Allied health multidisciplinary case conferencing webinar – 7 October 2021

Hello everyone. My name is Dr Anne-marie Boxall.

I am the Chief Allied Health Officer for the Australian Government Department of Health, and we welcome you to our live webinar today on allied health multidisciplinary case conferences.

We really appreciate you taking the time out of your busy day to hear about this exciting new initiative that the Australian Government is funding through the Medicare Benefits Schedule (MBS).

So, what we are planning on doing today is giving you a brief overview of the new MBS items for case conferencing.

We will have a brief session from me, providing an overview of the items, and then we will hear from our panel members today.

So before I go on, I will just like to introduce our panel members.

So I mentioned myself, I am Anne-marie Boxall, the Chief Allied Health Officer. We also have Louise Riley.

Louise Riley is the Assistant Secretary of the Medical Benefits Division in the Commonwealth Department of Health.

We are very grateful, and very happy to have two clinicians joining us today as well.

First of all, we have Robyn Stephen. Robyn is a speech pathologist and she's the principal clinician at the Melbourne Child Development Centre and we also have Peter Clark. He's a dietitian, and he is the principal clinician at Healthier You Dietetics.

So, thank you to our panellists for joining us today. And thank you to all of you for joining us today.

Before I do go on, I would like to acknowledge the traditional owners of all the lands on which we meet today. I would like to pay my respects to Elders past present and emerging and I would particularly like to welcome any Indigenous people joining us today on this webinar.

We are recording this webinar today.

It will be made available to all of you after the session on the health.gov website and we hope that that is a useful resource for some of your colleagues who may not have been able to join us today.

We sent out some information before this. We will be running a question and answer session as well, and that will be run separately through Poll EV. So there is a link there up on your screen.

If you have got the link in your invitation, please try it into your browser now.

So it is separate to this webinar, and it is through Poll EV and the address is there.

We encourage you to submit any questions you have now and we can then get to them after the presentation.

We may not get to all of the questions today.

So, what we will do is we will do our best to answer as many as possible and we will provide some answers afterwards as well.

There is also another opportunity to ask questions about these items, and that is through the AskMBS function, and we will provide a link to that later on in the in the webinar. So that is the housekeeping done for today.

So we willl now move on to the substantive part of the presentation.

So, as I mentioned, first of all, I will be just doing a short overview of the multidisciplinary case conference items.

Then Louise will be talking about how to access these new items.

Then we will get some insights from Robyn, a clinician's insight about how these might work.

And then we will go to a panel discussion where we will bring Peter into the conversation as well and open up for your questions and answers.

So, moving on to the overview.

All right so the background to this, what we are talking about today, are new Medicare benefits items on the MBS schedule, and they are to reimburse allied health professionals, participating in doctor led multidisciplinary case conferences.

Sorry. That is quite a mouthful. So it is essentially so allied health can be reimbursed. for doing case conferences with patients. The items will be available from the 1st of November this year.

This item was funded through the Budget in May this year and it is taken us some time to get the back-end administration of this all sorted.

So, it will become live from the 1st of November this year.

The reason we have gone down this path to create new MBS items is that this was a recommendation from the MBS Task Force which reviewed all the existing MBS items.

There were 2 groups as part of that review that made this recommendation. The first was the Allied Health Reference Group,

and also the General Practice and Primary Care Clinical Committee endorsed it as well.

So, this is something that the sector has been calling for and it is something that the Australian Government has now responded to by making funding available.

Next slide please Dan.

So, who were eligible for these? So, patients that will be eligible for these new case conference items are two groups.

First of all, they are patients who have a Chronic Disease Management Plan under a medical practitioner

They need to be in the community or in a residential aged care setting.

So this is not for patients who are in an admitted setting and it is not part of a hospital discharge.

The other group of patients that will be eligible for these new items are those that are requiring early diagnosis or treatment.

They need to be under 13 years of age, so children under 13,

who are suspected of having a pervasive development, a developmental disorder, including autism, or have an eligible disability. They need to be under the care of a specialist, a consultant physician or a medical practitioner so these are the existing pervasive developmental disorder items under the MBS.

Next slide please.

The eligible allied health providers, I wouldn't read out the list because you can see them there and they are also listed in our fact sheets, but essentially the eligible allied health professionals mirror those that are eligible for the MBS at the moment.

So, there is no expansion of the allied health professionals that are able to access the MBS.

This item is extending these case conference items to existing allied health professional groups.

It is slightly different for the two types of patients, the chronic disease management and pervasive developmental disorder items and that reflects what the Government's policy is on the types of treatments that these groups need.

So, there is the two groups of eligible providers there.

Next slide please.

So, why do case conferences?

Probably do not need to convince many clinicians of this, but I thought it is worthwhile just reminding people as well,

Multidisciplinary case conferences are really valuable. They do improve patient outcomes and that is why the Government wants to fund them.

Case conferences lead to better care coordination for the patient

It improves decision making amongst clinicians treating the patient.

It helps to reduce hospitalisation. It does lead to better outcomes for patients

And we think, with more allied health providers being remunerated to participate in this case conferences,

We are going to get more allied health, taking those items up. And again, this is going to further reinforce the benefits for patients.

We also know that best practice, includes multidisciplinary case conferences.

And there is lots of benefits, I think, for patients in this as well.

We think that it means that it is easier for the team and the patient. to talk about what their shared goals are for treatments.

It is a great way of clinicians trying to identify what outcomes matter most to the patients, and then focusing on those outcomes. It is a really great way to communicate amongst the team as well.

And we think it is a great way of building positive relationships between parts of the multi-disciplinary team and including with the medical profession as well.

And case conferences are also a fantastic way of being very clear about who is doing what to support the patients.

So we think this is a really fantastic initiative and we think it will help out patients and improve their outcomes.

Next slide.

So, what we are going to do next is handover to Louise Riley,

and she's going to give us a little bit more information about how these MBS items will work.

So, over to you Louise.

Thanks Anne-marie, and apologies everyone, I have got a very full house at the moment, so there might be people wandering around. I have told them to make themselves a little bit scarce.

Yes, so my name's Louise Riley. I head up the Medicare Reviews Unit in the Medical Benefits Division.

here in the Department, and as Anne-marie already mentioned,

These items flow from some work from the MBS Taskforce and the committees that fed into that. And, my branch has an ongoing, and a lot of work in implementing the recommendations from the Taskforce.

So, thanks Dan, next slide.

So, in terms of claiming the new items, so there are 3 items for each category.

The time-tiered items so both for the chronic disease management items, and for the pervasive developmental disorder items.

There is three: 15 to 20 minutes, 20 to 40 minutes and over 40 minutes.

So, in terms of service caps, so these items are in addition to service caps. So I think that is, you know, for example, five that is triggered by a chronic disease management plan or for diagnostic, and I think it is 20 for pervasive developmental disorders So the case conferences do have to be initiated by the treating doctor for the patient.

So, whether that is a GP or the specialist or the consultant physician, and certainly, in terms of how often that can be claimed.

It is in line with existing arrangements, we have lined it up with what it is for doctors essentially.

So there is no restrictions for those patients, or those people who are using because of a diagnosis for pervasive developmental disorder.

But for the people you are seeing, who have chronic disease management, or who you're treating for chronic disease management, it is every 3 months.

In terms of how many people, or how many practitioners rather, participate in the

in the case conference, so at least 2 other providers must participate for the MBS items to apply.

The most obvious example would be the patient's doctor, treating doctor and two other allied health providers, or possibly another specialist and another allied health provider.

I think later on we have got some examples of what the different mixes can be.

So, in terms of the item numbers, so I know many of you would have been and, I have, a challenge of implementing Telehealth in my branch as well and many of you would have been probably using some of the telehealth items that we implemented as part of the Government's response to the pandemic.

So, in terms of these items and, and this is, these are permanent, is that you use the same item number, and it can be used whether it is a face to face or a telephone or a video case conference.

Okay, thanks Dan next side.

So, in terms of the, the items structure. As I mentioned, there is three items quite clearly in that table for each whether it is chronic disease management or, PDD and of course, 15 to 20 again, at least 20 but less than 40 and at least 40. and I am sure for those of you who have claimed on the MBS before,

Those percentages and schedule phase will be familiar. So, it is the 85%

It is a long-standing historical thing that we publish 100% and 85% and some of them even in hospitals have 75%, but when you claim you will get 85% benefit.

Thanks, Dan.

So as I mentioned, we had some information about some eligibility case studies so we have, we have run together some different scenarios here about how the items might work.

So, as you can see there under scenario 1, we have got a doctor and allied health provider, the patient and their carer.

So, in that instance, it wouldn't be eligible.

So, there has to be, as I mentioned, there has to be 3 providers, the patient and the carer do not count to the three.

In terms of the second scenario there, we have got a doctor and two or more allied health providers and the patient.

That is an obvious one so yes, because two other providers are present. So, in that instance, they are eligible to claim.

So, again, the items are available, as I mentioned, is face to face video or telehealth, so people can be in the same room or they can be virtually in the same place, sort of like we are now today or on this video or webinar.

And then the fourth one, we have got a doctor, two allied health providers and a third provider who speaks to the doctor afterwards.

So in the in that instance, the third provider is not participating in the case conference.

So the first three, so the doctor and the two allied health professionals scenario two would be eligible to claim.

And then in scenario five, we have got a doctor, an occupational therapist (OT) and an educator.

So the OT, in terms of the allied health professionals who can claim the

OT is the only eligible provider there who can claim. Certainly educators can and should be should participate where it is relevant.

And of course, in many cases it would be appropriate, but as detailed there in the reason only eligible allied health providers can claim.

But other providers, excluding family and carers, can count to the two-provider minimum.

Thanks Dan.

So, as Anne-marie mentioned, there is some information

available, and we are always happy to answer your questions

if you especially if you think of some that you wish you had asked after today.

So there is a Fact Sheet online which you might have been sent to link to already. I am not sure.

But it is online.

It even looks something like that.

And it is on MBSonline.gov.au.

I am sure if you type in allied health case conferencing, it will appear.

certainly in terms of questions

relating to interpreting the schedule and about the items, askMBS@health.gov.au

It is a very widely used email address.

We have a team of people that answer those questions.

And then, of course, on the department's website, there is some more information if you just go to health.gov.au and I am sure if you type in in the search space there, if you type in allied health, you're likely to find it that way as well.

Thanks, Dan.

Great, thanks Louise.

So we will hand over now to Robyn Stephen, who's going to talk to us about multidisciplinary conferences from her perspective.

Over to you, Robyn.

Thank you so much Anne-marie. Thanks Louise.

I am writing down notes as well, and the item numbers are very important.

So I think I am just listening to the conversation, I am listening with clinician's ears and speaking to all the clinicians that are here today.

I had the privilege of being on the MBS Review the Allied Health Reference Group.

So I worked over at least a sort of 12-month period.

And I was there. I am a speech pathologist, but I was there as an allied health practitioner with other allied health practitioners, and we were trying to represent all of you.

And so many things were put on the table.

So all the questions you're probably thinking of, you know, why case conferencing?

What about this? What about that?

What about increasing the CDM numbers?

You know, so many questions that you probably have.

So I have, rest assured that actually all been put on the table.

We are grateful that something has come through.

And what has come through at the moment is the case conferencing items.

And I know we are all cheering

Anne-marie on for many of the other, and Louise, for many the other recommendations that were put forward.

So I am sure you might have lots of questions flying.

What about what about that?

And they have all been considered.

Lots of research was produced about are five CDM items even ethical, even evidence based.

So it is all been put there.

Not to say that we cannot keep putting those arguments forward.

So, yes. So we are very grateful for this step forward.

Thanks Dan, we will go to the next slide.

So Anne-marie has talked a lot about the benefits of case conferencing.

The fact that you all here today means that you understand the importance of case conferencing and Peter had just a word when we were just setting up to say that it is evidence based, it is best practice, and we are doing it all the time.

So it is an opportunity, I suppose, for us to get some payment for that time.

In terms of case conferencing, and what I have heard from the other allied health practitioners as part of the Reference Group is that using a case conference at the start of setting up a CDM plan can be beneficial.

But Peter might speak a little bit more about this in terms of

who should be part of the team and how to allocate those five

precious sessions as effectively as possible.

I think with case conferencing, parents feel that they have a coordinated and supportive team, so they do not have to go to their GP and report something that the psychologist or the speech pathologist has put forward and be in a position of having to justify that, you know, the case conference enables everybody to put their view, the allied health practitioners, to put their view and to decide what is the best case, what is the best plan going forward, as Anne-marie said.

And I think that patients have confidence in the advice. If they are hearing that the general practitioner or the consultant physician or their specialist and their physio and their podiatrist are all saying the same things.

They've got more lot more likelihood of having confidence in the advice and following the advice.

And I think, you know, patients can be supported holistically with better outcomes as Anne-marie said, and it gives them opportunity to be a tad education between the practitioners so that you take that education to have a broader perspective for all clients that you're working with.

I know that for many years I have worked with an occupational therapist, and I consider that occupational therapist, Kathy, as my left hand.

And even when I am working as a speech pathologist with my right hand,

I have got all of my Kathy thoughts in my left hand about what would Kathy say about this?

And I would refer to an occupational therapist, but I can be more holistic because of that working relationship and that that can be the case for all of us working together.

I think the new MBS items may encourage allied health practitioners to start the conversation with the doctors to initiate case conferences.

So I note and Louise might be able to answer this

later on, but I know there is two levels of rebates or two number items for the consulting physicians, the GPs and specialists to use, depending on whether they organized the case conference or whether they just participate.

So Louise might tell us a bit more about that.

But we know how to be successful in trying to help

GPs to get over the line just in terms of forming a CDM plan.

So, again, I am hoping that maybe Louise can help us with these afterwards by sending us the item numbers that the doctors need to use, because with the CDM, if we tell the doctors, look, this is how it all works.

This is the form we need to use.

This is what you need to fill in and this is what you need to send us.

And we are happy to do that kind of background work.

You know, maybe there is a practice nurse that we could talk to. If we can give them that information. I did not want to put the numbers up because that is not my area of expertise. But information we can, the easier we can make the task for both our general practitioners and consultant physicians and specialists more likely it is that they will be able to participate, that they will want to participate.

And yeah, and I have made the last point.

So thanks, Daniel. The next slide.

So there are hurdles, I believe, and the hurdles, of course, are the motivation of the doctor to initiate or to participate, and I have just spoken about how we might be able to help that.

Also with the case conference, the patient has to give permission for the case conference to go ahead, and that has to be documented by whichever doctor that it is.

But it means that there is potential for a patient to have to pay fee for three health professionals.

I know as allied health practitioners and as Peter mentioned before, we are doing this all the time and not getting any payment for it.

So I would certainly consider in our practice that we might just charge the rebate fee that the patient was going to get, but that might be a difficulty for some patients who just wouldn't be able to afford three gap fees for three health professionals.

The number of case conferences for the CDM plan are very generous.

It is actually five from my reading per year.

However, as we know, there is five CDM sessions.

So as to how many case conferences you would need if if you have only got five sessions, CDM sessions.

You know, I think at a recent meeting we were at with Anne-marie, where the allied health practitioners were saying, well, you know, what do you do?

Have a conference, say, well, we need more, you know, we need more sessions to be able to do what we need to do. So I think the CDM, particularly it is it sounds lovely, but I wonder how practical it is to be using that number for many. You know, to have that opportunity, it seems an opportunity lost.

So I feel that we need to keep data at our practices and I am really hoping that associations will develop some system for us where we can use so we where we can collect this data in terms of how we try, what successes we have, what roadblocks we have.

And I think it is also great to collect data on the multidisciplinary conferences that just occur between allied health practitioners, because, you know, do we have a case to say that, you know, it does not always need to be doctor initiated because there are so many case conferences that occur between allied health practitioners.

Next slide thanks Daniel.

So, the way that I am currently using the case conferences is it is really we have set up a team, so a multidisciplinary team for differential diagnosis of developmental condition, so the team is a speech pathologist, myself and a paediatrician and a psychologist.

So we have been operating this team for about six years.

We now have two teams.

So it is very, extremely well organized.

So, you know, so this is not necessarily what is happening in every practice.

But the assessment phase, we can use a case conference because the three of us are interviewing the parent in terms of getting all that very critical case history information.

And then we have a telephone call.

So we have a case history.

We assess the child with some paediatricians.

Then we will go into an educational visit.

And then we have another case conference where we are all on the phone together and we are saying, okay, we have got all these pieces of information.

You know, what is that differential diagnosis?

And then we have another case conference where we with the parent, where we provide the feedback and make the plan for this child. So other situations we I think other teams that I work in

is where we are talking about a child with attentional difficulties and trying to understand the root of those potential difficulties for children with learning disorders.

Also, you would be wanting to have psychology, speech pathology.

OT if you got handwriting and the paediatrician involved to look at the history, the child's development and make the plan. Selective mutism is absolutely evidence based where you need your doctor and you need to speech pathologist and psychologist all working together and the educator.

Absolutely, the educator for actual treatment to be successful.

And again, so speech sound disorders, I think it would be really great if we had case conferences with the general practitioner about, because general practitioners see so many children coming through with speech sound disorders.

And to talk about the differential diagnosis between those that are going to need really intense intervention compared to those that are developmental and need a short intervention.

Next slide. Thanks, Daniel.

So in practice as well, I think I have been involved in case conferences when there is particular crisis points for children and families, where particularly where there is behavioural disintegration.

And at that time, you'd want all the people who are working with the child in the family to be involved in supporting the family with what's going to be a plan going forward.

Transition times, it is really important too.

So when the child is transitioning, particularly into school, transitioning from primary school into secondary school, another great times to have case conferences about particular types of interventions.

I know I had a really great case conference with a general practitioner who had known a particular family's journey for a long time.

We were beginning the process of developmental assessment, and we really needed the you know, we really appreciated the general practitioner's understanding of this family and ability to support this family through the assessment process that was happening.

And so, again, as I said,

I think it is overall a positive change, a step in the right direction.

Please keep data and thank you very much to Doctor Anne-marie Boxall and her team.

Thanks so much, Robyn.

And look, we really appreciate having the input of clinicians and practicing clinicians who are already working in this space and supporting our work in this.

So thanks. Thanks for Robyn for her insights.

So we will now go to Peter.

Also, a clinician, a dietician.

Just wanted to ask a couple of questions to Peter to give you a chance to enter any questions you would like to ask of the panel on poll EV now.

We have got some questions in there which we can go to, but now's the chance to type your questions away.

So we will start with you, Peter.

So have you participated in multidisciplinary conferences before in your clinical practice?

As I think both you and Robin have already pointed out, that it is best practice if you can get everyone involved in the treatment team together and just have a common dialog about what's going on.

Often you'll hear things that other people are doing that give you insights into your own stuff, which is very, very useful.

And I found, particularly when I am in a co-located centre in a medical centre or somewhere, often these things happen either spasmodically or structured.

They can be either way, and they are very, very useful.

But the big difference is I did them for free, whereas as I can see, you know, from November the 1st, we can get paid for it.

So I think there is a lot of potential for these items, particularly, as Robyn said, you know, potentially leading up for a Chronic Disease Management Plan.

But I would also bookend it.

I would look at once someone has finished their five visits, whether it be five to me or whether it be split among others.

Now, getting that team back together and saying, well, where to from here?

Knowing that they may have some treatment, that is still yet to happen of course.

Maybe we need to look at how we are going to coordinate that until I get the next set of five visits.

And so I think there is a lot of potential in the way these used.

Great. Thanks, Peter.

And so, you know, can you give us a bit more information about how these new MBS items will, what will it mean for your practice?

Yeah, so I see patients all day, so maybe I can just look at it from their perspective, which is, you know, I see one lady who, she has diabetes and she is managed by myself and a diabetes educator.

She has had a whole lot of psychological issues and her psychologist is actually in Sydney.

I am in Port Macquarie and her GP is here as well.

And I think there is a lot of potential to get that whole treatment together, the team together, and just compare notes as to where we are at for her.

She's going to go on and have bariatric surgery a bit further down the track.

And so I think there is even potential to get the surgeon involved in those types of discussions.

So I think there is a lot of potential there for those who treat eating disorders.

I think there is a lot of potential to engage these item members at the start, at the end and through the treatment course for those people.

So I think I think, you know, the the creativity of how these could be applied is something that is really best left up to the treatment team.

I think the GP obviously coordinates it, but that with some suggestions from us as to how these could be positioned, as Robyn said, I think it could be a really useful way to continuing that treatment for everyone.

Great, wonderful. Thank you.

So look now go to the questions from participants.

So I have got one here already, and I'll read it out.

And I think just trying to scan it first to see who it needs to go to.

I think this one's a question for Louise.

So the question is, I am a dietitian, so there you go, in specialist eating disorder, private practice.

Our patients are referred under eating disorder management plans as opposed to team care arrangements or chronic disease management items.

Are Dietitians in this situation able to access the new case conference items?

So I guess, the legislation defines a chronic disease as one that has been or is likely to be present for at least six months or is terminal.

So if a patient meets these criteria, then eligible allied health providers would be able to participate in the case conference organised by that person's practitioner.

I guess the other point, and I know it is sort of been hinted at a few times in some of the other discussion is that these patients do not have to have a plan in place.

You may choose, a practitioner may choose to initiate one of these for many reasons, and one might be to inform the development of a plan.

But a plan doesn't have to be in place to do one.

Thanks, Louise. So we do have another question that is pretty

I think you may have answered, but I will ask it specifically as well, because it relates to that.

So do allied health professionals need to be specifically listed on the patient's CDM plan or can they be included in case conference to provide input into the management, even if they are not directly a treating provider?

Yes. So absolutely right, Anne-marie.

So as I mentioned the plan doesn't have to be in place. So, you know, as long as if they are claiming one of the case conferencing items, as long as they are an eligible provider, then that would be OK. Great.

So another one for you, Louise.

Could you have a case conference, for example, with a GP, a medical specialist and a specialist allied health person for example, a specialist clinic, but then also the treating allied health person of the same discipline?

Does it make sense there is more to the question, I think yes.

Does it make sense? Yes. Yes. And the answer is yes.

OK, great. Excellent.

So that is good. Oops. Sorry.

I am trying to operate two screens here.

I am too, Anne-marie

OK, I can see, sorry Anne-marie,

I might just let my team who are listening in to messaging me as well.

And one of them have said, it really depends on the specific item being claimed.

So I guess in all cases, we would always say, I am going to sound like a boring bureaucrat right now.

Please make sure you check your item descriptors and the explanatory note that goes with them just to double check.

Great. So here's the question I think

I will ask it and I will start the answer, but I think actually Robyn and Peter can probably answer this one as well.

So it says, can you suggest ways an allied health professional can initiate a case conference from a GP when they are not co-located in a practice?

So that is start with a letter to the GP after CDM is initiated and suggested.

So what are our thoughts on essentially overcoming that hurdle that Robyn mentioned right at the beginning about getting the GP to do it in the first place?

So I'll let the clinicians handle the clinician side of it because they've got more experience than me.

But one of the things, the broader things that we are doing in the government is we are trying to improve the education at the GP level of these case conferencing items.

So we will be doing some promotional activities to GPs.

We will be working with our PHNs, our primary health networks to promote this as well.

And also, I think, you know, this work that we are doing to in general improve the profile and the understanding of what allied health professionals contribute to patient care in Australia.

So we are doing some really big picture policy work to try and promote the role of allied health and what they can do.

And this is one part of it.

So I think this join the dots kind of exercise here where we need to say, you know, about allied health, these are the things you can do.

And you can also include them in case conferences now and they get paid.

So we can do part of that as well.

But I think as Robyn and Peter mentioned, there is stuff you can do at the practice level as well.

So I might go firstly to Robyn to see if she has got any thoughts and then to Peter as well.

So to you, Robyn.

Thanks, Anne-marie.

I think we are just going to have to be really persistent, so but also, we have to help the doctors know why a case conference is going to be beneficial.

So we have to say, if we have a case conference for this particular child,you know, we are going to be able to achieve these and be quite explicit about the outcomes that we are going to achieve.

The role of the doctor, what we want to find out.

So it really, as I say, break down the task, what we want to find out from the doctor, how that is going to be so much benefit to the patient, and it is going to assist the outcomes and it is going to solve some problems for the doctor.

So I think, and I also just think persistence like I know it is you know, it is time we do not have, but just to keep on, you know, I had a case like that this week where I wanted to speak to a paediatrician, and I was unsuccessful.

But I emailed her three times to say, you're seeing this child on the 6th of October for a diagnosis.

You going to want our information and I want to speak to you about this child.

And I didn't get any response.

But look, you know, I am not pointing the finger because everyone's in all sorts of situations at the moment.

But persistence, I think we just have to be persistent.

And then when the doctors had really good experiences with case

conference, they will say, OK, oh, yeah, I can see how that really works, but it is got to be worth their while in terms of what they are going to get out of it.

Absolutely. Thanks, Robyn.

And Peter, do you have any ideas?

And look, I see some parallels with the introduction and the additional items that people of Aboriginal descent when that first came in, that those items were introduced.

And then what I found is I had to communicate with the GP to either in writing or simply ring them up and just say, look, there is some extra opportunities for us to continue the care for these kinds.

And this could be something you might want to consider.

And I think certainly, you know, the additional items with the items from people of Aboriginal descent enabled ongoing access to me.

These case conferencing might not mean that I get additional visits this year, but it may mean that we we can manage the care as we transition through the year and coordinate it in a way that we are all comfortable, that we are all headed in the same direction, knowing that we may get an additional opportunity in the new year with additional items and so, I think I think there is a big opportunity there, and I think, you know, in the end, worst case scenario, just pick up the phone and tell people that is what I would do.

Fantastic, and look, it is really nice.

It is a struggle, I know, and it is really nice to hear that people are doing things like that.

So just picking up the phone and trying to get through and finding ways of communicating with GP's and we will get there in the end and I think it will improve.

But I always find it heartening to know that we are both working to tackle the same problem from very different angles.

So it is really fantastic.

OK, so we have got another question here.

And this one does look like it is in Louise's bag.

So do all allied health providers need to have seen the patient prior to the case conference, which I think with answered.

But what documentation is recommended. Oh, goodness.

I think I do not have the answer for that one off the top of my head,

I would have to take that one on notice.

Sorry, Anne-marie. OK, no, that is fine.

I think one thing we did sort of briefly mention it that I might just reinforce is so if the patient isn't already does not already have a Team Care Arrangement, we have mentioned that it is OK for the allied health professional to be included and to be reimbursed.

But there needs to be documentation that the patient has agreed to having that allied health provider at the case conference and the allied health professional needs to make sure that that is recorded accurately.

So that to me, in practice, it sounds like a conversation with the GP.

Is the patient aware that I have been invited?

Does the patient agree?

Have you noted it down?

And the allied health professionals so that, that is an important part of the documentation.

And I do think that is explained in the fact sheet as well. Yes. And Anne-marie

Yes, I was going to say while you've been talking, the marvellous Brooke and David in my team have come in with answers, and so you are exactly right.

Approval from the patient just needs to be documented.

And, of course, as per usual, you know, best practice, know, a report back to the patient or the carer following the case conference would always be appropriate as well.

Excellent. Great.

So now I have a question that I do not know that any of us know the answer to but I'll ask anyone who does is free to welcome to answer. Are there specific telehealth platforms disallowed?

We use Zoom Professional.

Is this acceptable?

Louise, you look like, you know the answer.

Yeah, so I am pretty certain that as long as it meets privacy legislation and that businesses and providers have made sure that it does, then it is fine.

Peter seems to be nodding, too.

Peter, are you able to shed any light?

No, no, no. The only thing I was going to say, as long as is a private, secure network, then surely anything.

OK, everyone seems to be agreed.

As long as it is a private, secure network, it is fine.

So that is great.

And I just would remark here that allied health, we have been particularly impressed about allied health and their adoption of telehealth and particularly the use of video conferencing.

So shout out to all of the allied health professionals there who have done a great job and have adopted, been innovative, quick to adapt and have adopted technology so that it really does the best in terms of quality care.

So thank you for those people who've done it.

OK, we do have another question.

Does a practice nurse count as one of the three required health professionals? Louise. No.

The answer is no.

Yes, because they have to be eligible.

Oh, see, now I am looking.

I can see them frantically typing.

It would be the same as the scenario on the slides where one was an educator, and I cannot remember the answer to that.

Maybe Daniel can look. It would be exactly the same scenario as that.

I think I think I can answer.

So if the practice nurse is an important part of the care team, they can be part of the case conference.

But the practice nurse, if they are not an eligible MBS provider under those case conferences, the practice nurse will not be reimbursed.

That is exactly right, Anne-marie.

And that, of course, recognizing some practice nurses do become eligible

mental health providers.

So just putting that little caveat on.

But that is exactly the answer.

So thank you. I think that is possibly one that we might like to include in our sort of Q&A document as well, because I can see that one coming up again.

So whoever submitted that question, thank you.

I think that was really, really helpful in clarifying the communications that we put out to the sector on these.

All right. I am just seeing if there are any further questions at this stage.

Yes, Robyn has a question, Robyn.

I do have a question for Louise in terms of the different item numbers for the doctors, depending on whether they are organised or just participated. Yes.

So therefore, to me, that was a bit of a window for allied health communicating and initiating and maybe even organising, and so long as you've got the doctor participating.

So allied health technically cannot initiate.

They can certainly, as we were talking about before, they can nudge the provider to initiate and include them.

And we would absolutely encourage that.

But yes, and recognizing that, for example, especially, you know, an obvious example would be a child being seen, and, you know, you might involve the treating paediatrician, the GP and some allied health providers as well.

But the allied health provider, the only way they can initiate is sort of informally at this stage.

Yes. Look, I just understand that. I do not understand the wording.

I do not understand the different item numbers where a doctor can be the one who organises it or can just be a participant.

So that is what you're talking about. Sorry. Yes. Yes.

So if a GP organised it for the paediatrician to attend.

Yes. So it is doctor to doctor you're talking about.

Yes. So in that case, you know, if the GP organised it and the paediatrician attended, the paediatrician claims an item for participating rather than initiating it. Thank you.

Great, ok. Any chronic disease and then the GP is the coordinator of chronic cares.

Yes, so I think that is right, and I think the difference here isthat for some of the pervasive developmental disorders and disability, sometimes the GP is not the primary clinician.

So it is an important distinction.

OK, we have got another question here, which I think is probably one for both me and Louise.

So what information is being provided to GPs and other medical professionals about the potential for client care using these conference items?

It would be a shame

if, you know, the medical profession were not educated on it in the first instance.

So, great question.

So I mentioned briefly beforehand that we will be doing some promotional activity to the medical sector about these case conferencing items.

So we will be sending out information through our channels,

through PHNs and directly to the medical profession to alert them to this information, to this change, this important change, so that it is a prompt to them to refer patients for relevant case conferencing and chronic disease management and other MBS items.

So that is something that we are doing.

We are also doing things informally, so presenting at key meetings with the health professional associations and medical groups to promote the items as well.

I think I have a meeting in the next week or two to talk to the peak medical bodies about this.

So we are doing some things and Louise, is there anything else you wanted to add on to that?

Yeah, thanks Anne-marie. I guess the other point is that we want them to be used more.

Of course we do.

But also recognising that many GPs and specialists already do use these items and the items that are available for them, rather, and that these items are about reimbursing participation for allied health providers.

But I absolutely agree.

We need to nudge them.

So we will certainly do some work in that area.

Another one for you, Louise.

So this is about pain management.

And the person who's written the question says physios, OT psychologists and pain medicine specialists would really value this.

So does it matter if the GP is not involved, if they have a written chronic disease management plan?

So I guess, again, this comes back to as long as the pain management specialist is an eligible doctor, they can absolutely initiate a case conference.

And again, the patient, if they meet the definition of having a chronic condition, then they can have a case conferenc where people, hopefully with the patient, would work out a treatment plan.

So and I have just lost my train of thought Anne-marie.

Help me out. Sorry.

So it is whether GP needs to be involved was the question.

So the answer, the short answer is no.

It could just be the consultant physician or the treating specialist and other providers.

That is good. Great news.

OK, another great question.

So Aboriginal Torres Strait Islander people are entitled to an extra five chronic disease management items a year.

Will the case conferencing entitlement for these patients be the same?

Yes, as I mentioned, and just to reinforce the case conferencing items do not count towards those caps.

So whether the patient is an Indigenous is a patient who has the Indigenous items or under the 715, I think it is, or a chronic disease management plan or as I mentioned, they do not have to have a plan.

Essentially, it does not matter because these allied health case conferencing items do not count towards the cap.

Right. So they are in in addition to.

Yes. OK, look, we have got another question here.

I think this is clarifying what we have discussed before, but I think it is worth asking again.

So does Doctor-led include led by a specialist or is it just a GP? That includes led by a specialist.

Which is great, and that applies to both the chronic disease management and the pervasive development disorder? Yeah.

And of course, as Peter mentioned, you would hope with chronic disease management that the GP is very much involved in coordinating that.

But it is not always the case.

OK, I haven't read this question so I'll read it out and then work out who can answer it.

If people are also receiving services from a social worker under better access, and they wish the social worker to also attend the case conference, could the social worker also claim for their attendance?

I think that one is for you, Louise.

Yes, so at the moment and this literally came up just prior to us all getting online today,

I think we have got to double check that.

I think at the moment and there is a big I think they are at the moment, no, but we will double check and get back about the eligibility of social workers to claim.

OK, great. And just to reinforce, we will be, the AskMBS fact sheet and service is a way of asking information.

If there are a few questions that we have essentially taken on notice today, what we might do is pull together the answers and distribute it to the list of participants today so you do not have to go looking for it.

So there is a there is a couple of we have taken on notice, and it will do our best to answer those as quickly as possible.

Yes, OK. And sorry, I might just say we are pretty sure at the moment that unfortunately the social worker cannot claim, but they would absolutely, we would hope they could participate if relevant.

But that is certainly something that we need to look into.

OK, so we have got another one here that is a very interesting one.

So we will see who wants to answer it.

How can a professional association collate data from clinicians practice management software?

Should this be supplemented by the government to get the correct data and assist in the huge costs associated to get the appropriate data like our medical colleagues?

So I think I'll provide some answer to this, but I might because you mentioned it earlier on, Robyn, about the role of professional associations.

I'll just go to you to see if you've got anything and then to Peter and then I'll have a go to.

Well, I think it is a great question.

It does cost practices a lot of time, a lot of money or time is money to collect data. So

I think it would be fantastic if there was a grant so that professional associations could set up a situation where it was easy to collate this data because, you know, the data is the real information of what is happening out there.

And if there seems to be not a take up of these case conferencing items, we need the data as to say we will how

You know this. You know, how often was the case conference prompted by the allied health professional without any response?

What ways were they prompted, what ways did you prompt, as Peter said, a phone call or an email or through the practice nurse?

And I think it'd be really interesting to keep the data of how often allied health has conferences between each other as well.

That is great.

Look, I am aware we have got two minutes left, so I might,

Peter, did you want to say something briefly?

Just to say, I am doing my PHD, and part of the research is the answer to that question is you cannot. It is impossible in Australia at the moment to get any type of collated data across any of the fields, because we all have different systems in place. In the physiotherapy field

I think there is something like 17 different systems in place in the small amount of work I have done in the dietetic field, testing systems in place, and they do not talk to each other.

So to coordinate that for a profession, it is a great goal and that is certainly part of my PHD, but at the moment that cannot be done.

So whatever you can capture locally, do it. Someday in the future will be able to collate that, I am sure. Excellent.

That is a fantastic lead to my final comments.

And we do need to finish at two o'clock.

Is that we are absolutely considering this very issue of being able to get the rich source of data that is in different professional groups, clinical software, given the range of different clinical software systems that are about.

So we are investigating it.

We haven't got firm plans yet, but we are absolutely looking into this.

And so it might be some time, but we will be on to it.

So, look, that is all we have time for today.

So I just wanted to really thank both

Peter and Robyn and Louise for their fantastic contribution.

We really, really appreciate it.

It is been really valuable, I think, to be able to have this session and to be able to hear live questions from clinicians about what matters to them and what issues need to be resolved.

So I thank you all for your participation.

And we will as I said, we will be posting this online and very happy to take questions through AskMBS at a future point.

So thank you very much, everyone. Goodbye.