New MBS item numbers for eating disorders: What GPs need to know

Amanda Lyons

29/11/2019 3:20:57 PM

The new items, designed to help patients with these debilitating and hard-to-treat disorders, may also draw the map for treatment of other complex health problems.

Young woman with water bottle
Eating disorders ‘have one of the highest mortality rates of any psychiatric illness’.

‘They are extremely complex illnesses, and have one of the highest mortality rates of any psychiatric illness.’
That is Australia’s Federal Health Minister Greg Hunt describing eating disorders earlier this year.
Minister Hunt made his comments as he announced $5 million in funding for research into eating disorders.
In addition to this funding boost, the Federal Government has implemented new Medicare Benefits Scheme (MBS) item numbers for the treatment and management of eating disorders, starting from 1 November.
The new items come in a suite of 64, 11 of which are available for GPs. They are designed to enable patients with severe and complex eating-disorder presentations to access up to 40 sessions of psychological treatment and up to 20 sessions with a dietitian every year under an Eating Disorder Plan (EDP).
The new item numbers also enable treatment under a stepped-care model, a decision Dr Cathy Andronis, Chair of the RACGP Specific Interests Psychological Medicine network, describes as innovative.
‘Stepped-care models enable those who need more intensive care to access more sessions, rather than using mental health plans and a one-size-fits-all approach,’ she told newsGP.
According to Dr Jenny Conway, a GP with a special interest in eating disorders, general practice is central in the application of the new MBS numbers.
‘The GP’s role is pivotal in implementing these item numbers as we are one of the health professionals who can assess the patients and, if eligible, then perform the new EDP,’ she told newsGP.
‘The EDP is available to all patients with a diagnosis of anorexia nervosa, as well as patients with severe and complex presentations of bulimia nervosa, binge eating disorder or other specified feeding and eating disorders.
‘Other patients with less severe illness can still access Medicare-rebated sessions under the Better Access mental health care plan and Chronic Disease Management, [as well as] team care arrangements.’
Dr Andronis acknowledged that implementing the EDP, which involves a different approach from earlier treatment plans, may present GPs with a ‘steep learning curve’.
‘It’s a whole new model where you integrate biological and mental health referrals,’ she said. ‘So you have to be much more aware of how to coordinate care for the patient, and also be able to do the monitoring of the medical issues involved in eating disorders, making the plan quite complex in some respects.’
However, Dr Andronis believes the new approach enshrined by the EDP is a positive one, and its comprehensive nature helps to facilitate the monitoring GPs will need to undertake.
‘Having to review the patients at least every 10 sessions means that not only can you keep an eye on how the management is going and monitor medical issues, you’re also involved in the care and the system is coordinated,’ she said.

Dr Cathy Andronis is hopeful the new MBS items for eating disorders will prove successful, and perhaps be considered for other complex disorders as well.

There have been some concerns within the profession that GPs may not be adequately equipped to implement these plans, given the different approach from prior models of treatment. To assist with this issue, Dr Conway highlighted a number of resources GPs can access for further information.
‘Excellent resources are available at the National Eating Disorders Collaboration website, including how to recognise early signs of an eating disorder, links to current guidelines for assessment and cheat-sheets to help GPs navigate the new item numbers,’ she said.
Eating Disorders Victoria also has very useful resources for both GPs and patients, as does the Butterfly Foundation, including information about support groups and helplines.’
There were also some criticisms of the proposed new item numbers when the MBS Review Taskforce report by the Eating Disorders Working Group was released. Chief among these was the suggestion that the stepped approach was restricted to such a small section of the patient population when it could be potentially effective in managing other health issues; for example, other types of mental health problems such as bipolar disorder, or complex physical issues such as obesity.
Dr Andronis, who was involved in the Eating Disorders Working Group review, said she understands and appreciates these concerns, but explained the MBS wanted ‘to start somewhere’.
‘The Government wanted to start with one group, and focus particularly on a group that had high mortality rates,’ she said.
‘Anorexia patients have the highest mortality rates. They also have lots of longer-term medical conditions and morbidity because of their eating disorder.’
Dr Andronis characterises the new item numbers and the implementation of the EDP as representing ‘a whole new way of operating’ for the MBS, with the possibility of extension to other healthcare issues.
‘The program is apparently to be reviewed in a year’s time and, if successful, it can hopefully be extended to people who have other mental health needs and disorders that also need more intensive care,’ she said.
‘It’s really a good way to practice a stepped-care model, which means you get more care to those who need it, in a much more efficient way.
‘So let’s see what happens.’
In the meantime, Dr Aline Smith, another GP with a special interest in eating disorders, is simply hopeful that GPs will use the item numbers to help patients with severe and complex eating disorders gain access to the help they need.  
‘I am hoping that these MBS items will be used widely by GPs to refer their patients to appropriate, evidence-based services to effectively treat them, particularly those who have limited financial resources,’ she told newsGP.
‘I also hope they will motivate many more health professionals, including GPs, psychologists, psychiatrists and dietitians, to be upskilled in treatment of eating disorder patients.
‘This would be a great outcome of the items, not to mention getting patients the right evidence-based treatment at the right time with the right people.’

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Dr Karen Spielman   30/11/2019 10:11:18 AM

I agree with Drs Andronis and Smith that these new item numbers represent an exciting opportunity to work collaboratively with colleagues to provide appropriate comprehensive care to these high risk patients. I would also like to direct colleagues to resources at the Inside Out Institute (see link below) including an importable template for the GP EDP and links to training, resources and a treatment services database

Dr Annemie Beck   7/12/2019 7:31:27 PM

I have done 2 of these plans for patients since this option became available because I have a number of patients who has very severe Eating Disorders, however, I am appalled by the rebate allocated to this. Time spent to draw up this plan, with treatment options available.... 8 hours of research and preparation of some form of templates on a weekend prior to seeing the first patient. Consultation time with first patient...70 minutes to discuss options and write the plan and individual referrals. Second patient, I used the backbone of the documents from first patient, and it still took about 65 minutes! And the rebate is the same as for GP Mental Health Plan that is very comfortably prepared in 40 minutes, even leaving plenty of time to provide appropriate psycho education. Compare this with the rebates for GP management plan (item 721) which is frequently billed along with Team Care Arrangements (item 723) and I have to wonder what would entice a GP to even attempt a EDP?