenure of six months or less, provided that at least one other staff member has met the requirement or is considered to be exempt.

15 Usual practice patients Patient registration for the PIP IHI should only be undertaken by the patient s usual care provider. This is the practice that has provided the majority of care to the patient over the previous 12 months and/or will be providing the majority of care to the patient over the next 12 months. Patients must confirm they want the practice nominatied on the IHI and PBS Co-payment Measure patient registration and consent form to be their usual care provider and the practice responsible for their chronic disease management.

16 Usual practice patients Before a general practitioner submits the IHI and PBS Co-payment Measure patient registration and consent form, they should be satisfied their peers would agree their practice provides the usual care to the patient, given the patients needs and circumstances. The term usual care provider wouldn t generally apply to a practice that provides only one service to a patient.

17 Definition of a chronic disease The MBS definition of a chronic disease is a disease that has been, or is likely to be, present for at least six months. It includes but is not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke.

18 Aboriginal and/or Torres Strait Islander health assessments Conducting ATSI health assessments (MBS item 715) is a useful first step to make sure ATSI Australians get the best level of health care. It encourages early detection, diagnosis and intervention for common and treatable conditions that cause considerable morbidity and early mortality. Practices are encouraged to bulk-bill their ATSI patients to help improve affordability and access to care.

19 Allied health services ATSI patients who have had a health assessment, can be referred by their general practitioner for: Allied health services for up to five services per visits per year (MBS items ). Up to 10 follow-up services per calendar year (MBS item 10987) from a practice nurse or ATSI health practitioner, on behalf of the general practitioner. Allied health services (including AHWs or ATSI health practitioners) for up to five services per calendar year (MBS items ) where the patient has both a GPMP (MBS item 721) and a TCA (MBS item 723) for a chronic condition. Alternatively, a practice nurse or ATSI health practitioner can provide five follow-up services per year for patients with either a GPMP or TCA (using MBS item 10997).

20 Eye health ATSI people have a greater chance of eye disease, with common eye health problems including Refractive Error, Cataracts, Diabetic Retinopathy and Trachoma. As part of conducting the ATSI health assessment (MBS item 715), general practitioners should examine the patient s vision, and ensure that all patients with diabetes have an annual retinal examination. It is also recommended to check for Trachoma and conduct a Trichiasis check for patients who have grown up in remote communities or have a history of sore or watery eye. It is important that if indicated, general practitioners refer the patient to appropriate follow-up services.

21 PBS Co-payment Measure The PBS Co-payment Measure promotes greater access to PBS medicines by reducing the co-payment for eligible ATSI patients. Practices must receive patient consent to register their eligible patients for this measure and annotate PBS prescriptions with CTG. Practices should note that patients registered only for the PBS Co-payment Measure will not attract a patient registration payment.

22 Applying Practices can apply for the PIP Indigenous Health Incentive: Through Health Professional Online Services (HPOS) at humanservices.gov.au/hpos; or By completing the PIP application form available at humanservices.gov.au/healthprofessionals then Incentives and Allowances > Practice Incentives Programs > Forms and guidelines, and sending it with the required supporting documentation to: Incentive Programs Department of Human Services GPO Box 2572 ADELAIDE SA 5001 Fax:

23 The practice must: Obligations of the practice Keep all IHI and PBS patient registration and consent forms at the practice if patients have been registered online through HPOS; or Send or fax all IHI and PBS patient registration and consent forms to DHS for patients to be registered manually. Prove its claims for payment by being able to provide: Proof that a system is in place to make sure their ATSI patients, aged 15 years and over, with a chronic disease are followed up. Proof of completing appropriate cultural awareness training. Records of patient consent.

24 The practice must also: Obligations of the practice Give information to DHS as part of the ongoing audit process to verify that the practice has met eligibility requirements. Make sure the information given to DHS is correct. Advise DHS of any changes to practice arrangements. This can be done: Online via HPOS. Changes via HPOS are immediate and can be made up to, and on, the relevant point-in time date. By completing the PIP Change of Practice Details form, or by advising DHS in writing by no later than 7 days before the relevant point-in-time date.

25 Aboriginal or Torres Strait Islander patient journey incorporating a health assessment, chronic disease management and the Practice Incentives Program An Aboriginal health assessment (MBS item 715) can be carried out every 12 months. A GPMP and TCA is recommended every two years with six monthly reviews. Register your practice for the Practice Incentives Program Indigenous Health Incentive. 12 month cycle A practice nurse, Aboriginal health worker (AHW), or Aboriginal and Torres Strait Islander (ATSI) health practitioner spends minutes (or more as required) with the patient discussing health, collecting data and carrying out preliminary observations. These are recoded in the patient notes and suggestions or recommendations may be made for the general practitioner to follow up, consider or complete referrals. The general practitioner sees the patient (on the same day) and reviews the notes and observations recorded by the practice nurse, AHW or ATSI health practitioner. The general practitioner may see the patient for minutes (or more as required). Health targets may be set, additional examination or interventions may be discussed and referrals completed. All patients should have an eye examination. Medicare billing for this consultation may be: Aboriginal health assessment MBS item $212.25; and Bulk bill MBS item $9.25. A practice nurse, AHW or ATSI health practitioner may provide up to ten follow up services in a calendar year for a person who has received an ATSI Health Assessment using: MBS item $24.00; and Bulk bill MBS item $9.25. Patients who have had an ATSI health assessment can be referred by their general practitioner to eligible allied health professionals for up to five services per calendar year using: If a patient is diagnosed or observed to have a chronic or terminal medical condition, consider and discuss a chronic disease management item such as a general practice management plan and/or a team care arrangement. A General Practitioner Management Plan (GPMP) and/or Coordinate the Development of a Team Care Arrangement (TCA) may be completed by a general practitioner with the assistance of a practice nurse, AHW or ATSI health practitioner. Medicare billing for this consultation may be: GPMP MBS item $144.25; and/or TCA MBS item $114.30; and Bulk bill MBS item $9.25. Patients with both a GPMP and TCA can be referred to eligible allied health professionals (for up to five services per calendar year (MBS items ). Alternatively, registered AHWs or practice nurses can provide five follow-up services per year for patients with either a GPMP or TCA using: MBS item $24.00; and Bulk bill MBS item $9.25. A review of a GPMP and/or TCA can be carried out once in every three month period. Medicare billing for this consultation may be: Review of a GPMP MBS item $72.05; Review of a TCA MBS item $72.05; and Bulk bill MBS item $9.25 for each relevant item. Practices participating in the Practice Incentives Program (PIP) Indigenous Health Incentive (IHI) may register eligible ATSI patients over the age of 15 who have a chronic disease and claim the patient registration payment of $250 per eligible patient per calendar year. In addition, the PIP IHI may pay an outcomes payment for eligible patients who have had target level of care completed in a calendar year (Tier 1 - $100 per patient per year) which comprises of a GPMP or TCA and: At least one review of the GPMP or TCA; or Contribute to a multidisciplinary care plan (MDCP) for a patient in a residential aged care facility (MBS item 731) For providing the majority level of care to a registered patient the practice may also receive the Tier 2 payment of $150 per patient per year. Patients with a chronic disease or chronic disease risk factor, and in the opinion of the doctor: Would experience setbacks in the prevention or ongoing management of chronic disease, if they didn t take the prescribed medicine, and Are unlikely to follow their medicines routine without help through the measure; may register for the Pharmaceutical Benefits Scheme (PBS) co-payment scheme and receive a reduction in the co-payment required for prescribed medications. Patients holding a concession card will not be required to pay a co-payment. General practitioners should indicate CTG (Closing the Gap) notation on prescriptions. MBS items to

26 More information Check to see if your patient is already registered with another practice. Call