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Health assessments fiasco close to resolution

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The winter edition of the Department of Human Services’ Forum newsletter caused a furore with advice that practice nurse time could no longer be counted towards the practitioner’s time when claiming for health assessment items under Medicare.

The change was a surprise to the AMA, which in 2009 had been successful in convincing the Department of Health to include the time spent by nurses in gathering and providing information related to health assessments in the Medicare item.

Clear on what had been agreed, the AMA was quick to challenge the advice from the DHS and to call for the previously agreed arrangement to be reinstated.

It is hard to understand what the Department was thinking when it decided to change established arrangements without consultation with the profession. Apparently, they didn’t think revising the 2010 Health Assessment Factsheet, which made it clear that nurse time counted, was that significant.

In a classic case of Yes Minister, the Department of Health was quick to respond with a clarification that suggested DHS had got it wrong. However, its advice that a practice nurse may assist a GP with performing the health assessment offered little comfort to GPs around the country. A plain English statement along the lines of ‘Yes, nurse time counts’, would have provided more comfort.

In an effort to obtain such an assurance, the AMA met with representatives of the Department of Health and the Department of Human Services, who undertook to make it as clear as possible that practice nurse time counted towards the time spent by GPs when claiming a health assessment item, assuming the complexity requirement of the item had been met. Essentially, it means that time is not the only determinant of the item claimed.

To assist the Department of Health in this regard, the AMA asked that the long-standing section in the factsheet’s Q&A that had made this arrangement clear (before being surreptitiously replaced in April) be reinstated.

At the time of writing, the Department of Health is working hard to get the wording just right. In a sign that progress was being made, the Department of Health recently issued a statement to the media in which it said that “both GP and practice nurse time can be used to decide which Medicare item would be the most appropriate to bill Medicare for a particular health assessment”.

While this statement was welcome, the profession clearly requires that the Department of Health and the Department of Human Services to publish definitive advice that resolves any outstanding uncertainty.

The DHS has apologised after providing incorrect information to callers seeking clarification about health assessment item inclusions, and has stated it will be monitoring this issue to ensure there is no recurrence.

Meantime, the AMA is still waiting on a full and clear statement from Department of Health and the Department of Human Services, which has been promised.

The AMA remains committed to working with these departments regarding the interpretation of MBS items, and this episode should be a clear lesson to them both about the importance of consulting with the profession about how the MBS works before publishing material that overturns accepted practice and interpretation.