If a patient already has a GP management plan in place and comes in for a review, what happens? Let’s find out.
It’s less than a week until the chronic disease management item overhaul goes live, and questions about how exactly to manage patients through the transition still abound.
Luckily, the Department of Health, Disability and Ageing came out with answers to some of the more specific questions surrounding the change at an RACGP-run webinar on Tuesday.
While the exact item descriptor is yet to be released, a DoHDA fact sheet confirmed that each written plan must describe a patient’s chronic condition and associated healthcare needs, their health and lifestyle goals, actions to be taken by the patient, treatment and services the patient is likely to need and which services the patient will be referred to.
The new items will be eligible for the bulk billing incentive, but not the tripled bulk billing incentive available on the time-tiered consult items.
Here’s how the program will work under different scenarios.
My patient already received a new GP management plan in 2025, do I have to write a new one?
Patients who already have a plan in place can continue to access care as normal until that plan needs to be reviewed or renewed.
Speakers from the department’s MBS policy and review branch confirmed that the old chronic disease items would completely disappear from the MBS on 1 July.
While new GP management plans and team care arrangements will not be able to be created or reviewed, any existing plans – i.e. those made on or before June 30 – will still be valid.
It is only at the review or renewal point that the GP would have to switch to the new item numbers.
This is done by using the new plan preparation item number 965.
If a patient received a new GP management plan in April, for example, and returned for a review of that plan in September, the GP would have to prepare a new plan under the new item at that September appointment.
The patient, however, would be able to continue accessing services as normal under the April plan right up until the September plan was written.
My patient has already accessed some of the allied health services allotted to them under an existing GP management plan. Will these reset when I write a new plan?
DoHDA spokespeople also confirmed that making a new plan under the new chronic disease management items would not reset the number of allied health visits per calendar year, which is capped at five for non-Indigenous Australians and 10 for Aboriginal and Torres Strait Islander Australians.
Related
Continuing with the above example: if a patient received a GP management plan in April of this year, went on to access two allied health services under the April plan and then received a new plan in September, they would still only have three allied health services left for that year.
The number of subsidised allied health services resets to five on 1 January for all patients, regardless of when their plan was written.
I’ve heard these new plans can technically be reviewed ad infinitum. Is that true?
Under the new system, chronic condition management plans will be considered out of date if they were not written or reviewed within the previous 18 months; other than that, there is no time limit.
One of the major features of the reforms is that writing a plan will now draw the same rebate as reviewing a plan.
The creation-of-a-plan item needs to be used at least once, the DoHDA spokespeople told webinar audiences.
When an item 965 is claimed, it will act as a “trigger” for the other supports and items to come into place.
Following that, the spokespeople acknowledged that many patients may just have ongoing reviews for their original plan.
My patient has obesity. Will that still be included within the definition of a chronic disease?
The definition of a chronic condition is not changing as a part of the item number overhaul.
Generally, the DoHDA presenters said, GPs can exercise their own clinical judgement on when a patient may benefit from the multidisciplinary approach and structured format that a chronic condition management plan can unlock.
The DoHDA fact sheet on upcoming changes notes that there is “no list of eligible conditions” and defines a chronic medical condition as one that has been or is likely to be present for at least six months, or is terminal.
