Australian Doctor Australia Doctor 18th August 2017 | Page 13

How will GPs be paid to work under the Health Care Homes scheme ?

THE basic premise of the Health Care Homes reform is to free up practices from the strictures of fee-for-service MBS item descriptors . The biggest restriction on doctors is that the MBS only funds ( with a few exceptions ) the care provided when the GP is in the room , face to face with the patient .

Practices don ’ t receive funds for sending test results by text , or speaking to patients on the telephone .

Practices can ’ t run shared medical appointments funded by Medicare or offer small group health coaching .

They don ’ t get funds for care co-ordination - making sure patients turn up to specialist appointments for instance .

So the revolution is that practices in the trial will be offered bundled payments — with the freedom to cover the patient ’ s chronic disease care in ways beyond what the MBS schedule currently allows .

There are three levels of funding ( see box ). The funding goes to the practice , not the GP . The practice is free to use the money to fund nurses , medical practice assistants and even nurse practitioners with the power to prescribe and to make specialist referrals under Medicare .

This might be the attraction for practice owners . Yes , they will have to negotiate with their GPs about what they are paid for the work they do — hence why the reforms should be seen as a big deal for the financial future of GPs . There is also the question of how much clinical control GPs will retain over the management of patients .

However , the flow of funds means that practices , in theory , can cut the costs of caring for their enrolled patients by task substitution .

Under the health department rules , the bundled money will have to be used to develop a patient ’ s electronic shared care plan — this is fundamental . This shared care plan , which will be drawn up by a GP , will include real-time information to aid decision making as well as a list of treatment goals and an outline of who in the healthcare team is responsible for what .

Beyond the shared care plan , the bundled payments can be used to cover the cost of reviewing the patient , conducting comprehensive health assessments , case conferencing , telehealth services and any after-hours care related to the patient ’ s chronic condition . But they will not cover the costs of allied health .

Under the system , patients will access Medicare-funded allied health services , with the same number of services triggered by MBS GP management plans . But access will be automatic for enrolled patients — no MBS management plan claim needed .

The bundled payments will not be expected to cover the cost of specialist care either . But the funds will have to cover diagnostic services ( radiology and pathology ) used as part of the monitoring and management of a patient ’ s chronic condition .

In terms of co-payments , practices will be allowed to ask enrolled patients for a financial ‘ contribution ’ to their health care .

How many enrolled patients will each full-time equivalent GP be expected to care for ? The Federal Department of Health suggests , on average , around 55 registered patients — so , initially , only a relatively small part of GP income will come through this radical , new funding model .

Patients whose health status changes dramatically will be able to move into different funding tiers during the year , but that will require an application to the health department .

Enrolled patients will still access fee-for-service MBS rebates for acute care unrelated to their chronic and complex condition . However , it is expected that the number of claims will be small . ●

Introducing BELSOMRA ® ( suvorexant )

The only orexin receptor antagonist demonstrated to help patients fall asleep and stay asleep 1 , 2

BELSOMRA is indicated for the treatment of insomnia characterised by difficulties with sleep onset and / or sleep maintenance . 1

Following initiation of treatment , continuation should be re-evaluated after 3 months . 1

> 5 million prescriptions written worldwide 3

LEVELS OF FUNDING

PBS Information : This product is not listed on the PBS .

BEFORE PRESCRIBING , PLEASE REVIEW THE APPROVED PRODUCT INFORMATION . PRODUCT INFORMATION IS AVAILABLE AT WWW . MSDINFO . COM . AU / BELSOMRAPI

BELSOMRA ® ( suvorexant 15mg and 20mg ). Indications : Treatment of insomnia , characterised by difficulties with sleep onset and / or sleep maintenance . Continuation should be re-evaluated after 3 months . Contraindications : Narcolepsy ; hypersensitivity to any ingredient . Precautions : Somnolence and CNS depressant effects , impairment of driving skills and other activities that require mental alertness , rule out underlying psychiatric or physical disorders causing worsening of insomnia , complex behaviours associated with use of hypnotics such as sleep driving , worsening depression or suicidal ideation , presence of severe COPD or severe OSA , sleep paralysis , hypnagogic / hypnopompic hallucinations , cataplexy-like symptoms , abuse , severe hepatic impairment . Interactions : Co-administration with other CNS depressants or alcohol ; strong or moderate CYP3A inhibitors , CYP3A inducers , midazolam , digoxin . Adverse effects : fatigue , upper respiratory tract infection , diarrhoea , dry mouth , nausea , dizziness , somnolence , headache , abnormal dreams , medication administration error , others : see full PI . Post-marketing experience : nightmare . Dosage : Take no more than once per night and within 30 minutes of going to bed , with at least 7 hours remaining before the planned time of awakening . Based on PI approved 23 December 2016 .

References : 1 . BELSOMRA Product Information . 2 . Herring WJ et al . J Clin Sleep Med 2016 ; 12 ( 9 ): 1215 – 25 & Supplementary Tables . 3 . IMS Health , National Prescription Audit ( US and Japan ), November 2014 – September 2016 .

Copyright © 2017 Merck Sharp & Dohme Corp a subsidiary of Merck & Co . Inc ., Kenilworth , New Jersey , USA . All rights reserved . Merck Sharp & Dohme ( Australia ) Pty Limited , Level 1 , Building A , 26 Talavera Rd , Macquarie Park , NSW 2113 Australia . NEUR-1207010-0028 . First issued June 2017 . BEL0011 / AD _ FPC .

Top level — $ 1795 a year High-risk chronic and complex needs patients . Covers 1 % of the population . Will include palliative care patients .

Medium level — $ 1267 a year Multi-morbidity and moderate needs chronic disease patients who need support in managing their condition . Covers 9 % of the population .

Low level — $ 591 a year Largely self-managing patients with multiple conditions , covering 10 % of the population .

www . australiandoctor . com . au 18 August 2017 | Australian Doctor | 13