The MBS Review Advisory Committee has released a draft report recommending that the number of individual MBS-referred chronic condition management services be upped from five per year to 12, with Indigenous patients able to access as many as 17.
It would mark the first significant change to chronic condition management services since their introduction 22 years ago.
The draft report, which was published this week, also recommended replacing the ‘at least 20 minutes’ individual MBS-referred CCM service items with three time-tiered items, covering appointments of at least 20 minutes, at least 40 minutes, or at least 60 minutes.
These, it said, should have “proportional per-minute benefits”.
Other recommendations included expanding eligibility for MBS group services to patients with one or more conditions, as well as allowing group services to be provided by mental health social workers, chiropractors, physiotherapists, and speech pathologists.
“The CCM Working Group advised that costs will be controlled by several factors, including: having general practitioners as the ‘gatekeepers’ to CCM services; workforce capacity; the time needed to shift to group service models of care; [and] the variation in uptake of services,” the draft report read.
“Implementation of these recommendations is subject to Government consideration through a Budget process.”
Chronic condition management would continue to be funded through the GP Chronic Condition Management Plan item; there were no suggested changes to the way that these plans were created and formulated.
Instead, the MRAC review focussed on what patients were able to access through a GPCCMP.
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Medicare data showed that about one third of patients currently reach the annual cap of five subsidised services per calendar year. Almost 80% of GPCCMPs are used for physiotherapy or podiatry, and the majority are written for Australians over the age of 60.
According to the draft report, providers and patients have consistently raised concerns about the number of appointments needed to be effective, arguing that longer and more frequent appointments would have a greater impact.
“The findings from the qualitative research showed that peak bodies, providers and patients all support increasing the number of individual sessions available each calendar year,” it read.
“Feedback noted that patient needs evolve and that they often require access to more than one health professional for treatment (especially patients with a complex chronic condition or multimorbidity), which quickly reduces the number of reimbursable sessions.”
Quantitative research, meanwhile, found that the common midpoint session length was 40 to 44 minutes, significantly longer than what was currently funded.
“The current discrepancy between the 20-minute floor and typical session lengths results in a gap fee that either increases financial burden for patients or is absorbed by providers, affecting financial viability,” the report read.
“As well as addressing these issues, increasing the session length could reduce provider burnout and improve quality of care for patients.”
Once the review is finalised, MRAC will formally provide recommendations to the government for budget consideration.
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