From 1 July, the rebate for reviewing care plans will rise to $156.55, up from $82.10. The rebate for writing a plan will also be $156.55, down from $164.35, while the existing team care arrangements and GP management plans will be replaced with a single GP chronic condition management plan.
Medicare data shows that GPs much more commonly prepare once-a-year care plans, rather than reviewing existing plans, Dr Bollen explains. And to date, they’ve been financially better off to bill a level C consult where the triple bulk billing incentive applies, rather than a care plan review.
However, the new chronic condition care plan framework changes that, he says.
“GPs will likely be upset that the annual combined Care Plan (item 721) and Team Care Arrangement (item 723) MBS benefit has reduced from $294.60 to $156.55 under the new Chronic Condition Management Plan (item 965),” Dr Bollen acknowledges.
“If you haven’t been doing quarterly reviews, then this will definitely change your income.”
“However, by changing our own and our patients’ habits, performing quarterly reviews will both increase your income and increase the quality of the care you provide.”
To put it in perspective, under the new system if you write a care plan and then review every three months, you will receive an MBS amount of $626.20 per annum—compared to $459 if you write an annual care plan, team care arrangement and one review under the current system, Dr Bollen says.
Dr Bollen recommends using software such as CUBIKO to review your own use of items 721, 723 and 732, as well as reviewing those patients visits for prescription-related issues and follow-up tests for chronic conditions over a year.
“When you review your practice data, it becomes apparent that patients do visit the practice frequently, and missed opportunities for proactive care occur.”
“As a profession we do need to get rid of the attitude that care planning is all about the podiatry referral. We need to flip the conversation to discuss the purpose of these consultations,” he says.
He suggests framing it as a chance to plan for their healthcare and wellness needs over the next 12 months, with three-monthly reviews to ensure you both are on track.
Dr Bollen points to practices he works with that have run an audit tool across older patients aged over 75. They’ve been shocked to find that despite regular health assessments and care plan reviews, there are still clear gaps in care. In many cases, they haven’t updated practice software templates to ensure they align with the latest evidence, he adds.
The higher rebate for care plan reviews is an opportunity to address this, Dr Bollen says.
“This is an opportunity for formal quarterly review to proactively review your care, especially for people over 65 with multi-morbidities,” Dr Bollen says.
The focus needs to shift from seeing care plans as a document that’s required for someone to access allied health professionals, to an opportunity to identify their goals and support their health and wellbeing, he says.
“It’s a chance to ask, ‘What are the gaps in care? How can we actually help improve your wellness and your well-being and reduce your risk of ill health and hospital admission?’ That’s what care planning is all about.”
With team care arrangements ending from 1 July, he urges GPs to improve their communication with allied health professionals. Referral letters should include the patient’s history, medications and social history, he notes, but often those details are left out.
“Now that we don’t need to do team care arrangements, it’s a great opportunity to improve our relationships with all of the team,” he adds.
“From an outcomes perspective for patients, they’ll get more value out of it…more will be done in the practices that utilise nurses to do care plan reviews with the GPs.
While he says quarterly reviews are “a real positive,” they will require more organisation from practices.
He recommends pre-booking patients every quarter. “I was working with a really good practice the other day that does this so well. They say ‘So, I’m going to see you quarterly, we will bulk bill you for your care plan review. If you come in between, there will be a gap to pay, but at that quarterly review, we’ll focus on what are the things we proactively need to do to keep you upright and out of hospital.’ So, they’ve got this lovely spiel, and the patients book in every quarter.”
By pre-booking patients, they know how much work they’re going to have, he says – although as practices grow it will be a struggle to get enough nursing hours.
It’s also important to be clear on what’s in it for the patient, to make it worth their while.
The lack of improvement across the 10 national PIP-QI indicators indicates that for many people proactive care is either not occurring or not being tracked in many practices, leading to gaps in care, Dr Bollen says.
To address this, he recommends creating a checklist for each patient.
Along with discussing the patient’s goals and barriers to achieving them, and any necessary checks for their chronic conditions (e.g. blood tests, foot checks for diabetes etc) this allows you to proactively support their wellbeing incorporating:
For patients at risk of or living with frailty you can conduct a muscle health check (4m walk test, timed sit to stands x 5, grip strength with dynamometer), and all people aged 65 and up should be screened for frailty as per the RACGP Red Book guidance, he notes.
Another way to increase the value for both patients and practices is to combine the heart health check with a care plan review.
“You can link a health assessment with a review, and that’s something that will add value from a patient perspective, but also financially to the practice as well. You can dovetail those.”
While it takes too long to do the heart health check alongside preparing a new care plan, the review is less time-intensive, making it ideal to do both together.
Scrapping the team care arrangements will also benefit GPs, he says.
“You can reduce a lot of that unproductive work. This is very positive. There’s less low value paperwork to do,” Dr Bollen says.
“Instead, if a referral is required a GP will be sending a sensible letter to another health professional describing the patient’s current issues, and expectations, just as we do with a medical specialist.”
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