From Chronic Disease Management to Chronic Condition Management in the MBS
Previously set to commence on November 1, 2024, the Medicare Benefits Schedule (MBS) will undergo significant changes that will reshape how healthcare providers manage chronic conditions in Australia. These changes represent a shift from the existing Chronic Disease Management (CDM) framework to a more streamlined and efficient Chronic Condition Management (CCM) program. While this initiative has now been postponed to July 2025, understanding what is being replaced and why these changes are happening is crucial for all healthcare providers.
What Was Chronic Disease Management?
Chronic Disease Management (CDM) has been a key component of the MBS for many years, designed to help General Practitioners (GPs) and other healthcare providers manage patients with chronic conditions. The CDM framework allowed GPs to develop and coordinate care plans through a series of item numbers that supported both the creation and ongoing review of these plans.
The key item numbers under the CDM framework were:
MBS Item 721: This item covered the preparation of a General Practitioner Management Plan (GPMP), which outlined the patient’s health needs and the services required to address those needs.
MBS Item 723: This item was used for coordinating a Team Care Arrangement (TCA), which involved collaborating with other healthcare providers to deliver comprehensive care.
MBS Item 732: This item facilitated the review of the GPMP or TCA, ensuring that the patient’s care plan remained relevant and effective over time.
These item numbers were essential in providing structured, ongoing care for patients with chronic conditions. However, as healthcare needs and practices have evolved, the CDM framework has been recognised as needing updates to better reflect current clinical guidelines and improve patient outcomes.
The Transition to Chronic Condition Management
Starting November 1, the CDM items will be replaced with the new Chronic Condition Management (CCM) program. This change is not just a rebranding; it’s an overhaul aimed at simplifying and modernising the process of managing chronic conditions.
The new item numbers and their respective functions are as follows:
Developing a GP Chronic Condition Management Plan:
Face-to-Face Consultation:
MBS Item 965 (replaces Item 721) can be completed once every 12 months, provided the patient meets the applicable criteria.
Prescribed Medical Practitioner Item 392
Telehealth Consultation:
MBS Item 92029
Prescribed Medical Practitioner Item 92060
Reviewing a GP Chronic Condition Management Plan:
Face-to-Face Consultation:
MBS Item 967 (replaces Item 732) can be completed once every 3 months, provided the patient meets the necessary criteria, which is yet to be clarified.
Prescribed Medical Practitioner Item 393
Telehealth Consultation:
MBS Item 92030
Prescribed Medical Practitioner Item 92061
These changes are designed to streamline the management of chronic conditions by reducing redundancy and clarifying the requirements for each service. The introduction of specific items for telehealth consultations also reflects the growing importance of digital health solutions, particularly in a post-pandemic world where access to healthcare must be flexible and inclusive.
Key Changes and Their Impact
One of the most significant updates is the transition from specific forms required for allied health referrals to the use of referral letters, which aligns with the referral process already in place for medical specialists. This shift is intended to streamline communication between GPs and allied health providers, making it easier to coordinate care across different healthcare professionals. Instead of filling out a standardised form, you will now need to ensure that your referral letters include all relevant clinical information in a format that is consistent with the new MBS guidelines.
The changes also place a greater emphasis on preventative care and the regular review of management plans. By encouraging more frequent check-ins, the updated MBS items aim to catch potential issues early, before they escalate into more serious health problems.
For providers preparing CCM documents, this transition will also need to involve updating templates and documentation practices to align with the new MBS requirements. This means that current workflows, especially if they are automated or semi-automated using practice management software like Best Practice’s Enhanced Primary Care (EPC) function, MedicalDirector Care, ZedMed CDM function, or My GPMP Tool, will need to be revised. Under the previous CDM system, providers often needed to prepare two separate documents: one for the GP Management Plan (GPMP) and another for the Team Care Arrangement (TCA). With the new CCM framework, these processes are consolidated, meaning providers will now generally only need to prepare one comprehensive document instead of two. This consolidation reduces overlap and makes the documentation process more efficient, allowing providers to focus more on patient care.
Preparing for the Changes: Training and Resources
Healthcare providers should start preparing for this transition by:
Evaluating and adjusting your practice’s workflows to ensure that they align with the new MBS requirements. This includes modifying templates and updating automated processes within your software tools.
Providing training for your staff on the new item numbers and any changes in the processes for creating and reviewing care plans under the CCM framework. Encourage them to review several training resources currently available, including:
The Department of Health Webinars offering detailed guidance on the new item numbers and practical applications.
RACGP Training Webinars and modules specifically designed to help GPs integrate these new items into their workflow.
Primary Health Networks (PHNs): Many PHNs offer localised training sessions that include practical examples and case studies to help healthcare providers adapt to the new framework.
To conclude, the transition from Chronic Disease Management to Chronic Condition Management marks a significant shift in how chronic illnesses are managed within Australia’s healthcare system. By introducing new item numbers, streamlining referral processes, and emphasising preventative care, these changes are set to improve patient outcomes and reduce the administrative burden on healthcare providers. As 2025 approaches, taking advantage of the available training and resources will be crucial for ensuring a smooth transition and continuing to provide high-quality care to patients with chronic conditions when the changes are commenced.
