ACT pilot gives GPs an MBS-free option

4 minute read

A trial in the nation’s capital will experiment with block funding in its purest form.

Canberran GPs now have the option to dip their toes into the patient enrolment waters far earlier than expected, as a new pilot program seeks to prevent hospitalisations in at-risk cohorts.

The pilot, which is open to expressions of interest until April 2024, will be run through ACT primary health network Capital Health Network and has capacity for 15 practices.

These practices will enrol up to 25 patients whom they have identified as teetering on the verge of hospitalisation for a three-month intervention involving free-at-point-of-care consults and enhanced timely access to allied health. 

The whole trial lasts six months, so practices are expected to run two three-month patient cycles. Patients from the first cycle are allowed to continue in the second cycle if they choose.

Each practice gets a choice between two funding options.

The first option is fully funded, meaning the practice gets payments of $1210 per patient up front to cover the costs of five 40-minute consults, assuming a base rate of $6.06 per minute.

This works out to $242 for a 40-minute consult, more than double the $117.40 MBS rebate for a consult of that length.

GPs can choose how they split this time – the EOI documents note it could be done as 10 20-minute consults, for instance.

If a patient ends up requiring more than five 40-minute consults over the three-month intervention, practices will be recompensed at the end of the three-month cycle.

The only catch is that, should they choose this option, the practice must agree not to bill the patient at all: no private billing, no bulk billing, no MBS at all.

Practices that opt for the second stream must bulk bill, but do receive a larger chunk of cash on registration.

All participating practices, no matter which funding stream they choose, receive a payment of $3550 on engagement to cover the cost of selecting patients and setting everything up, along with $510 per enrolled patient.

Practices in the fully-funded stream get two extra block payments of $2000 – one on engagement and one at the six-month conclusion.

The bulk-billing practices, meanwhile, get $10,875 in block funding on engagement and another $10,875 at six months.

Participating practices also have access to a virtual medical specialist advisory service to help avoid the need for constant referrals.

“We want to do this because we recognise that GPs are at the centre of care for people with complex and chronic conditions who may need to use the emergency department more frequently than others, and that they have the capability to provide the level of care required,” said Emily De Alvia, part of the project team at the ACT Health Directorate.

“However, through this pilot we want to provide some additional support to GPs and stronger integration with the hospital system to facilitate ongoing and meaningful change.”

The target population is people who have complex multimorbidity and are at risk of hospital presentation in the next six months; people who are at high risk of hospital presentation in the next six weeks; and people who have had eight or more emergency department presentations in the last 12 months.

“It’s not for people who may need acute hospital services immediately or in the next week, but really for those people where we can see that they’re deteriorating and know that there’s something we could do to intervene before that happens,” Ms De Alvia said.

There’s no indication yet that the pilot is linked to MyMedicare, although MyMedicare will eventually include a stream targeting frequent hospital users.

The ACT project will be receiving federal government funding, but it’s from the $100m set aside in the October 2022 budget – long before the patient enrolment scheme was announced – for testing new models of primary care.

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