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?