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30 Sep 2014

With GP co-payments dominating media and advocacy priorities since early 2014, previous discussions around reforming chronic disease management (CDM) items in the Medicare Benefit Schedule (MBS) have not progressed. It is time for this conversation to be kick-started and reach a successful and appropriate conclusion.

Evidence shows that a comprehensive, coordinated and longitudinal approach to the management of chronic and complex disease delivers good outcomes for patients, improving their health and wellbeing. It can also help reduce health system costs that arise from poor health outcomes and avoidable hospital admissions.

Instead of focussing on how it can further strip funding from frontline care, it is time for the Government to turn its attention to how it can make better use of available health funding. Investing in primary health care to support quality general practice is the answer.

To help reduce the burden of chronic disease on health expenditure, GPs need to be supported to provide preventive care and proactive management of chronic disease.  It is important that funding for this essential work be well targeted and directed towards high quality care.

We know that the Department of Health thinks that the claiming data on current CDM items indicates that they are not being utilised as intended. They point to the fact almost every GP Management Plan results in a Team Care Arrangement, with few reviews being undertaken.

This presents an opportunity for the profession to take a proactive approach to the reform of existing items, particularly if we want to avoid the sort of blunt cuts we saw applied to the GP Mental Health items a few years ago.

There is also the opportunity to push for cuts to red tape as part of sensible reform. There is too much focus in the existing items on paperwork and compliance, when what we need is time to have a real conversation with patients about their care needs, and to develop a structured approach to their care. Streamlined referral processes to allied health for patients who need this is essential.

The AMA has consistently stated its willingness to help make chronic disease items work better for patients and GPs alike. We want to see investment in quality, longitudinal care, built around the central role of the usual GP. The items need to reflect modern GP practice so that we can focus on delivering care for patients.

Making the CDM items work better will necessitate revisiting the regulatory requirements of the CDM items and making appropriate changes. Given some of the poor templates for management plans and team care arrangements I’ve seen residing in desktop software, they too will need a revamp.

There is some light at the end of the tunnel.

After pressure from the AMA, the Health Department is now looking again at how it can work with the profession to get the CDM items right. This is a discussion we have to have. Policy cannot be driven by the limited examples of poor practice that the Department sees taking place, but instead should focus on how we can better support the vast majority of GPs who are doing great work in this area.

The AMA’s role in this debate will be to ensure that vital funding is protected and directed to supporting high quality GP care and improved health outcomes for patients. 

Published: 30 Sep 2014