Just when you thought you had a handle on care plans, the HIC have been tinkering with item numbers again. As of July 1, we now have the new GP Management Plans and Team Care Arrangements, and care plans have been thrown out the window – or have they? On closer inspection of the piles of information sent out by the HIC, it would seem that care plans have been simplified rather than shelved and made more flexible for busy GPs and practice nurses.

GP Management Plans & Team Care Arrangements
The easiest way to explain the changes is for you to imagine splitting the old care plans right down the middle, so that the two parts now become a GP Management Plan (GPMP) and a Team Care Arrangement (TCA).

The GPMP (Item 721) is for patients with a chronic or terminal disease, and documents the goals for patient care, the tasks needed to accomplish these goals (including self-management), and any treatment arrangements, such as who will see the patient and when. Sound familiar? This is just like the old care plan without the need to involve and communicate with other providers. This is particularly useful when the patient has a chronic condition without complex needs, or where time limits only allow for the documentation of a plan, with the flexibility to complete the TCA at a later date if needed.

The TCA (Item 723) also requires the patient to have a chronic or terminal condition, with the addition that the condition must also be considered complex, and so require a collaborative approach between the GP and at least two other providers. The same rule applies here as with the old care plans, there needs to be two way communication between the GP and other providers, and each provider must be giving the patient separate and ongoing care. Once again, the management goals and the proposed care to reach these goals must be documented, such as the services the other health professionals have agreed to provide. In this way, documenting a stand alone TCA ($95.00) is virtually the same amount of work as documenting a combined GPMP and TCA ($120.00 + $95.00).

The same but different
As before, the GP can be helped with the writing up of the GPMP and/or TCA - this assistance will usually be provided by a practice nurse or Aboriginal health worker, and copies need to be offered to the patient and sent to the providers listed in the TCA. And if you would like your patient to be able to access the Medicare rebate for five allied health and three dental care referrals each year (Items 10950 through to 10977), you will need to complete both the GPMP and TCA.

The next difference is that the old care plan was only available for patients in the community – the new item numbers can also be claimed for private in-patients being discharged from hospital, including residents of aged care facilities. The important point here is to be sure they don’t have a current plan in existence, as the new GPMP & TCA cannot be claimed within twelve months of a care plan.

The next difference is that although you can claim the preparation of a GPMP or TCA annually, the recommended frequency is two years. A similar rule applies for the reviews, with a minimum claiming period of three months and a recommended period of six months. This flexibility allows for patients who have stable conditions and good self-management to have less frequent reviews, and more frequent where there is an acute exacerbation or where a patient is newly diagnosed.

It should be noted here that the item numbers can be claimed inside the minimum period if there have been significant changes in the patient’s condition, but it is recommended that you call the HIC before starting the rewrite, as some practices have had their claims rejected in the past. Likewise, you need to be clear about whether the patient has had an asthma action plan or a mental health plan (both considered management plans in their own right) in the past twelve months, as this may affect your ability to claim a GPMP, except under exceptional circumstances.

For more information, the HIC website contains detailed information regarding the new item numbers (www.hic.gov.au/providers), while the NRDGP website has templates that can be used as they are or adapted to your needs (www.nrdgp.org.au). If you have any questions, please contact me on 6622 4453.

Therese Greenlees is the division’s practice liaison officer.