The Enhanced Primary Care Plan: Does Your Patient Really Understand It?

The Enhanced Primary Care Plan (EPC) was introduced by the Australian government as a Medicare initiative in 1999. The program is designed to be a Medicare rebate, covering part of the consult cost for up to a maximum of five visits per calendar year. Presently the EPC rebate for podiatric services is $52.95 per appointment, this has quickly become an issue for both patient and podiatrist as costs of business have grown beyond the point where this is a sustainable rate per appointment (especially for those in metropolitan areas) and a GAP payment is now a required for those attending.
The plans are designed for those who require on-going multi-disciplinary care provided in a structured manner and allows the General Practitioner to oversee and coordinate the management of patients with complex conditions.

The rest of this article looks to keep this in plain English and as straight forward as possible so all parties can understand the role they play in the under-taking of an EPC program and what the initiative has really been developed for.

Eligibility
Community-based patients (attending private practice or community centres) may be eligible for a EPC plan if they currently have chronic or terminal condition which relates directly to the service which they have been referred too. It is important to highlight at this point that an EPC is received because you as a patient have a chronic condition and your eligibility is NOT based on your age or economic status such as being on a pension.
A chronic condition is best defined as an ailment which has been present for or is likely to be present for more than six months. There is no official list of conditions, however, those which are commonly referred to include;

• High Blood Pressure
• Diabetes
• Stroke
• Heart Attack
• Osteoarthritis
• Musculoskeletal Conditions
• Auto-immune Disease

As stated above, the condition identified as being the reason for referral needs to be directly related to the scope of practice of that professional and must be identified in the care plan completed by the GP.
A referral is valid for the full number of stated appointments on the care plan, if not all appointments are used within a calendar year then left over appointments can be used the following year. However, there are restrictions of 5 rebated appointments per calendar year and any further visits will most likely require full consult payment.

Practitioners Role
It is necessary for the practitioner to meet specific requirements proposed by Medicare Australia and the Department of Human Services.
Full assessment and management details obtained within the first visit of the EPC plan should be communicated back to the referring GP at the soonest possible convenience. Additional, communication may be considered necessary dependant on the circumstances of the individual.
At the end of the final allocated visit further information should be once again communicated to the GP about the patient’s current condition status and what management plan has been suggested for further intervention.

Claiming with Medicare
With the added benefit of most private practitioners and clinics having HICAPS facilities these days the ability to claim your Medicare rebate has become much easier. It is possible to claim for anyone who is listed upon your Medicare card.
It is suggested by Medicare Australia that you register the following details with the organisation to decrease the chances of any delay in receiving your rebate benefit.
Make sure to; Register your bank account details, register your family for Medicare Safety Net, destroy old Medicare Cards, take your Medicare card with you when attending all health appointments and inform Medicare when you change address.

The first article to be released this financial year for FootNotes may seem a boring read but it is important to understand how the system works to reduce misunderstandings with both practitioners and patients.
Our next article focuses on plantar fasciitis and how heel pain can affect your quality of life.

Until Next Time

 

Jackson McCosker
Director/Chief Editor

 

References

Chronic Disease Management. (2014, February). Individual Allied Health Services Under Medicare. Australia: Australian Government Department of Health.

Medicare Services. (2016, May). Medicare Services. Australia: Australian Government Department of Health Services.