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RACGP CDM changes: A recap on what we know so far
With new Medicare items going live on 1 July, experts walk GPs through the billing, workflow, care team, and software changes it will create.
The MBS fee for the preparation or review of a plan will be $156.55 for GPs and $125.30 for prescribed medical practitioners.
With changes to Medicare chronic disease management (CDM) items coming on 1 July, RACGP members were recently given an overview of what it will mean for them on the ground, as well as the practical steps involved in the rollout.
Following record-breaking registrations, more than 1000 members attended the college-run webinar on 5 June, which is now available on the RACGP website.
Members also submitted hundreds of questions ahead of the event, with many answered by a panel made up of RACGP President Dr Michael Wright, RACGP Vice President Dr Ramya Raman, Cubiko founder Chris Smeed, and Best Practice Software Commercial and Government Head Jessica White.
The webinar comes as, from 1 July, the new CDM framework comes into effect.
Under the new regime, existing items for the preparation of GP management plans, team care arrangements and reviews will cease and be replaced with a new GP chronic condition management plan.
The Medicare items will be simplified to have a single item for plan preparation and a second item for plan review with the same Medicare rebate for both items.
The MBS fee for the preparation or review of a plan will be $156.55 for GPs and $125.30 for prescribed medical practitioners.
The RACGP requested further information from the Department of Health, Disability and Ageing (DoHDA) about transition and compliance arrangements following the webinar, and has indicated that it will share this information with members once received.
Dr Wright told the webinar the college wants to ensure the transition to the new framework is ‘as painless as possible’ for GPs, practices, and patients.
‘Managing chronic disease is one of the greatest challenges in the health system today … increasingly, this care is provided by GPs in the community and the need for us to do this will only increase as our population ages further,’ he said.
‘Providing this chronic disease care can be complex, and that’s why having a clear framework for delivering and being paid for providing CDM is crucial.
‘CDM items have been a key feature of Medicare and GP care for over 20 years, and we know these items are important for patients, GPs, and other health providers in providing well-coordinated chronic disease care, and they’re also crucial for the financial viability of practices.’
The changes, first due to be implemented in November last year, were delayed following RACGP advocacy calling for more time for GPs to prepare.
During the webinar, Mr Smeed said his reaction to the incoming changes has been ‘a bit of an up, down, left, right – I don’t know what to feel’, and he expects many GPs have felt the same way.
‘Looking at about 1500 general practices from all across Australia, we know that between 10–13% of their billing comes from CDM, so it is quite a significant amount of a practice’s total billing,’ he told the webinar.
‘So, when we start changing this area, we want to make sure we get it right.
‘If we went from doing just the one plan at the start of the cycle to doing one plan and two reviews, you’ll actually end up financially in a much better place.’
Mr Smeed spoke in detail about the expected financial impacts of the changes, saying the ‘encouragement is to be looking to do more reviews’, and the new process will lead to time savings.
‘Don’t think about it just in terms of the change to the gross billing, you have to think about it and where it’s going to be in terms of the changes to your workflows as well,’ he said.
‘Sometimes, if we just look at the gross billing numbers, we forget about the workflows and how that impacts what we’re doing.
‘What workflows actually work is going to be the real key – when we all start doing this in three weeks’ time, we’re going to have a lot of learning about what workflows actually work, and what’s different, and what works and doesn’t work.’
As Ms White added, ‘there’s a bit to do, but it’s doable’.
She walked attendees through incoming software changes, saying that there is ‘lots of exciting stuff coming as part of this change’, as well as additional practical steps GPs can take.
‘It’s also a really great time to start thinking about your patient registration process at your practice,’ Ms White said.
‘Do you have posters up? Are you educating your practice and your patients? Do they know how to use the Medicare app? Do you have paper forms? All those wonderful things.
‘Another really important one is having a think about your recall and your reminder process … can you use what you already have? Can you rename those reminders? Do you need to adjust your process? Who’s also managing this process at your practice?’
The Medicare item change has so far drawn mixed reaction from GPs.
According to a 2024 newsGP poll, 69% of respondents said that if chronic disease funding is not increased, they would have to start charging a fee for Medicare items 721 and 732, rather than bulk billing patients.
More recently, at the RACGP Practice Owners Conference – held just days after the Government released the new CDM details – GPs’ reaction to the changes ranged from calling it ‘a step in the wrong direction’ to the items being labelled ‘fantastic’.
Dr Raman described the new items as ‘a major structural shift’ to how GPs think about and deliver CDM.
‘It’s actually not just about tweaking and a change of the item numbers, but it’s thinking about it in terms of a more integrated, outcome-focused framework,’ she said.
‘I see this change as a promotion of more team-based care, continuity and personalised care planning.
‘It’s an opportunity for us to lift the standard of care, and it does mean that we’ll need to invest a bit of time in trying to understand how we integrate that, and there’s going to be quite a bit of learning that’s going to happen over the next few weeks, probably over the next few months.’
The RACGP says it will update its website’s FAQ page and keep members informed as it continues to work through these changes.
A dedicated CDM webpage has also been established to provide the most up-to-date information.
The DoHDA has also released detailed fact sheets covering:
The RACGP is also hosting an ‘
Upcoming changes to women’s health assessment items and chronic disease management items’ webinar on 24 June for those wanting more information.
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