Fifine Cahill, Department of Health and Ageing:Nurse Practitioners and the Medicare Benefits Schedule (MBS): Medicare Rebates And Rules

NURSE PRACTITIONERS AND THE

MEDICARE BENEFITS SCHEDULE

(MBS)

MEDICARE REBATES AND RULES

Fifine Cahill

Assistant Secretary

Primary Care, Diagnostics and Radiation

Oncology Branch

Department of Health and Ageing

Overview

• Expanding Medicare Support for Nurse

Practitioners Measure

• Understanding the frameworks in place

• Current figures

• Looking towards the future

Expanding Medicare Support for

Nurse Practitioners Measure

• $36.6 million over four years was allocated in

the 2009-10 Budget.

• Representatives of professional groups were

members of the expert advisory group that

helped to develop the Measure.

• Medicare Benefits Schedule (MBS) nurse

practitioner items introduced on 1 November

2010

The measure was introduced to:

• Improve the flexibility and capacity of the

primary care health workforce;

• Advance the position of nurse

practitioners in private practice; and

• Provide a sustainable model of practice.

An eligible nurse practitioner can:

• treat their own patients;

• provide Medicare rebateable primary care

services within their scope of practice under:

- four time tiered attendance items;

- six telehealth items; and

- ten specific pathology items.

• www.mbsonline.gov.au

Within their scope of practice, nurse

practitioners may also:

• refer patients to specialists and

consultant physicians;

• prescribe medicines under the

Pharmaceutical Benefits Scheme;

• request pathology and diagnostic

imaging services.

To access Medicare arrangements,

an eligible nurse practitioner must:

• have a Medicare provider number;

• be working in a private practice;

• have professional indemnity insurance;

and

• have collaborative arrangements in place

with a medical practitioner.

• Medicare benefits are only payable for

nurse practitioner services provided

under a collaborative arrangement with

specified medical practitioners.

• Collaborative arrangements are

covered under the Health Insurance

Regulations 1975

Collaborative arrangements – nurse

practitioners

A collaborative arrangement between

a nurse practitioner and a medical

practitioner must always provide for:

• consultation;

• referral of a patient; and

• transfer of a patient’s care.

Forms of collaboration

• through an employment relationship; or

• referral to a nurse practitioner by a medical practitioner; or

• a written agreement between a nurse practitioner and a medical practitioner; or

• an arrangement acknowledged by the medical practitioner and patient and detailed in the nurse practitioner’s written records.

An eligible nurse practitioner can

provide services at:

• Nurse practitioner’s private consulting

rooms;

• The patient’s home;

• Health clinics;

• General practices; and

• Aboriginal Medical Centres.

Referral requirements

• Referrals must be within the nurse

practitioner’s scope of practice.

• A referral made by an eligible nurse

practitioner is valid for 12 months.

Current figures

1 November 2010 to 31 January

2013

• 148 nurse practitioners;

• 144,177 general attendance

services;

• 76,188 patients.

Current figures

1 November 2010 to 31 January

2013

• 130,807 PBS prescriptions;

• 2,178 diagnostic imaging requests;

• 35,886 pathology requests.

Current figures

1 November 2010 to 31 January 2013

• $3,809,466 paid in MBS rebates;

• $3,843,230 paid in PBS prescriptions

Nurse Practitioner Services by Selected Time

Periods, 1 November 2010 to 31 January 2013

Nurse Practitioner Services by MBS Item Number,

1 November 2010 to 31 January 2013

Nurse Practitioner Services by State/Territory,

1 November 2010 to 31 January 2013

Nurse Practitioner Services by Australian Geographical

Classification – Remoteness Areas, 1 November 2010 to

31 January 2013

Looking towards the future

• Aged Care Models of Practice

Program

• Collaborative Arrangements

Nurse Practitioner - Aged Care

Models of Practice Program

• In the 2010-11 Budget, the Government

provided $18.7 million over four years

to develop, test and evaluate a range of

models of nurse practitioners in the

aged care sector.

Nurse Practitioner - Aged Care

Models of Practice Program

The program aims to:

• identify effective, economically viable and

sustainable models of practice;

• facilitate the growth of the aged care

nurse practitioner workforce; and

• improve access to primary health care for

clients of residential and community aged

care services.

Nurse Practitioner - Aged Care

Models of Practice Program

• Funded organisations include:

• Individuals/sole traders;

• Small providers;

• Peak bodies;

• Medicare Locals;

• Consortiums; and

• Universities

Nurse Practitioner - Aged Care

Models of Practice Program

Models tested include nurse practitioners

working in:

• Private practice;

• Residential Aged Care Facilities;

• General practice;

• Specialist medical practice.

Nurse Practitioner - Aged Care Models

of Practice Program

• Projects are funded in all states and

territories.

• Projects are underway in rural, regional

and remote areas.

• Includes organisations providing

Aboriginal and Torres Strait Islander and

culturally specific care.

Nurse Practitioner - Aged Care

Models of Practice Program

National Evaluation:

• Undertaken by the University of Canberra.

• Evaluator collecting data on the cost,

financial viability and economic

sustainability of each model.

• Results of the evaluation, including best

practice models, available in 2015.

Collaborative arrangements –

midwives

• More Choice for Women – Expanding

Medicare Support for Midwives measure

introduced 1 November 2010.

• The inclusion of legislative requirements

for collaborative arrangements was

central to the introduction of the

midwifery and nurse practitioner

measures.

Collaborative arrangements –

midwives

• Collaboration between providers is

pivotal to ensuring safe, high quality

care and to enable the seamless

escalation of care if clinically required.

• Midwives report ongoing difficulties in

establishing collaborative arrangements

with individual medical practitioners.

Collaborative arrangements –

midwives

• The Commonwealth agreed to vary the

secondary legislation on collaborative

arrangements to enable agreements

between midwives and hospitals and

health services.

Collaborative arrangements –

midwives

• Collaboration will continue to be

fundamental to midwifery care under

Medicare and Midwives will continue to

be required to collaborate with doctors.

• The proposed change will be to the way

collaborative arrangements are

demonstrated.

Collaborative arrangements –

midwives

• There will still need to be pathways in

place for consultation, referral and

transfer of care to a medical practitioner,

where required.

• Stakeholder consultation is underway to

effect this change.

Questions and comments?