Today's profession: Views and practices of private practice dietitians re Medicare Chronic Disease Management program

Abstract

Aim: To explore private practice dietitians' experiences of Medicare Chronic Disease Management allied health program operations, particularly regarding workplace environments, patient management practices and acceptance of the program. Methods: A cross‐sectional national survey was administered electronically in 2008. All private practice members of Dietitians Association of Australia were invited to participate. A 38‐item questionnaire asked about referrals, patients, fees, billing and participant demographics. Descriptive statistics, χ2 and Spearman's rank order correlation coefficient were used for analysis (if P < 0.05). Results: There were 356 (47%) dietitian participants; 94% were Medicare providers. Most (75%) worked in private practice ≤20 hours per week (median 12.0) and half (47%) in sole practices. Medicare referrals made up 0–100% of their practices. Patients were seen as complex because of their chronic conditions. Many dietitians reported inability to complete initial patient education within funded consultation time. Consultation time was often increased and patients were required to pay more than the scheduled fee. Fees were lower for follow‐up consultations. Dietitians' acceptance of the Medicare‐Plus Chronic Disease Management program was low. Conclusion: Current Medicare policy arrangements provide insufficient initial consultation time for counselling; and available frequency of follow‐up consultations is low. As a consequence, eligible patients have limited access to low‐cost dietetics services. The results support a need for review of the Medicare‐Plus Chronic Disease Management policy for dietetics interventions and alignment with other counselling services to better meet the needs of providers and also of patients with chronic conditions and diet‐related risk factors.

Time and financial outcomes of private practice dietitians providing care under the Australian Medicare program: A longitudinal, exploratory study

“…No significant differences in the time dietitians spent on initial and review consultations were found in the present study. Dietitians have previously reported that due to the counselling nature of dietetics, half hour initial consultations are insufficient to provide adequate care . However, dietitians consider the time frame covered by Medicare (20 minutes) adequate for review consultations .…”

“…Dietitians have previously reported that due to the counselling nature of dietetics, half hour initial consultations are insufficient to provide adequate care . However, dietitians consider the time frame covered by Medicare (20 minutes) adequate for review consultations . Therefore, it appears more financially sustainable for dietitians to retain patients through review consultations, rather than conducting numerous initial consultations.…”

“…charge Medicare directly for the schedule fee listed in the Medicare Benefits Schedule, incurring no expense for the patient) . Therefore, there are concerns that dietetics services under the CDM program may not be financially sustainable and clearly warrant further investigation …”

Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care

“…A 2007 study of dietitian CDM providers found that type 2 diabetes mellitus, obesity and cardiac conditions were regarded as the most commonly referred diagnosis types for Medicarereferred dietetics patients. 16 Furthermore, the number of CDM services provided to patients per each Medicare provider by dietetics and by diabetes education in 2008-09 were among the highest of all providers, 9 suggesting that patients with type 2 diabetes were receiving these education services. Indications are that patients who require the Medicare services for chronic conditions may be receiving them.…”

Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study

“…Under existing MBS funding, patients with chronic conditions (including patients with obesity who have co-morbidities or multiple risk factors) are eligible for a GP Management Plan (GPMP), which includes five subsidised allied health visits. However, these five visits are often insufficient to meet all the care needs of patients and to provide care consistent with best-practice guidelines; for example, weight management guidelines produced by the Dietitians Association of Australia (Cant 2010). This is particularly the case for patients with obesity and complex comorbidities who require care across multiple allied health specialties.…”