An independent review into the additional eating disorder-specific MBS item numbers rolled out in 2019 finds ‘unequivocal support’ of their benefit.
While additional MBS-subsidised sessions for eating disorder care – four times the Better Access offering – are welcomed, disease-specific item numbers can still be limiting, says the RACGP’s obesity management specific interest group chair.
In 2019, the federal government introduced a suite of eating disorder-specific MBS item numbers in response to recommendations from the eating disorders working group of the Medicare Review Taskforce.
The items covered initial eligibility assessment, treatment plan preparation, treatment progress review by a GP or specialist and up to 40 psychological treatment services and up to 20 dietetic health services within a year.
Last week, La Trobe, Deakin and other partnering universities released the recommendations of their independent review into the new items, commissioned by the Department of Health and Aged Care.
The evaluation found that approximately one in five people with an eating disorder used the eating disorder MBS items.
There was “unequivocal support” from patients and professionals alike that the new MBS items were a “substantial improvement” on services previously available through Medicare, added the report.
The reviewers recommended retaining the session maximums of 40 psychological treatment services and 20 dietetic health services per 12 months, which is substantially higher than the 10 Medicare-rebated sessions offered through the Better Access mental health scheme.
“The average number of (psychological) services used under the Eating Disorders MBS items (13-14 services) was higher than the maximum number previously available through MBS under the Better Access Mental Health Treatment Plan initiative,” read the report.
“Having a higher number of treatment sessions was associated with significantly greater eating disorder symptom improvement, satisfaction with treatment, and perceived helpfulness of treatment for recovery.
“Additionally, 93% of people who had received treatment for an eating disorder perceived the Eating Disorder Plan to be superior to a Mental Health Treatment Plan for providing sufficient sessions to work through concerns.”
Speaking to The Medical Republic, chair of the RACGP’s obesity management specific interest group Dr Terri-Lynne South said that while some mental health conditions work well with brief interventions, some, like very restrictive eating disorders, need more touch points for improvement.
Dr South said the lobbying for additional subsidised sessions prior to 2019 was “evidence based”.
The RACGP has often refuted the need for disease-specific MBS item numbers, due to the holistic nature of general practice.
“We know with mental health disorders there are often other co-existing mental health conditions and also physical health conditions,” said Dr South.
“I do think the increased number of services for the eating disorder care plan is great, but … it doesn’t have to be linked to a specific disease, per se.
“We just need a broader way that we can apply management plans.”
Despite the perceived benefits and burgeoning uptake of the services, health professionals expressed frustration at the time requirements and insufficient remuneration, particularly for assessment.
“Low willingness to take on new clients may also stem from health professionals’ concerns about their suitability to deliver these services, with a significant minority of providers rating themselves low on knowledge, confidence, and skill in providing safe and effective eating disorder care,” read the report.
The report recommended offering higher MBS rebates to credentialled eating disorder clinicians to improve the quality of care.
“Providing incentives for more experienced health professionals to provide clinical supervision to recent graduates and health care providers inexperienced in eating disorder care is also recommended,” said the reviewers.
The reviewers also recommended increasing access to bulk billed services, particularly in areas of socioeconomic disadvantage, and promotion of telehealth as a viable delivery option.
Dr South said whether patients were able to afford and access the services a GP referred them to or recommended was always a consideration.
“When you’re seeing somebody in the throes of a severe restrictive eating disorder then there needs to be a coordinated team approach and a significant number of hours and sessions, and it can be quite overwhelming for the patient, not just from a cost point of view,” she said.
“But at the same time, individual healthcare practitioners do need to be able to run a financially viable business.”
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The reviewers called for the removal of “clinically underweight” from the eligibility criterion to reduce practitioner confusion and under representation of some disorder types.
“This criterion is not required to be assessed for people with a diagnosis of anorexia nervosa and is not applicable for people with eating disorders other than anorexia nervosa,” said the report.
“We also recommend streamlining the process by which eligibility decisions are made for people with bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders (including atypical anorexia nervosa).
“These simplifications should improve the efficiency and accuracy of eligibility decisions and help to rectify relative under-representation of individuals with bulimia nervosa, binge eating disorder, and atypical anorexia nervosa in utilisation of Eating Disorders MBS items.”
The report also recommended providing online tools and resources to help health professionals assess eligibility, know where to refer and coordinate progress evaluation.
