Medicare Benefits Schedule - Item 866

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Case Conferences

MULTIDISCIPLINARY CASE CONFERENCE - MEDICAL PRACTITIONER (OTHER THAN A SPECIALIST OR CONSULTANT PHYSICIAN)


These services are for patients who:

    (a)     have at least one medical condition that:

         i.      has been (or is likely to be) present for at least six months; or

         ii.      is terminal; and

    (b)     require ongoing care from a multidisciplinary case conference team which includes:

         i.     a medical practitioner; and

         ii.     at least two other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and one of whom may be another medical practitioner.


For the purposes of items 735-758, a multidisciplinary case conference is a process by which a multidisciplinary case conference team:

    (a)     discusses a patient’s history; and

    (b)     identifies the patient’s multidisciplinary care needs; and

    (c)     identifies outcomes to be achieved by members of the case conference team giving care and service to the patient; and

    (d)     identifies tasks that need to be undertaken to achieve these outcomes, and allocates those tasks to members of the case conference team; and

    (e)     assesses whether previously identified outcomes (if any) have been achieved.


Participation in a multidisciplinary case conference must be at the request of the person who organises and coordinates the conference.

Category 1 - PROFESSIONAL ATTENDANCES

866

866 - Additional Information

Item Start Date:
01-Nov-2002
Description Start Date:
01-Nov-2002
Schedule Fee Start Date:
01-Jul-2019

Group
A15 - GP Management Plans, Team Care Arrangements, Multidisciplinary Care Plans
Subgroup
2 - Case Conferences

Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

Fee: $286.80 Benefit: 75% = $215.10 85% = $243.80

(See para AN.0.62 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.62

Case Conferences by Consultant Psychiatrists - (Items 855 to 866)

A range of new items has been introduced for case conferences by consultant psychiatrists in community settings and for discharge planning for hospital in-patients.  These items are introduced to improve the effectiveness of psychiatric case conferences and make it easier for psychiatrists to work with general practitioners and allied health professionals, thereby ensuring better coordinated care for patients. Three new items (855, 857 and 858) cover the organisation of a community case conference and a further three (861, 864 and 866) cover the organisation of a discharge case conference.  Where a consultant psychiatrist organises a case conference a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines.  The consultant psychiatrist and one other medical practitioner (other than a specialist or a consultant physician) are counted towards the minimum of three. 

Items 855, 857, and 858 apply to a community case conference (including a case conference conducted in a residential aged care facility) organised to discuss one patient in detail and applies only to a service in relation to a patient who suffers from at least one medical condition that has been (or is likely to be) present for at least 6 months, or that is terminal.  Items 855, 857, and 858 do not apply to an in-patient of a hospital. 

For items 861, 864 and 866 a discharge case conference is a case conference carried out in relation to a patient before the patient is discharged from a hospital.  Items 861, 864 or 866 are payable not more than once for each hospital admission. 

The purpose of a case conference is to establish and coordinate the management of the care needs of the patient. 

A case conference is a process by which a multidisciplinary team carries out the following activities:

-                  discusses a patient's history;

-                  identifies the patient's multidisciplinary care needs;

-                  identifies outcomes to be achieved by members of the case conference team giving care and service to the patient;

-                  identifies tasks that need to be undertaken to achieve these outcomes, and allocates those tasks to members of the case conference team; and assesses whether previously identified outcomes (if any) have been achieved. 

For the purposes of items 855 to 866, a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines, each of whom provides a different kind of care or service to the patient, and one of whom must be the patient's usual medical practitioner.  The consultant psychiatrist and the medical practitioner are counted toward the minimum of three.

The patient's carer may be included as a member of the team (See A.49.8 below), in addition to the minimum of three health or care providers but do not count towards the minimum of three for Medicare purposes. 

For the purposes of items 855 to 866 a consultant psychiatrist should generally be the consultant psychiatrist that has provided the majority of services to the patient over the previous 12 months and/or will provide the majority of services to the patient over the coming 12 months. 

For the purposes of A.49.5,  "formal care provider" includes in addition to the consultant psychiatrist and a medical practitioner (other than a specialist or consultant physician):

-                  allied health professionals such as, but not limited to: Aboriginal health care workers; asthma educators; audiologists; dental therapists; dentists; diabetes educators; dieticians; mental health workers; occupational therapists; optometrists; orthoptists; orthotists or prosthetists; pharmacists; physiotherapists; podiatrists; psychologists; registered nurses; social workers; speech pathologists.

-                  home and community service providers, or care organisers, such as: education providers; "meals on wheels" providers; personal care workers (workers who are paid to provide care services); probation officers. 

The involvement of a patient's carer, such as a friend or family member, in a multidisciplinary case conference team can provide significant benefits in terms of coordination of care for the patient.  Where the patient has a carer, the consultant psychiatrist should consider inviting the carer to be an additional member of the multidisciplinary case conference team, with the patient's agreement and where the carer's input is likely to be relevant to the subject matter of the case conference.  The involvement of the patient's carer is not counted towards the minimum of three members. 

Where the patient's carer is not a member of the multidisciplinary team, the practitioner should involve the carer and provide information to the carer where appropriate and with the patient's agreement.  However, the practitioner should take account of the impact of the tasks identified in the case conference on the capacity of the carer to provide support to the patient.  Additional responsibilities should not be assigned to the patient's carer without the carer's agreement. 

Organisation of a case conference

Organise and coordinate a case conference means undertaking the following activities in relation to a case conference:

-                  explaining to the patient the nature of a case conference, and asking the patient whether the patient agrees to the case conference taking place; and

-                  recording the patient's agreement to the case conference; and

-                  recording the day on which the conference was held, and the times at which the conference started and ended; and

-                  recording the names of the participants; and

-                  recording the matters mentioned in A.49.4 and putting a copy of that record in the patient's medical records; and

-                  offering the patient (and the patient's carer, if appropriate and with the patient's agreement), and giving each other member of the team a summary of the conference; and

-                  discussing the outcomes of the case conference with the patient. 

General requirements

In circumstances where the patient's usual medical practitioner, is not available to be a member of the case conference team, another medical practitioner known to the patient may be substituted. 

It is expected that a patient would not normally require more than 5 case conferences in a 12-month period. 

The case conference must be arranged in advance within a time frame that allows for all the participants to attend. The minimum three care providers must be present for the whole of the case conference. All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these. 

In explaining to the patient the nature of a case conference and asking the patient whether he or she agrees to the case conference taking place, the medical practitioner should:

-                  Inform the patient that his or her medical history, diagnosis and care preferences will be discussed with other care providers;

-                  Provide an opportunity for the patient to specify what medical and personal information he or she wants to be conveyed to or withheld from the other case conference team members; and

-                  Inform the patient that he or she will incur a charge for the service provided by the practitioner for which a Medicare rebate will be payable.

-                  Inform the patient of any additional costs he or she will incur. The benefit is not claimable (and an account should not be rendered) until all components of these items have been provided. (See General Notes 7.6)

Related Items: 855 857 858 861 864 866


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change