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Chronic Disease Items – time for a rethink?

The number of our patients with chronic diseases and complex care needs is increasing and the current system does not support the provision of well-coordinated multidisciplinary care. Existing Medicare funded chronic disease management (CDM) arrangements are too limited, cumbersome, and difficult for patients to access, and are wrapped up in red tape and bureaucracy.

29 Jan 2013

The number of our patients with chronic diseases and complex care needs is increasing and the current system does not support the provision of well-coordinated multidisciplinary care. 

Existing Medicare funded chronic disease management (CDM) arrangements are too limited, cumbersome, and difficult for patients to access, and are wrapped up in red tape and bureaucracy.

The great failure of current arrangements is that they were designed by bureaucrats with little understanding of how day-to-day general practice works.

It is well known that governments are happy to use red tape to try and control program expenditure and many GPs would share my suspicions that this is the real reason why the current CDM items have so many compliance requirements that are in no way linked to good clinical care.

There is no evidence to demonstrate that the compliance requirements involved in CDM items are leading to better outcomes for patients, although there is plenty of evidence that GPs are very frustrated at the lengths they must go to ensure that patients can access the care they need.

The AMA believes there is a better way and last year revised its chronic disease plan. 

The revised plan proposes arrangements that would better support GPs to provide patients with chronic and complex disease with access to multidisciplinary care and essential support services.  The AMA plan recognises how GPs work at the coalface and what type of care patients need. 

The AMA has been pushing this plan and recent talks with the Department of Health and Ageing (DOHA) indicate that the Department, too, is coming to the view that it may well be time to have a closer look at the CDM items to see if there are possibilities for a less prescriptive approach that fits more closely with accepted clinical practice.

DOHA is about to embark on a consultation process and the AMA will be very much engaged in this process.

We also know that, based on MBS data, the number of CDM review items (732) claimed is much lower than the number of GPMP (721) and TCA (723) items claimed.

This highlights to me that, while GPs review patients on a regular basis, they are billing the normal consultation items so as to avoid the red tape requirements of the review items. 

It is good to see that the AMA’s chronic disease plan has at least got the Government thinking about a new approach to CDM items.

While it is very early days in this discussion, and we have seen past efforts at reform achieve very little, including MBS simplification, there may prove to be an opportunity to deliver sensible changes that recognise quality GP care and better support patients to access the care they need.


Published: 29 Jan 2013