The department ran out of time to meet its own deadline.
By the time that the Department of Health and Aged Care pulled the plug on its November rollout of new chronic disease management items earlier this week, it was already about a month too late.
Even if it had settled on viable new rebates for chronic care plans, there would have been no time left for GP software vendors to design and implement new workflows.
On Wednesday, DoHAC confirmed that the major overhaul of GP management plan and team care arrangements had been pushed back by eight months from its original start date of November.
Under the changes, which will now take place in July 2025, GP management plans and team care arrangements will be combined into a single chronic condition management plan and the fees for developing and reviewing a plan will be equalised.
A department spokesman told The Medical Republic on Wednesday that the deferral was to “support all practices and providers, including GPs and allied health providers, to be ready for the changes”, including “work to prepare practice software”.
Best Practice software chief product officer Danielle Bancroft told TMR that adjusting practice management software to accommodate for the changes was not as simple as substituting one item number and price point for another.
“There’s a component of changing codes which are incorporated in our update that we get from Medicare, and that piece is very simple,” she said.
“What’s not simple is that a lot of those codes are then bound in logic to provide enhanced workflows.
“With the CDM changes, for example, quite a lot of the workflows are driven around the billing code – [the software] will automatically open templates and stuff like that.”
Adding to the regular level of complexity is the fact that management plan items are used so frequently that they can constitute up to 30% of practice revenue.
Because of this popularity, they tend to be built into certain functions.
“If a code changes around the [GPMP tool] or the template associated to that code changes, we have to change the code logic that launches the appropriate template, for example,” Ms Bancroft said.
“We could push the template [out], but it’s the actual core code that runs that workflow – so that’s where it’s programmatic changes.”
With certain elements of the chronic disease management overhaul still unclear just over one month out, Ms Bancroft said it would not have been viable to get a solution to market in time.
“You’d need to be able to design it, put it in for development, adequately quality test it and push a release out,” she said.
“It’s a safety risk, as soon as you’re touching clinical software.
“And in that case, four weeks just isn’t enough to cover your bases.”
In the weeks leading up to the delay announcement, pressure had been mounting for DoHAC to reveal rebates for the new items.
It never did so, not even to the AMA or RACGP.
“There was an implementation liaison group involved in the design of the new item numbers, but even they didn’t get [told],” AMA vice president Dr Danielle McMullen told TMR.
“There’s a separation of clinical advice from the financial advice, but we’ve made it clear that the funding of the MBS is really critical to how it operates and so discussion of that from an early stage would have been helpful.”
The only information on how the items will be funded comes from the 2023 budget, where the overhaul was first announced.
“It was obvious in the budget that there was a saving attached to these items and the AMA has made it clear to government that any save needed to be from changed behaviour in terms of [a reduction in] inappropriate care plans,” Dr McMullen said.
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RACGP president Dr Nicole Higgins told TMR that she had gotten the sense that DoHAC had not appreciated the complexity involved in its reforms.
“When they’re making these big policy changes, they need to bring all the stakeholders on early, co-design it, and make sure that we have a smooth rollout and effective change management,” she said.
“I think that has been the learning for the government in this process.”
Both Dr Higgins and Dr McMullen said they supported the policy overall, but wanted to ensure the funding details were right.
“The feedback from members has been mixed,” Dr Higgins said.
“They actually wanted to change over to the increased [rebates for] reviews and reduction in the red tape, but the problem was [ensuring adequate] funding.”
