Chronic Disease Management - Diabetes

The Health and Hospitals Reform agenda and May 2010 Federal Budget have heralded significant changes ahead for general practice. The fee for service funding through Medicare has been the primary foundation of funding for general practice services for many years. The introduction of voluntary registration of diabetes patients is the first of an expected range of Chronic Disease Management (CDM) programs in which practices will receive block or capped funding for their registered patients.

Diabetes

On 1 July 2012 the Diabetes CDM program will commence and diabetes patients will be encouraged to enrol with the practice of their choice for their diabetic care. The practice will receive $950 as the annual payment of which $250 will be held by the newly formed Primary Health Care Organisations to purchase allied health care. All diabetic care provided by the practice for a registered patient will be funded from the $950 payment; not through MBS claims.

There will also be outcomes payments for a percentage of patients achieving defined clinical targets. These targets are not yet known.

The business rules for this program are still being developed but regardless of the specifications, practices need to start preparing themselves now for these changes.

Information Management

The key area for practices to address immediately is Information Management. Information is the key to enabling practices to successfully manage this transition and to adjust their business practices.

Clinical Data

Most practices now have access to clinical audit tools such as Pen CAT that enable the interrogation of clinical data. These tools are only useful if quality data is being recorded. Rubbish In = Rubbish Out.
To ensure that system has quality data:

Use coding for diagnosis such as ICPC codes, instead of free text descriptions.
Ensure that clinical data is recorded consistently in the correct fields by all providers.
Invest time to use the clinical audit tools to assist with data cleansing.
Delegate the responsibility for the management of data to a switched on, IT savvy employee.

Budgets

Unfortunately many practices still do not work with an effective annual budget for monitoring and reporting on financial performance. Budgeting is an essential business tool regardless of the size and nature of the business.
The block funding for registered diabetic patients means that practices will no longer be able to rely on MBS service reports to track income and expenditure. Practices will need to use budget to understand the income generated through registration and more importantly the cost of delivering the diabetes services.

Prepare Now