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