Practice Incentive Payments and Service Incentive Payments Summary

ITEM ACTIVITY
Patient register and recall / reminder system

ITEM NUMBER & TYPE OF

CONSULT

PIP
($ PER WPE)
$1.00 (Approx. $1,000 per FTE GP)

SIP
($ PER PATIENT)

NOTES
One-off payment only Practice must be registered for PIP Incentive payable with quarterly PIP payments

N/A In-surgery consultations: Level B - 2517 ($32.10) Level C 2521 ($60.95) Level D 2525 ($89.75)

Diabetes

Annual cycle of care for patients with Diabetes

$40 per patient

These item numbers should be used in place of the usual attendance items, when a consultation completes the minimum annual requirements of care. Payable once per year per patient.

Outcomes payment

N/A

$20.00

Payment made ONLY to practices where 20% of diabetes have completed an Annual Cycle of Care Payment only made to practices that have a min. of 2% of all patients with diabetes

Asthma

In-surgery consultations: Level B 2546 ($32.10) Asthma Cycle of Care Level C 2552 ($60.95) Level D 2558 ($89.75)

$100 per patient

Asthma initiative is for patients with moderate to severe asthma. At least 2 asthma related consultations within 12 months (review consultation is to be a planned consultation)

These item numbers will trigger the payment of an incentive through the Practice Incentives Program (PIP) in addition to attracting a Medicare rebate.

ScreeningCervical

Sign-on payment

N/A

$0.25 (Approx. $250 per FTE GP)

One-off payment only Practice must be registered for PIP Incentive payable with quarterly PIP payments Payments are made for women screened between the ages of 20-69 yrs. These MBS items must be used instead of the standard consultation items, in order to be eligible for this payment These MBS items can not be used in conjunction with items 10994, 10995, 10998 or 10999 (as these are practice nurse item numbers for cervical screening) Payment is made to practices where a min. of 70% of women aged between 20 and 69 yrs have been screened in the past 12 months

Screening at risk women who have not been screened in the past 4 years

In-surgery consultations: Level B 2501 ($32.10) Level C 2504 ($60.95) Level D 2507 ($89.75) $3 per patient Screened (WPE)

$35 per patient

Outcomes payment

N/A

Accredited practices registered with the SIP will receive the extra incentive of $35 when claiming item 10995 & 10999 Nurse must be qualified and trained to take cervical smears and conduct preventative checks

Practice Incentive Payments and Service Incentive Payments Summary

ITEM ACTIVITY ITEM NUMBER & TYPE
OF CONSULT

PIP
($ PER SWPE)

SIP
($ PER
PATIENT)

NOTES
Monies paid to GPs who notify the Australian Childhood Immunisation Register (ACIR) of a vaccination that completes an age-appropriate immunisation schedule A Notification Payment from the ACIR is also given. SIP is paid monthly. GPs must complete a registration form - ACIR Payment Account Details For Immunisation Providers which is lodged with Medicare Australia Enquiries: 1800 653 809 $3.50 for age-appropriate immunisation rate 90% and over Practices must register with the General Practice Immunisation Incentive (GPII) Program. Enquiries: 1800 246 101 or www.medicareaustralia.gov.au

Immunisation

Completing an Age -appropriate N/A immunisation schedule ACIR notification Outcomes payment N/A $3.50 (per WPE)

$18.50 per patient

$6.00

3-Step Process 1. Assessment Level C / D 36 / 44 2. Mental Health Item: Plan In surgery 2574 / 2577 3. Review of Mental Out of surgery 2575 / 2578 Health Plan

N/A

Assessment must be specific and documented. Plans include medications, adverse effects, family involvement, crisis plan, etc. NB: The Mental Health Plan does NOT have to be a multi-disciplinary, although an EPC Care Plan is an option. Reviews will require a recall consultation to review progress and make amendments, if NB: This does not include necessary. These must be done between 4 weeks and 6 months after the original plan. SIP of $150 Plus Consultation fees Min. $290 - $360 per patient, p.a
additional consults and EPC Care Plan revenues.

Mental Health

NB: 3 Step Mental Health Program able to be claimed until APRIL 2007

Practice Incentive Payments and Service Incentive Payments Summary

ITEM Tier 1:
The practice maintains electronic patient records, which include clinical data on allergies/sensitivities for the majority of active patients; and The practice implements appropriate information security measures (eg: virus protection, firewall, backup& recovery, access control and practice procedures/processes to support/maintain appropriate information security). The practice also uses appropriate security (e.g. encryption )

ACTIVITY

PIP
$4.00 (per SWPE)

NOTES
A Security Self Assessment (SSA) tool has been developed for this purpose. The SSA is based on the materials developed by the GPCG. Practices must meet all the requirements in the SSA that apply to their practice IT category. Practices may wish to use and IM/IT specialist to assist with the SSA A copy of the SSA can be found at www.gpcg.org.au or contact your division on 43 65 2294

IM / IT

Tier 2:
The practice qualifies for Tier 1 and The practice uses electronic patient records to record and store clinical information n the majority of active patient records, including current and past major diagnoses and current medications. $3.00 (per SWPE)

Payments for the IM/IT incentive will be paid quarterly The practice must inform Medicare of any changes that may affect the practices eligibility for the PIP/SIP incentive

ITEM

ACTIVITY Tier 1:

Practices that qualify to Tier 2, have already met the requirements for Tier 1. Therefore the total payment received by practices will be: $3 + $4 = $7 per SWPE

PIP

NOTES

After Hours Care

Ensuring patients have access to 24-hour care as specified in the application form.

$2.00 (per SWPE)

After Hours refers to any time outside 8am to 6pm weekdays and 8am to 12noon on Saturday

Tier 2:
Practices > 2000 SWPE On average, the practice covers at least 15 hours per week of its after hours care from within the practice Practices < 2000 SWPE On average, the practice covers at least 10 hours per week of its after hours care from within the practice $2.00 (per SWPE) This arrangement must be for all its patients This is in addition to Tier 1 payment

Tier 3:
The practice provides 24-hour care from within the practice

$2.00 (per SWPE)

All after hours care must be provided to all patients from within the practice. This is in addition to Tier 1&2 payments

Quality Prescribing

Practice participation in quality use of medicines programs, endorsed by The National Prescribing Service

$1.00 (per SWPE)

This incentive is to assist practices in keeping up to date with information on the quality use of medicines. Payment will only be made if the practice meets a minimum participation level, set at three activities per FTE GP per year

Teaching

Teaching of medical students

Enquiries: CCDGP 4365 2294

or

Medicare

Payments are made to practices that host university medical student placements. $100 per session Maximum2 sessions per day (As per Australia PIP Helpline: 1800 222 032 or www.medicareaustralia.gov.au www.medicareaustralia.gov.ay/providers/incentives/allowances/pip )

GP Management Plan
Flow Chart Item 721

GP Management Plan
Patient with chronic condition that has been, or is likely to be present, for at least six months or that is terminal. (Not necessarily requiring multidisciplinary care). Identify

GPMP Set up Item 721

Claimed by GP with assistance of PN or other Every 2 years

GPMP Review Item 732

Claimed by GP with assistance of PN or other Every 3-6 months, or when clinically required

Contact patient by phone or send a letter Arrange a time to see the patient This can be carried out in a number of ways by a number of people: Opportunistically- when patients make an appointment with the practice, flag them as eligible for a GPMP Register and recall system The Pencs Clinical Audit Tool to generate a list of eligible patients, excluding in-active patients etc. General Practitioner Practice Nurse Reception/ Administration staff Practice Manager Prepare a written plan using the practice template and keep in patient file. This can be prepared: Prior to, or during the consult with the patient, book a long consult with the GP By the practice nurse, Allied Health Professional (AHP) or an Aboriginal Health Worker (AHW) with or with out the patient present. If preparation is done by practice nurse, AHP or an AHW it must be followed by a 10-15 minute consult with the patients normal GP to finalise and sign the plan. Include: Individualised goal setting, information and advice for the patient List and record information and resources handed to or discussed with patient The person providing the service and their contact details Lifestyle goals/ changes to achieve such as smoking status, nutrition, alcohol intake and physical activity level as well as addressing the guidelines for management of the chronic condition(s) the patient is diagnosed with.

Prepare

Consult

Check for eligibility and existing care plan- ask patient/ check with Medicare Australia Discuss benefits of and cost involved in the care plan Assess patient Identify, agree to and record patient needs and relevant conditions, goals to be achieved, actions planned, and the person providing the treatment/ service Patient signature or a record of their consent on plan and print a copy for patient Add a copy to the patients file and if a copy is required by any other health providers, patient consent for information sharing must be recorded Discuss options for Team Care Arrangement Plan (if clinically required) Schedule date for review of plan in 3-6 months time If the patient has: Diabetes- complete and Annual Cycle of Care SIP and consider group referral (see over). Asthma- consider the Asthma Annual Cycle of Care SIP A mental health issue- consider GP Mental Health Care Plan A mental health issue and complex health care needs- they are also eligible for the GP Mental Health Care Plan: Item number 2710 or 2702 as well as 723 and 721 Claim Item Number 721. The GP can claim the item number once all documentation is complete, patient consent obtained and the GP has seen the patient.

After

Examples of Chronic Diseases

721 and 723 Guidelines

A GPMP and a TCA can both be claimed at the same time provided the two services are delivered as per the Medicare items. The TCA does not need to be an entirely separate document to the GPMP preventing unnecessary duplication. Provided the relevant information is documented. The TCA can be included as an addition to the patient's GPMP as an extra page that includes the goals, the collaborating providers, the treatment/services they have agreed to provide, patient actions and a review date. A separate standard consultation should not be billed with a GPMP, TCA or review of either service unless it is clinically indicated that a problem must be treated immediately; or the GPMP was not the original purpose of the consultation. Accounts that include both a CDM item and a consultation must be annotated accordingly.

AIDS/ HIV Arthritisosteoarthritis, osteoporosis, rheumatoid arthritis Asthma Chronic Kidney Disease COPD Chronic Renal Impairment Colorectal Cancer Coronary Heart Disease Dementia Diabetes Lung Cancer Mental Health Most cancers (excluding BCC, SCC of skin) Multiple Sclerosis Oral Diseases Palliative care Parkinsons Disease Prostate Cancer Stroke Thyroid illness

721 Referral Options

As of May 1 2007, the allied health items 81100 to 81125 allows people with type 2 diabetes with a GPMP to receive Medicare rebates for group services provided by eligible diabetes educators, exercise physiologists and dietitians, on referral from a GP. These services are in addition to the five individual allied health services available to eligible patients each calendar year under items 10950 to 10970. For more information visit the Department of Health and Ageing website at: www.health.gov.au/epc

723 Referral Options

Patients with both a GPMP and TCA in place are eligible for 5 Allied Health rebated services and per calendar year. Allied Health Professionals who utilise these rebated visits include: Aboriginal Health Worker, Audiologist, Chiropractor, Diabetes Educator, Dietitian, Exercise Physiologist, Mental Health Worker, Occupational Therapist, Osteopath, Physiotherapist, Podiatrist, Psychologist, and Speech Pathologist. In a TCA referrals can be made to other professionals that are not involved in Medicare rebates these can include: Asthma Educator, Social worker, Quitline, Arthritis SA, Weight management, Home Medicines Review, RDNS, Helping Hand, Meals On Wheels, Pharmacists (preferably for medication management through a Home Medicines Review- Item 900), and the Practice Nurse (as long as they are providing a service independent to the role of the GP.)

Exclusion List

Obesity, Smoking, Unspecified chronic pain, Pregnancy, Impaired glucose tolerance, Hypercholesterolaemia, Hypertension and Syndrome X.
On their own these are not regarded as chronic conditions. A patient may have complications or co-morbidities that may be a result of or exacerbated by such risk factors making them eligible for CDM services.

Resources
For resources, referral forms and templates visit www.megpn.com.au.

Melbourne East GP Network acknowledges Adelaide North East Division of General Practice for the development of this flowchart

Team Care Arrangement

Flow Chart Item 723

Team Care Arrangement

Claim with or with out a GP Management Plan Claimed by GP with assistance For patients requiring multidisciplinary care Identify

TCA Preparation Item 723

Claimed by GP with assistance of PN or other Every 6 months

TCA Review Item 732

Claimed by GP with assistance of PN or other Every 3-6 months, or when clinically required

A Team Care Arrangement allows patients with chronic conditions needing multidisciplinary care access to Allied Health Professionals accompanied with Medicare Rebates for these visits (5 visits per calendar year per patient). Identifying eligible patients can be carried out in a number of ways: During the preparation of the GP Management Plan discuss whether the patient could benefit from the care provided by another health professional(s) and decide what profession(s) would be most beneficial. Prior to consult; in a previous consult it may have been discussed what Health Professionals would be required. After a number of months with a GPMP in place the patient might require outside health professional in put into the management of their chronic disease, a TCA can be prepared at this point in time.

Prepare

Communicate with the identified Allied Health Professionals (AHP) via phone conversation, email, letter or fax regarding the individual needs of the patient goals and outcomes desired. Discuss reporting/ communication methods between the AHP and the GP in relation to patient progress. Confirm the bulk billing or gap arrangements that suit the patients needs. Note: to be eligible to receive the 5 allied health rebated visits the patient MUST have both a 721 AND 723 claimed and recorded with Medicare Australia. If the claim is made via mail this can take up to 2 weeks to process by Medicare; delaying the closest possible AHP visit to 2 weeks after the claim of a 723. A separate document for a TCA is not necessary if there is an existing GPMP. Document the AHP or other health professional involved in the TCA, their name, contact details, agreement to participate, and the goals for their treatment and services for the patient.

Consult

Discuss AHP goals with the patient either prior to confirmation with AHP (claim a normal consult or if appropriate an item 721- preparation of a GP Management Plan) or following confirmation with AHP (in this case an item 723 can be claimed on the day of the consult with the patient). Note: Prior to claiming item 723 participation from all AHP must be confirmed Practice Nurse can be utilised to discuss option for care with patient, and investigate AHP and other health professionals and gain agreement to participate. Fill in the EPC Referral Form- indicating the number of visits allocated the AHP filling in separate forms for each AHP involved. Give form(s) to patient for AHP to claim for the rebate from Medicare. Patient signature or a record of their consent on plan and print a copy for patient Add a copy to the patients file and if a copy is required by any other health providers, patient consent for information sharing must be recorded Schedule date for review of plan in 3-6 months time If the patient has: Diabetes- complete and Annual Cycle of Care SIP if required.

After

Claim Item Number 723. The GP can claim the item number once all documentation is complete, patient consent obtained, agreement from AHP to participate and the GP has seen the patient.

Examples of Chronic Diseases

721 and 723 Guidelines

A GPMP and a TCA can both be claimed at the same time provided the two services are delivered as per the Medicare items. The TCA does not need to be an entirely separate document to the GPMP preventing unnecessary duplication. Provided the relevant information is documented. The TCA can be included as an addition to the patient's GPMP as an extra page that includes the goals, the collaborating providers, the treatment/services they have agreed to provide, patient actions and a review date. A separate standard consultation should not be billed with a GPMP, TCA or review of either service unless it is clinically indicated that a problem must be treated immediately; or the GPMP was not the original purpose of the consultation. Accounts that include both a CDM item and a consultation must be annotated accordingly.

AIDS/ HIV Arthritisosteoarthritis, osteoporosis, rheumatoid arthritis Asthma Chronic Kidney Disease COPD Chronic Renal Impairment Colorectal Cancer Coronary Heart Disease Dementia Diabetes Lung Cancer Mental Health Most cancers (excluding BCC, SCC of skin) Multiple Sclerosis Oral Diseases Palliative care Parkinsons Disease Prostate Cancer Stroke Thyroid illness

721 Referral Options

As of May 1 2007, the allied health items 81100 to 81125 allows people with type 2 diabetes with a GPMP to receive Medicare rebates for group services provided by eligible diabetes educators, exercise physiologists and dietitians, on referral from a GP. These services are in addition to the five individual allied health services available to eligible patients each calendar year under items 10950 to 10970. For more information visit the Department of Health and Ageing website at: www.health.gov.au/epc

723 Referral Options

Patients with both a GPMP and TCA in place are eligible for 5 Allied Health rebated services per calendar year. Allied Health Professionals who utilise these rebated visits include: Aboriginal Health Worker, Audiologist, Chiropractor, Diabetes Educator, Dietitian, Exercise Physiologist, Mental Health Worker, Occupational Therapist, Osteopath, Physiotherapist, Podiatrist, Psychologist, and Speech Pathologist. In a TCA referrals can be made to other professionals that are not involved in Medicare rebates these can include: Asthma Educator, Social worker, Quitline, Arthritis SA, Weight management, Home Medicines Review, RDNS, Helping Hand, Meals On Wheels, Pharmacists (preferably for medication management through a Home Medicines Review- Item 900), and the Practice Nurse (as long as they are providing a service independent to the role of the GP.)

Exclusion List

Obesity, smoking, unspecified chronic pain, pregnancy, impaired glucose tolerance, hypercholesterolaemia, hypertension and Syndrome X.
On their own these are not regarded as chronic conditions. A patient may have complications or co-morbidities that may be a result of or exacerbated by such risk factors making them eligible for CDM services.

Resources
For resources, referral forms and templates visit www.megpn.com.au.

Melbourne East GP Network acknowledges Adelaide North East Division of General Practice for the development of this flowchart