Medicare Local After Hours Funding

Transcription

1 BARWON MEDICARE LOCAL Medicare Local After Hours Funding Information and Guidelines Amended May 2014 This document provides the background information and guidelines for practices funded under the 1 Medicare Local After-Hours Program

2 Contents 1. Introduction... 3 Background... 3 Purpose Program Overview... 5 Program Aims and Objectives... 5 After-Hours Program Guidelines and Criteria Funding Model Conditions of funding Reporting Requirements Conflict of Interest Taxation Implications Additional Information Complaints

3 1. Introduction Background In the Commonwealth Government announced the Establishing Medicare Locals & Improving Access to After-Hours Care which has seen the development of a National After-Hours GP Helpline and new funding to Medicare Locals (MLs) to address the after-hours primary care needs of their region. This is a mandatory role for MLs who are responsible for: Ensuring that local after-hours primary care services are well planned, coordinated and appropriate to community needs Ensuring that appropriate primary care services are accessible when needed, including linking after-hours services with the National GP After-Hours Helpline Ensuring patients are directed to the most appropriate point of care for their condition Better supporting health professionals in the arrangement and/or provision of after-hours care for patients The Medicare Local After-Hours Program comprises of three major stages: - Known Gap Filling Proposal - Stage One Plan - Stage Two Plan The below diagram provides an overview of the timeframes for Barwon ML in regard to key deliverables and Commonwealth funding changes. General Practices in Barwon ML region ineligible to apply for GPAH grants GPAH grants no longer offered PIP After Hours funding for General Practice ceases Tranche 1 MLs established Jul 2011 Oct 2012 Jul 2012 Jul 2013-Jun 2014 Jul 2014-June 2015 MLs to submit Known Gap Filling Proposals Barwon ML to start implementation of approved Stage One Plans Barwon ML implementation of Stage Two Plan and funding model AH Funding model and current levels of funding maintained for 2014/15 3

4 After-Hours in the Barwon Region Stage Two of the Medicare Local After-Hours Program commenced on 1 July 2013 when the Commonwealth re-directed the PIP After Hours payment funding and the GPAH grant funding to Medicare Locals. Barwon ML was tasked with the development of a comprehensive regional approach to the provision of after-hours primary care in the Stage Two Plan. This Plan built on the findings and outcomes of the Stage One Plan and incorporates approaches to sustain and support local after-hours service provision following the loss of the after-hours PIP and GPAH grants. For Stage Two of the after-hours program Barwon ML is took a sub-regional approach which recognised that after-hours service delivery models operate differently across regions and are based on factors including rurality, socio-economic status, availability of GP workforce, levels of demand, existing service provision and access to deputising services. The Barwon ML region was divided into ten sub-regions based on Australia Bureau of Statistics SAL2 geographical boundaries and includes the following: 1. Apollo Bay 2. Colac 3. Surfcoast- including Torquay, Jan Juc, Anglesea, Aireys Inlet and Lorne 4. Winchelsea 5. Golden Plains 6. Bellarine 7. South Barwon 8. Central Geelong- including Leopold 9. Northern suburbs 10. Lara 4

5 For the purpose of the Medicare Local After-Hours (MLAH) Program Guidelines: Primary Care is defined as generally the first point of contact people have with the health system and can include general practice, allied health services, community health and community pharmacy and relates to the treatment of non-admitted patients in the community. After-Hours Primary Care is accessible to and effective care for people whose health conditions is urgent and cannot wait for treatment until regular services are next available. The After-Hours period is defined as: before 8:00am and after 6:00pm weekdays; before 8:00am and after 12:00pm Saturdays; and all day Sundays and public holidays. The after-hours period can be further categorised into the following periods: the sociable after hours period, between 6:00pm and 11:00pm; and the unsociable after hours period, between 11:00pm and 7:00am. During the unsociable period it is particularly difficult for people to access after-hours primary care and for providers to be sustainable in operating their after-hours services. Purpose The purpose of these guidelines is to provide service providers with information regarding program objectives and guidelines. 2. Program Overview Program Aims and Objectives The aim of the Barwon ML After-Hours Funding is to ensure efficient and sustainable delivery of after-hours services across the whole Barwon ML region that are accessible to the local community. Barwon ML has the following objectives for the MLAH program: Provision of funding to support after-hours service delivery across the region that meet funding guidelines and provide access to community in all sub-regions of the Barwon ML. To increase community awareness of after-hours services within the Barwon ML region including the GP After-Hours Helpline. Provide support to General Practices undertaking co-operative after-hours arrangements to ensure services meet guidelines and criteria and provide a framework to support working relationships among participating GPs. 5

6 After-Hours Program Guidelines and Criteria Barwon ML developed the following principles to support its development of the after-hours funding model for the region. Barwon ML After-Hours Program Guiding Principles To work within the Commonwealth Government MLAH Guiding Principles focussing on accessible and effective care. Changes in after-hours service delivery across the region are expected to be implemented incrementally; service delivery should not remain unchanged. There should be noticeable change in after-hours service delivery for some sub-regions of the Barwon ML from July , with the expectation that changes in other regions occurs incrementally. There is a commitment to maintaining engagement with GPs. After-Hours service delivery should be efficient and affordable. Commonwealth After-Hours Guiding Principles Accessible Care Appropriate- meet the needs of the local population- considering demographics, workforce data and disease characteristics Timely- consider patient s travel time and ensure face-to-face services are available where appropriate Available- accessible to all patients regardless of their usual residency or general practice Affordable- ensure there are no financial barriers for patients to access care Equitable- ensure care is culturally appropriate and accessible by public transport & meet needs of vulnerable population groups. Effective Care Continuity of Care- ensure formal arrangements are in place to transfer information to the patients usual GP and use PCEHR when available Coordinated- ensure services are linked with other local after-hours services including health direct Quality and Safety- Ensure after-hours service providers are accredited to RACGP standards and have appropriate security measures in place Efficient- Use all resources to provide the best outcomes for patients Sustainable- ensure the after-hours workforce is sustainable and the service is monitored through regular financial reporting. 6

7 MLAH Funding Guidelines In line with the MLAH Guidelines and Barwon ML Guiding Principles funded after-hours service providers must consider the following criteria: Sufficient and Appropriately-qualified GP Workforce Service providers will need to demonstrate that the after-hours service has access to an appropriately qualified workforce with sufficient numbers to operate the service efficiently and without creating undue workloads for individuals. Support of Participating GPs Service providers will need to demonstrate the support of the GPs who will be providing the after-hours care. A letter of support from all GPs participating in the after-hours service should be provided with applications. This also applies to cooperative arrangements between providers. Where it is not possible to provide letters of support from participating GPs, for example where the service is in the process of recruiting a workforce, or plans to recruit if funding is approved, a detailed explanation of how a workforce is to be recruited should be provided. Quality and Safety of After Hours Services Quality: After hours services should be accredited against the Royal Australian College of General Practitioners Standards for General Practice. General Practices that are not accredited may still be eligible to apply if they can show evidence that they have registered for accreditation within the next 12 months. Safety: Practices need to show there are appropriate safety measures in place within both the clinical and home visiting setting. After-Hours home visits should be conducted in line with the RACGP safety guidelines for home visiting. After-Hours services delivered through a general practice must meet the RACGP standards for safety in clinical settings. Access Services need to ensure after-hours care is delivered in line with the following: o o Appropriate- meet the needs of the local population within the sub-region a service is located in. Available- After-Hours services must be accessible to all patients living within or visiting the sub-region in which the service is located regardless of the person s usual residency or general practice arrangements. The service must be available to all patients within the subregion the service is located in, not just existing patients of the service or patients of GPs subscribing to or providing the after-hours service. 7

8 o Timely- considering patient travel time and service delivery Travel time: Ensure patients do not need to travel more than a maximum of 70km to access a face-to-face after-hours service Deputising Services delivered in line with RACGP standards for General Practices. Practices must have transparent triage processes in place to assess the urgency of a patient s condition as per the RACGP triage guidelines. o Affordable- costs to the patient for after-hours services must be affordable. Services must have transparent billing processes in place and disclose costs to the patient prior to GP consultation as per the RACGP accreditation guidelines. Services will be required to provide after-hours fee structures on application for Stage Two After-Hours funding. Equitable- Practices should have processes in place to support the delivery of culturally appropriate care to Aboriginal and Torres Strait Islander (ATSI) patients including consideration for registration for the Indigenous PIP. Practices should also have processes in place that support the use of interpreter services for patients not proficient in English and services that support patients with hearing impairments. Continuity of Care After-hours services need to put, or have existing, continuity of care arrangements in place. These arrangements will ensure the effective and timely transfer of information between the after-hours service and the patient s usual GP. It is highly desirable that services consider how ehealth initiatives such as secure messaging via ReferralNet and use of the Personally Controlled Electronic Health record (PCEHR) could be built into the proposed service models to support continuity of care. Funding received can be used to support the implementation of e-health initiatives into an after-hours service. Practices should ensure services are linked with other local after-hours and emergency services including the healthdirect GP After-Hours Helpline. After-Hours Service Models Preference will be given to services currently operating within the Barwon ML region and where after-hours services are not available then alternative services will be considered. Barwon ML recognises that there are successful after-hours service models currently operating in the region and that each sub-region operates independently and will require different after-hours service models. Where appropriate Barwon ML supports the use of cooperative or rota after-hours service models but recognise that this model will not necessarily be the most suitable in all sub-regions. Cooperative after-hours models bring together GPs willing to participate in an organised roster for the provision of after-hours clinic services and/or home visits from a centralised clinic location. For the purpose of Stage Two After-Hours funding a Cooperative After-Hours Model must include a minimum of three practices and provide after-hours care through extended opening hours via a centralised clinic that allows for local GPs from other practices to opt into participating on the roster. Formal agreements should be in place with all practices participating in the cooperative model. 8

9 Rota after-hours models involve collaborative rosters where local GPs and practices cooperate to provide organised cross practice on call and/or clinic based services for patients in a defined geographic area. A Rota After-Hours Model can be defined as a minimum of three practices working collaboratively to provide after-hours care with the practice location rotating between the involved practices depending on which GP is on call or providing after-hours services. After-Hours service models need to demonstrate increased efficiency in delivering after-hours care and reduced demand on GPs and should consider after-hours service delivery in both the sociable versus unsociable after-hours period. 9

10 3. Funding Model Current Barwon ML after-hours funding will be maintained for the 2014/15 financial year for all practices who received after-hours funding in the 2013/14 financial year under the following funding streams. Stream One- Extended opening hours between 5-10 hours per week $7,500 per year for practices that provide extended opening hours for between 5 and 10 hours per week in the after-hours period and see any patient who presents regardless of their usual residency or general practice (based on published opening hours). Stream Two- Extended opening hours hours per week Stream Three- Extended opening hours 20+ hours per week Stream Four- Extended opening hours greater than 30 hours per week Stream Five - 24/7 on-call after-hours cover Home Visiting and RACF services $18,000 per year for practices that provide extended opening hours for between hours per week in the after-hours period and see any patient who presents regardless of their usual residency or general practice (based on published opening hours). $28,000 per year for practices that provide extended opening hours for greater than 20 hours per week into the after-hours period and see any patient who presents regardless of their usual residency or general practice (based on published opening hours). $38,000 per year for practices that provide extended opening hours for greater than 30 hours per week into the after-hours period and see any patient who presents regardless of their usual residency or general practice (based on published opening hours). $36,000 per year for practices that provide access to 24/7 on-call after-hours care in sub-regions in which there is no access to an alternative home visiting after-hours service. $35,000 per year incentive payment for services providing 24/7 on-call after-hours care through an urgent care centre or where no other after-hours services exist in the sub region. Practices providing 24/7 on-call care and extended opening hours are eligible to apply for Stream Five and Stream 1 through to Stream 4 depending on the level of care provided as per above, however practices receiving the urgent care centre or sole provider incentive payment are ineligible to apply for extended opening hours funding (Streams One, Two, Three and Four). Funding will also be available by tender to support a home visiting service incorporating services provided to RACFs for any patient who presents regardless of their usual residency or general practice for the region covering: Central Geelong South Barwon Northern Suburbs Lara Bellarine Peninsula In these regions providers will only be eligible for Stream 1 through to Stream 4 depending on the level of care provided as per above 10

11 Cooperative/Rota incentive Cooperative or Rota model incentives will require a minimum of three practices to receive the following incentives: $50,000 per sub-region per year incentive payment for practices that provide Stream Three extended opening hours or Stream Four afterhours care through a cooperative or rota after-hours model. $25,000 per sub-region per year incentive payment for practices that provide Stream One or Two extended opening hours through a cooperative or rota after-hours model. Practice Cooperative Incentive for the number of face to face after-hours hours per GP contributing to a Cooperative: o $1,000 per year per GP for contributing between 38 and 65 hours per quarter o $1,500 per year per GP contributing between 66 and 129 hours per quarter o $2,000 per year per GP for contributing 130 hours or more per quarter For practices that don t meet the above funding criteria Barwon ML will be delivering a home visiting and RACF service for the central Geelong, South Barwon, Northern Suburbs, Lara & the Bellarine regions. 11

12 Conditions of funding Barwon ML after-hours funding will be provided through a formal funding agreement for the period of July 1, 2014 June 30, The agreement will set out the terms and conditions of the funding in detail. Service providers should ensure they are familiar with and, where necessary, seek legal advice on, the terms and conditions of the proposed funding agreement. A copy of the standard Barwon MLAH Program Grants Agreement is available via the website All funded services will be required to contribute to the docgeelong website ( by updating practice opening hours and capacity and also contribute to the after-hours GP Helpline Service Directory as part of the funding agreement. Reporting Requirements Recipients of funding will be required to provide regular progress reports to Barwon ML on after-hours service delivery activity for their service model. Funded practices will be required to provide Barwon ML with service usage data via regular reporting including the total number of after-hours consultations and total number of aged care patients seen as outlined in the funding agreement. The After-Hours Funding guidelines are available on the Barwon Medicare Local website at A reporting template will be ed to all funded practices prior to the report due date. PEN CAT will be used to easily extract the required after-hours data. Data can also be submitted via a MBS after-hours item number report. Information contained in project progress reports will contribute to a regional after-hours service delivery database and may be used to measure the effectiveness of improving access to after-hours services within the region. This data will form part of Barwon MLAH Program reporting to the Commonwealth. The funded Home Visiting and RACF service will be required to report against the Minimum Dataset developed in collaboration with Victorian Medicare Locals and the service providers. These will be outlined in the contractual agreement. Conflict of Interest Service providers should declare any existing conflicts of interest. Taxation Implications Service providers are advised to seek independent professional advice regarding the treatment of this funding in relation to taxation implications for the recipient. Additional Information Additional information about the Barwon after-hours program can be found on the Barwon ML website Complaints As outlined above, it is a mandatory role for Medicare Locals to ensure the after-hours primary health care needs of the community within the relevant ML region are appropriately addressed. 12

13 Complaints regarding a funding agreement that has been executed will be handled in accordance with the Agreement. Barwon ML Contacts All inquiries about after-hours funding and contracts can be directed to: Stacey Stevenson- Contracts Officer Barwon Medicare Local stacey@barwonml.com.au Ph: