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Practice nurses kept in limbo

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The future of practice nurses remains under a cloud as the Federal Government works to clarify its intentions regarding charging arrangements for health assessments.

The Health Department and the Department of Human Services are understood to be rewording alterations to the way Medicare Benefits Schedule items for health assessments are to be applied following protests from the AMA that the planned changes were unclear and could fundamentally undermine the team-based approach to a vital aspect of primary care.

Under guidelines introduced in 2010, the Government made clear that the time spent by practice nurses in helping a doctor conduct a health assessment, such as by collecting patient information, could be included in the MBS item billed by the practice.

The interpretation has fostered the development of a teams-based approach between doctors and practice nurses to the provision of health assessments, which are considered an important tool in preventive and chronic care.

But, in a change sprung on the profession without prior notice, the Department of Human Services early this month appeared to impose a new interpretation that meant practice nurse time could no longer be counted toward the health assessment item.

In a swift reaction, AMA President Associate Professor Brian Owler condemned the change, warning it could have a “devastating impact” on the jobs of practice nurses, many of whom had been hired specifically to assist doctors in conducting health assessments.

A subsequent attempt by the Government to clarify its intentions failed to end the confusion and uncertainty that had developed around its intentions, and the AMA called for a clear statement.

At a meeting on 9 July, Government officials agreed with senior AMA staff that a clearer statement of intentions was required, and the departments of Health and Human Services have since been working on a form of words.

The episode has exposed the difficulty of balancing the conflicting goals of the departments – Human Services is intent on keeping tight control of Medicare payments and boosting restitution rates, while Health wants to preserve the preventive health benefits of health assessments, including those conducted through cooperation between nurses and doctors.

The AMA has called for a reaffirmation of the interpretation of the MBS health assessments item that has existed since 2010.

But the fact that almost two weeks have passed without a new form of words being produced has observers worried that the Government is intent on a change to current arrangements that will undermine the joint involvement of doctors and nurses in providing health assessments.

Adrian Rollins