Archived August 20 2008 - may contain information of historical interest (some links may not work)

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Medicare Benefits Schedule items relating to discharge from public hospitals - Information Sheet

Case Conference

A case conference entails all service providers involved in the care of a patient being present at the same time. This presence may be face to face, by video link, or by phone. The purpose of a case conference is immediate problem solving by identifying patient needs, desired outcomes, and tasks for each team member.

For a GP to be able to claim a rebate in relation to case conferences the following circumstances must apply:

The patient has a chronic illness or complex care needs. They can be of any age.
The GP and a minimum of 2 other service providers are involved in the discussion.
An informal carer is not counted towards the minimum of 3 service providers.
Patient consent to the GPs involvement must be gained; the day, time and participants recorded; the decisions recorded; and copies distributed to all, including the patient.

In relation to discharge, GPs can initiate a discharge case conference for private patients only. However GPs can contribute to a discharge case conference for private and public patients.

A Case Conference cannot be claimed on the same day as a Care Plan.

Case Conference Rebates
Contribution to hospital discharge case conference

Multidisciplinary Care Plans
A Care Plan is a shared vision for the individual (patient), GP and service providers to work together towards achieving the best possible health and well being outcomes for the individual. It is geared to longer term planning than a case conference.

A care plan may be compiled by one service provider making contact with other relevant service providers sequentially. The contact may be by phone, FAX, email, or written form.

For a GP to be able to claim a rebate in relation to care plans the following circumstances must apply:

The patient has a chronic illness or complex care needs. They can be of any age. The GP and a minimum of 2 other service providers are involved in the care plan. Informal carers are not counted towards the minimum of 3 service providers.

Patient consent to the GPs involvement must be gained; the day, time and participants recorded; the decisions recorded; and copies distributed to all, including the patient. The patient needs to be included in the preparation of the plan.

In relation to discharge, GPs can initiate a discharge care plan for private patients only. However GPs can contribute to a discharge care plan for private and public patients.

The care plan needs to include an assessment of needs; services/ treatments needed; community supports needed; management goals; arrangements for giving treatments/services; and review arrangements.

Care Plan Rebates

These services are designed to support the discharge services provided by the hospital but are separate and distinct services focused on the post-hospital care of the patient, and should be provided by the patient's usual GP.

Usual GP
This term has been defined as the doctor/practice who has provided the majority of services over the previous 12 months (and /or is likely to provide the majority of services in the next 12 months). When another doctor provides an EPC MBS service, a copy of the case conference/care plan report should be sent to the patient's 'usual' doctor (subject to the patient's agreement).

Patient Consent
"The MBS items may only be claimed if the patient gives consent to the care plan or case conference and to the sharing of information with the other providers involved. Consent may be given orally or in writing and must be recorded in the patient's notes.

Informed consent can only be given if the patient understands the care planning or case conference process; has been made aware that his or her medical history, diagnosis and care preferences will be discussed with other care providers; and has been given an opportunity to specify what medical and personal information he or she wants to be conveyed or withheld from the other members of the care planning or case conferencing team. Informed consent also requires that the patient be aware of the costs he or she will incur for the preparation of the care plan or case conference." (P.55 RACGP: 2000)

Private Patients
The EPC discharge items 722, 746, 749 and 757 are available in respect of services provided to private in-patients only. These relate to care plans or case conferences which must be prepared or organised by the medical practitioner who is providing in-patient care (in most cases this should be the patient's usual medical practitioner). These services are professional services provided to the patient in conjunction with in-hospital treatment, and therefore will be rebated at 75% of the MBS fee. GPs providing these EPC discharge services must be acting in a fully private capacity. These Medicare items are not available for services provided by GPs who are employed under contract or VMO arrangements to provide public hospital services to admitted public patients.

MBS items available for consultant physicians
From November 2000 new discharge case conferencing items are available for consultant physicians. Items 813 and 815, participation in a discharge case conference, are available to private and public patients, are out of hospital services and should be rebated at the 85% rate. Items 809 and 811, organisation and co-ordination of a discharge case conference, are available to private patients only, are in-hospital services, and will be rebated at 75% of the MBS fee.

For a consultant physician to be able to claim a rebate in relation to case conferences similar circumstances must apply to those outlined for GPs. However case conferencing items for consultant physicians require the involvement of an additional 3 care providers. The case conference participation needs to be for a minimum of 30 minutes, and the rebates are substantially higher than for GPs.

For more detailed information See Medicare Benefits Schedule book, 1 November 2000.