MyMedicare: What we know so far

With the Australian government’s notable commitment of $824.4 million towards digital health initiatives, we stand at a point in our healthcare landscape where change my be upon us. MyMedicare warrants a thorough understanding for its potential impacts on our practices and the broader healthcare sector. There are steps you can take to prepare for MyMedicare, but the focus of this article will be what we know so far.

Understanding MyMedicare

At its core, MyMedicare is an initiative designed to enhance the relationship between healthcare professionals and patients. It zeroes in on a crucial aspect of our healthcare system – continuity of care – particularly in the face of an ageing population and the increasing prevalence of chronic diseases. The program’s initial focus is on doctors and patients, with an expansion plan to involve nurse practitioners and other primary care providers in due course.

According to a recent response from the Department of Health and Aged Care, a key component of the MyMedicare system is incentivising GPs to sign up frequent hospital attendees – defined as those who visit a hospital more than ten times a year. A one-time payment of $2,000 is awarded to the GP upon enrolment of said patient, with the potential for an additional $500 per year if the patient’s hospital visits are reduced. This funding is expected to be utilised towards “wraparound care” by engaging allied health partners to assist in managing the health of these patients’ outside of the hospital setting.

Further, under the MyMedicare initiative, GPs can offer extended telehealth consultations to registered patients without additional charges. Although this does not directly translate into extra revenue unless there is a significant increase in longer telehealth calls. This enhances the flexibility and accessibility of care, which could indirectly contribute to the practice’s patient retention and satisfaction rates.

Starting 1 July 2023your practice can commence preparations for MyMedicare. The first step is to register your practice in the Organisation Register, which can be accessed through the Services Australia HPOS service. To assist with the registration process and provide detailed information.

Starting from 1 October 2023, MyMedicare registration will become an option for all Australians who hold a Medicare card or a Department of Veterans’ Affairs (DVA) Veteran Card. The registration process is designed to be voluntary, offering flexibility and choice to patients. Practices will be equipped to register their regular patients under MyMedicare, streamlining the connection between healthcare providers and their patients. Moreover, for added convenience, patients will also have the option to register online, ensuring an accessible and efficient process for all involved.

MyMedicare and Telehealth

The proposed MyMedicare system allows patients to register as continuing patients with their doctors. This crucial change allows for extended telehealth sessions, furthering the bulk-billing incentives applicable to these consultations. This adjustment is a positive stride towards accommodating the dramatic shift towards telehealth we have witnessed post-pandemic. The flexibility of telehealth, coupled with the potential of MyMedicare, could change how we deliver healthcare in Australia by improving accessibility and convenience for patients.

Once registered with MyMedicare, starting from November 2023, patients will unlock access to extended (Levels C and D) MBS-funded telephone consultations with their registered general practice. This offers patients the advantage of having more in-depth conversations about their health without needing to physically visit the practice.

Additionally, certain demographics such as children under 16, pensioners, and other Commonwealth concession card holders who are registered through MyMedicare, will gain access to a triple bulk billing incentive. This applies to longer (Levels C, D, and E) MBS telehealth consultations, again effective from November 2023.

One important thing to note is that these rebates will only be claimable by patients who are registered with your practice through MyMedicare. This is another significant reason for patients to consider registering with MyMedicare, and for practices to encourage their patients to do so. By utilising these benefits, patients will have greater access to healthcare and practices will be able to deliver more comprehensive care.


Implications for Emergency Care

MyMedicare aims to alleviate the burden on emergency departments by incentivising GPs to register frequent emergency department users as their patients. This strategy anticipates reducing non-emergency hospital presentations, freeing up vital resources for more critical cases. The potential for improved triage and reduced stress on emergency departments is significant, but its effectiveness hinges on successful implementation and uptake.

Uptake from GPs will require aligned incentives. At present a $2,000 one-off payment, an additional $500 per year for reduced hospital visits, and longer telehealth visits are the only pinned incentives. More incentives for GPs to go to the effort to enrol patients may be required for the program to be successful.

Next for successful implementation is the requirement of data interoperability between a hospital system or urgent care clinic, which measures the presentation and the primary care setting. There needs to be more information about how this will unfold.

Frequest Hospital Users Incentive

Another feature of the MyMedicare initiative is the Frequent Hospital Users Incentive, aimed at improving patient outcomes and boosting community-based care. This incentive seeks to link patients with chronic conditions to a general practice, thereby enabling comprehensive, multidisciplinary care within the community. The ultimate goal? Reducing unnecessary hospital visits while improving the management of chronic diseases.

The incentive payment facilitates the provision of personalised, multidisciplinary team care, uniquely tailored to each patient’s specific needs. This patient-centric approach is expected to significantly enhance chronic disease management, yielding better patient outcomes in the long term.

Key details, such as the funding amount per patient, the criteria for payment, and the recipient of the payment, are being collaboratively designed with stakeholders during the FY2023-24. The rollout of this incentive is planned for FY2024-25 in nine Primary Health Network regions, with an intended expansion to nationwide coverage over three years.

One critical aspect to note is that access to this incentive is exclusively granted through MyMedicare registration. As such, if your practice would like to be considered for this future incentive, it is strongly recommended to register with MyMedicare. Not only will this secure eligibility for the incentive, but it also aligns your practice with the future trajectory of Australian healthcare policy.

The Frequent Hospital Users Incentive is a transformative measure within MyMedicare, designed to enhance the quality of healthcare and patient outcomes, particularly for those with chronic conditions. By incentivising community-based, multidisciplinary care, this initiative is reinforcing the role of general practices as the primary caregivers in our healthcare system.

General Practice in Aged Care Incentive

Another pillar of MyMedicare’s potential to transform Australian healthcare is its focus on enhancing aged care. The General Practice in Aged Care Incentive, slated for implementation on 1st August 2024, seeks to ensure every aged care resident receives high-quality, consistent primary care services from their regular GP and practice.

Under this new incentive, GPs and practices enrolled in MyMedicare will be rewarded for providing a bundle of care to their registered patients residing in a Residential Aged Care Home (RACH). This bundle includes consistent, regular visits – a pivotal aspect of patient care and well-being.

Importantly, access to this incentive is exclusively available through MyMedicare registration. Therefore, if your practice is currently benefitting from the Practice Incentives Program Aged Care Access Incentive, or if you have patients in residential aged care, it is crucial to consider registering with MyMedicare. Moreover, if you’re planning to extend your patient cohort into residential aged care settings, MyMedicare registration becomes even more critical.

To ensure continuity of care for your RACH patients and to seize the benefits of this incentive, MyMedicare recommends registering your practice before 1st October 2023. By doing so, you’ll position your practice to enhance the level of care provided to aged care residents, while simultaneously aligning with the evolving direction of Australian healthcare policy.

The Aged Care Incentive is another example of how MyMedicare is encouraging more holistic and patient-centric healthcare approaches, fostering closer GP-patient relationships, and providing significant opportunities for practices to improve the quality and continuity of their services.

Chronic Disease Managment and MyMedicare

From November 2024, a significant shift will take place. Your practice will become the sole entity eligible to claim the chronic disease management plan rebates for patients registered with you. This move aims to reinforce the continuity of care for your patients, strengthening the bond and understanding between the patient and their GP. There are still facts unknown about the implementation of MyMedicare and claiming of Chronic Disease managment (CDM) items. 

The recent Budget announcement from FY2024-25 introduces incentives through MyMedicare. These incentives are specifically designed for GPs to encourage and support quality continuity of care. Key beneficiaries of this approach will be residential aged care residents and individuals with complex chronic diseases who frequently find themselves in hospital. These new measures aim to improve the health outcomes for these patient groups, reducing their hospital visits, and enhancing their quality of life.

More specifics about these new incentives will be released in the upcoming months. Practices should stay informed, as these developments could significantly impact their operation and financial planning. The introduction of these new incentives has the potential to change how practices handle chronic disease management and aged care services.

MyMedicare’s Potential Impacts on Medical Practices

MyMedicare brings with it the potential to shape our operational landscape and strategies. Realigning incentives encourages a focus on enhanced preventive care and long-term management. This could ease the load on public hospitals, potentially improving patient outcomes and satisfaction. However, the magnitude of this impact remains to be fully understood, given the program is in its early stages. Further information is required on all fronts. The proposed MyMedicare is very short on the recommendations from the Strengthening Medicare Taskforce Report of March 2023.

Challenges and Concerns with MyMedicare

The introduction of any new system inevitably raises challenges and concerns. These include issues around data privacy, managing a larger volume of data, and facilitating a seamless patient transition into this new system. In particular, the concept of voluntary patient registration raises the spectre of a two-tier system within healthcare. Such disparities must be anticipated and mitigated.

One of the critical considerations is the transition to this new system. Given the complexity of healthcare delivery, integrating a new system may pose operational challenges for practices, especially those without significant technological resources or expertise.

Furthermore, concerns are raised about the financial aspects of MyMedicare. The outlined incentives, while beneficial, may not be sufficient to cover the increased workload and resource commitment that continuous care might require. Especially for smaller practices or those serving disadvantaged communities, the financial sustainability of the scheme is a legitimate concern.

Lastly, patient privacy and data security are perennial issues with digital health initiatives. MyMedicare will need to assure practices and patients about the robustness of its data protection measures, especially as we’re talking about highly sensitive health information. The government’s track record in this area will be under scrutiny, and the practices will need to feel confident that patient data will be securely managed and protected.

These challenges are not insurmountable, but they require careful consideration and proactive management. As we move forward, it is vital to maintain an open dialogue between the government, healthcare providers, and patients to ensure the success of MyMedicare.

Unanswered Questions and Future Directions

There remain numerous uncertainties around MyMedicare. The practicalities of its implementation, the degree of autonomy that practices will maintain, and how feedback will be integrated into future revisions are all areas the government needs to clarify further. These uncertainties require our attention, as their resolution will significantly affect how we navigate this changing landscape.

We’re amid an exciting yet challenging time for Australian healthcare. MyMedicare represents a step towards modernising our system and addressing our population’s health needs better. As professionals, our role is not just to adapt to these changes but to proactively engage and shape them to benefit our patients, our practices, and the broader healthcare community.

Stay informed, stay proactive, and stay tuned as we explore this evolving digital health landscape together!

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