The Department of Health, Disability and Ageing has finally revealed the finer detail of its chronic disease management overhaul.
The new GP MBS fee for preparing and reviewing chronic condition management plans has been set at $156.55, meaning GPs will be earning slightly less for writing care plans going forward.
Changes to chronic disease management were first flagged in the 2023 budget and were originally meant to be in place by November 2024.
In September 2024, implementation was delayed by eight months to July 2025.
Officially, the deferral was to allow time for practices, providers and GP software vendors to adapt to the planned changes.
The planned rebates for the new set of items were kept confidential even from the AMA and RACGP members in the implementation liaison group working on the project.
“We did have some representation on the implementation liaison group who developed the rules around the policy changes, but that group wasn’t privy to the financial information and the proposed rebate structure,” AMA president Dr Danielle McMullen told The Medical Republic.
“[It] was, I think, a failing of the process because policy and funding go hand in hand in terms of outcomes.”
The full suite of changes, according to an MBS fact sheet released on Thursday evening, will see GP management plan items 229, 721, 92024, 92055, team care arrangement items 230, 723, 92025 and review items 233, 732, 92028, 92059 rolled into eight new items.
Preparing a GP chronic condition management plan will be covered under item 965 or 392 for face-to-face and 92029 or 92060 for video, while reviews will be covered under item 967 or 393 for face-to-face and 92030 or 92061 for video.
The rebates for these items will be $156.55 for GPs and $125.30 for other medical practitioners.
In a move intended to encourage patient follow-up, the rebate for reviewing a plan will now be equal to the rebate for writing a plan.
Plans can be written once every 12 months and reviews can be conducted once every three months.
Theoretically, the maximum available chronic disease funding per patient per year – assuming one plan and three quarterly reviews – is now $626.20.
Previously, the rebate for preparing a plan was $164.35, the rebate for preparing a team care arrangement was $130.25 and the rebate for a review of either was $82.10.
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Dr McMullen said the AMA was concerned the new pricing structure would constitute a cut in real terms for many practices.
“We know that often practices use quite a lot of practice nurse time as well as GP time to both prepare and review these items,” she said.
“We know that some practices where there was a comprehensive GP management plan and a separate team care arrangement in place, that when they were reviewing those they were reviewing both documents and claiming two of the 732 [review] items.
“We do think that the maximal available funding over the course of a year for an individual patient has been cut, as well as the individual rebate for the [plan preparation], and remain disappointed.”
RACGP president Dr Michael Wright said college members would likely increase prices if they perceived a cut to chronic condition rebates.
“These items are the most commonly bulk billed of all the GP items, and we’ve surveyed our members before … and our members have told us that if there were any cuts to the overall funding, it’s going to result in increased out of pocket costs for patients and lower bulk billing rates,” he told TMR.
“And that’s going to lead to worse health outcomes and increased hospitalisations.”
From 1 July, GPs will also no longer be required to fill out a specific form to refer for allied health services and can instead use the same letter format used to refer patients to non-GP specialists.
The requirement to consult with at least two collaborating providers before referring patients to allied health service, a requirement under the team care arrangement system, will also be dropped.
Another key change is that patients who are registered under MyMedicare will be required to see their nominated practice to access one of the new chronic condition care plans.
Patients who are not enrolled can see their usual GP and access a chronic condition care plan without registering.
Patients that have a GP management plan or team care arrangement put into place before July 2025 will continue to be able to access services consistent with that plan until July 2027.
The time given to implement the changes has been criticised by the RACGP who admit that the Government announcement will generate frustration in both GPs and patients.
“There will be a large number of patients and practice staff who will already be booked under the current model, and software providers will need to act fast to be ready by the start date,” Dr Michael Wright stated.
“I know this short notice gives little time to adapt to this major change that will significantly impact general practice workflows.
“That’s why the RACGP will be there every step of the way to support GPs and practices.”
