Medicare Enhanced Primary Care is one of CMS’ largest advanced primary care models. This voluntary model aims to improve patient-centered care through improved care management, care integration, and community connection. In addition, it offers upside-only performance incentives to reward participants for efforts to improve quality of care and cost outcomes for their patients.
The program enables Medicare patients with chronic or terminal medical conditions to access up to five allied health treatment sessions each year. These sessions are designed to assist you and your GP manage your condition by providing multidisciplinary care involving a team of at least two other health and care providers (your GP, physiotherapist, occupational therapist or podiatrist) through a ‘care plan’. The GP then lodges this care plan with Medicare and provides you with a list of available allied health services for which you can claim rebates.
While this is a positive initiative, we believe that it may compromise clinical learn more about this here outcomes and inequity of outcome for some patients based on socioeconomic status and ability to pay. Research to determine how patients and allied health practitioners are responding to this approach is required, as well as to assess whether the five funded treatment sessions result in improved outcomes compared with standard clinical practice.
To support GPs in their use of the EPC items, a qualitative study was undertaken with 30 general practices in Sydney. Using semi-structured face-to-face interviews, this research explored GPs’ perceptions of the EPC items, their use in practice and barriers to implementing them.
The key themes that emerged from the interviews were time, organisation, communication and education. The findings of this study suggest that there is a need for further education and resources to help GPs implement the EPC items into their practice. Additionally, we recommend that GPs are offered more training in the clinical aspects of these initiatives to ensure that they are delivered by qualified professionals.
A more critical finding of this research was the need for a rethink of the referral process. Specifically, the need for medical specialists to be gatekeepers of all allied health care appointments is outdated and needs to be replaced with more flexible arrangements that allow AHPs to refer to other practitioners without the need for a medical referral. In doing so, this will allow a wider range of patients to benefit from AHP interventions and, potentially, help ease pressure on medical referral capacity.
In Australia, the Medicare Allied Health items were introduced to enable GPs to organise a team of healthcare professionals (including physiotherapists) to care for patients with a chronic or terminal medical condition. These were known as EPC (Enhanced Primary Care) items and were referred to as a ‘care plan’.
A similar model was recently introduced in Colorado, which combines an incentive-based payment structure with the provision of new MBS items for allied health professional interventions. This model may serve as a blueprint for how to integrate front line healthcare workers such as physiotherapists into mainstream Commonwealth primary health funding.