Close the Gap
This page describes the practical steps for general practices seeking to make use of the Indigenous Health Incentive.
From May 1, 2010, the Australian Government introduced additional incentives to support General Practice and Indigenous Health Services to provide better care for Aboriginal and Torres Strait Islander Australians.
This page includes the following:
1. What are the benefits for General Practice?
2. What are the benefits for the ATSI patient?
3. Where to start - a brief guide for General Practice
4. Optimising the benefits for both the Practice and the ATSI patient
5. What to do before the appointment
6. What to do during the appointment
7. Useful websites
8. More information
1. What are the benefits for General Practice?
• Sign on payment - $1000 per practice. A once-off sign-on payment.
• Annual Patient registration payment - $250 per eligible patient per year.
• Outcomes Payment – up to $250
Tier 1 - $100 per eligible patient per year. Paid to practices for each registered patient for whom a target level of care is provided by the practice in a calendar year.
• Prepare a GPMP (item 721) or develop a TCA (732) during the calendar year.
• Or undertake 2 x reviews of the patients GPMP or TCA during the calendar year
• Contribute to the review of a multidisciplinary care plan for the patient in a Residential Aged Care Facility (731) on 2 x occasions during the calendar year.
Tier 2 – An additional $150 per eligible patient per calendar year. This is paid to the practice that provides the majority of MBS services for a registered patient in calendar year.
• To practice that provides majority of eligible MBS services for the patient (with a minimum of 5 x eligible MBS services) during the calendar year.
• ATSI Health Check (no more than once in every 9 months).
• A proactive practice can make $500 a year per patient registered for the ATSI health incentive.
2. What are the benefits for the ATSI patient?
• Better management of their chronic disease and overall health in a culturally safe environment.
• After ATSI health Check Item 715
• Access to 5 allied health services (MBS Items 81300-81360) per calendar year (this maybe subject to a gap payment need to check with individual allied health provider) and 10 follow-up services (MBS item 10987) with Practice Nurse or Aboriginal Health worker on behalf of the GP.
• Must use a specific GP referral form
• If patient also has a GPMP & TCA – another 5 allied health services per calendar year.
• Cheaper medicines – (with registration under the PBS copayment scheme) concessional price (under $6) or free if patient has a concession card.
3. Where to start? - A brief guide for General Practice
• Fill in PIP Indigenous Health Incentive application form and send to Medicare.
• Agree to seek consent from all ATSI patients with a chronic disease aged 15 and over to register for the Indigenous Health Incentive
• All patient 15 and over must have a Medicare card.
•There is no age requirement to register for the PBS Co-payment and patients need to register once only.
• Establish a recall & reminder system for all ATSI patients with a chronic disease.
• Conduct or at least offer an ATSI Health Check – Item 715.
• Make sure the Practice is providing the majority of care for the patient by actively recalling them.
• The patient can see the Practice Nurse up to 10 times in a calendar year.
• Have an ATSI health check every 12 months.
• See the GP as often as needed to manage their chronic disease.
•Annotate PBS prescriptions for ATSI patients participating in the PBS Co-payment from 1st July 2010, with the letters CTG (Closing the Gap).
• Fact Sheet Information for General Practitioners PBS Copayment Measure
4. Cultural Awareness training
•Two staff from the Practice to attend cultural safety training within 12 months of registration for IHI PIP incentive. (one of whom must be a GP)
•The RACGP have recently announced they have an online training tool through their GP learning platform which will satisfy the requirements of the Indigenous Health Incentive and be free of charge to general practitioners and practice staff that are members of RACGP. http://www.racgp.org.au/aboriginalhealth/culturalawareness
•Read more on the Courses and Events page of the Australian College of Rural & Remote Medicine website, where you will also find a link to the online enrolment form. Fees for the module begin at $100 for ACRRM member and $170 per non-member. There are also packages for pairs and groups.
5. Optimising the benefits for the both the Practice and the ATSI patient
• Each practice needs to decide on a strategy to improve self identification of ATSI patients. Current evidence suggests there is substantial under-identification of ATSI patients attending general practice.
• Each Practice needs to review the patient registration process, is the national standard identifying question “Are you of Aboriginal or Torres Strait Islander origin either asked verbally or on the patient registration form?
• Are existing patients asked the question?
• Is the answer always documented in the patients file?
• Are all members of the Practice aware of the need to ask questions regarding self identification? And also the importance of identifying the ATSI patients in the Practice in order to access the benefits of the incentives available to them to improve their health outcomes.
6. What to do before the appointment
• If the practice has already been recording this information, get the Practice Manager to run a search in the practice software for all ATSI patients.
• Get one of the GPs to review this list and any ATSI patient aged 15 years and over, with a chronic disease should be phoned and booked in for an appointment. Ensure that the patient has a medicare card.
• Inform the patient the appointment is so they can be registered for the Indigenous Health Incentive and to have a health check so their medical condition can be better managed. They may get cheaper medicines and more allied health services.
• Let the GP know the patient has identified as ATSI before the appointment. The GP can discuss the indigenous health incentive with the patient and make another appointment to register them and conduct the health check.
7. What to do during the appointment
• Ask the ATSI patient to give consent for the Indigenous Health Incentive and /or the PBS Copayment. They need to fill in and sign consent form - keep in patient’s file.
• GP to fill in and sign patient registration form – from 1 July 2011 Practices will need to fax both the patient registration form and the patient consent forms to Medicare to get $250 payment for that year.
• Give patient a copy of the ‘Closing the Gap’ PIP patient information sheet.
• Conduct an ATSI health check – item 715.
• Enter a recall in software or book an appointment for patient to see GP or Practice Nurse in a few months time depending on their medical condition.
• Also enter a recall in software to get patient back in 12 months to conduct another ATSI health check and to re-register them.
• The $250 registration payment will be paid to the Practice that registers the patient first. Practices can phone the PIP team on 1800 222 032 to find out if an eligible patient is currently registered with another practice.
• The Indigenous Health Incentive registration only lasts for a calendar year. Patients need to be called in annually to complete a new registration form and for the practice to get the $250 payment. Don’t risk losing your ATSI patient to another practice in a year’s time. Proactively manage their health care during the year and register them annually.
• The PBS Co-payment registration only has to be done once. This payment is intended to benefit ATSI people of any age who are eligible under the criteria.
• Patients can withdraw consent at any stage, they will need to complete a Patient withdrawal of consent form
• The Allied Health professionals who are eligible (must be registered with Medicare) to accept referrals for items 81300 to 81360 include
• Aboriginal Health Workers, Diabetes educators, Audiologist , Exercise physiologist, Dietitian, Mental health workers( Nurses & some Social workers), Occupational Therapists, Physiotherapists, Podiatrist, Chiropractor, Osteopath, Psychologist, Speech pathologist
• Please advise there may be out of pocket expenses for the allied health professional services and charges in excess of the Medicare benefit will be the responsibility of the patient. However such out of pocket expenses will count towards the Medicare safety net for that patient.
8. Useful websites
This resource kit contains a fact sheet and proformas providing information on health assessments for Aboriginal and Torres Strait Islander people updated with changes to the MBS item numbers resulting from the MBS review. The kit also includes fact sheets concerning the follow-up service items for practice nurses/ registered Aboriginal health workers and allied health professionals.
Link to Medicare Australia Includes Patient registration, Patient consent forms, Patient withdrawal of consent & Incentive application forms.
As of 1 May 2010, General Practices can register for the PIP Indigenous Health Incentive.
Link to PIP Indigenous Health Incentives page- http://www.medicareaustralia.gov.au/provider/incentives/pip/files/indigenous-health-incentive-guidelines.pdf
PIP Incentive Program Guidelines including PBS Copayment
http://www.medicareaustralia.gov.au/provider/incentives/pip/forms-guides.jsp
Information & Referral form for follow-up allied health services under Medicare for ATSI patients
www.health.gov.au/mbsprimarycareitems
Aboriginal and Torres Strait Islander Peoples MBS Health Assessment Resource Kit
GP Reference Kit - Information Pack for GPs re: Indigenous Chronic Disease Package NB this is the same as DOHA GP Booklet.
DOHA GP Booklet
Allied Health Follow Up Services
ATSI Health Assessments
Chronic Disease Follow-up Services
How to Identify Aboriginal and/or Torres Strait Islander Patients
Medicare Benefits Schedule (MBS) Items
Medicare Australia quick-link - http://www.medicareaustralia.gov.au/
The following links all relate to the PIP and CTG programs
Indigenous Health Incentive guidelines for General Practice
Indigenous Health Incentive application for General Practice
Indigenous Health Incentive and PBS Co-payment Measure Patient Consent
Indigenous Health Incentive and PBS Co-payment Measure Patient Information Sheet
Indigenous Health Incentive and PBS Co-payment Measure Patient Registration
Indigenous Health Incentive and PBS Co-payment Measure Patient Withdrawal of Consent
For more information on Conducting Aboriginal and Torres Strait Islander Health Checks please click here.