Workshop: Effective Use of the ‘Prompt’ Procedure for Improving Patient Care and Billing Outcomes. 3 of 4.
2. High-Value Items (HVIs): What Are They?
Definition of High-Value Items (HVIs) in the Billing Context
High-value items (HVIs) are services provided in general practice that significantly benefit patients and attract higher Medicare rebates, contributing to the practice’s financial sustainability. These items often focus on comprehensive patient care, such as chronic disease management, mental health, and preventive services, essential for maintaining long-term health outcomes for patients.
By identifying and delivering HVIs, practices can improve patient outcomes while boosting their billing potential, helping ensure the practice’s long-term success.
Examples of Common High-Value Items (HVIs):
- Health Assessments (e.g., 75+ Health Checks)
Health assessments are comprehensive evaluations offered to specific patient groups, such as those aged 75 and older. They identify health risks and provide preventive care, improving patient outcomes and contributing to significant Medicare rebates. - Chronic Disease Management (e.g., GP Management Plans)
Chronic Disease Management plans are crucial for patients with long-term conditions like diabetes or cardiovascular disease. These plans involve developing a structured approach to manage the patient’s health, ensuring care coordination and maximising Medicare rebates for these services. - Mental Health Treatment Plans
Mental health treatment plans allow GPs to provide structured, ongoing support to patients experiencing mental health challenges. These plans enable collaboration with other healthcare providers, improving patient care and generating important billing opportunities. - Preventive Services (e.g., Immunizations, Health Checks)
Preventive care services, such as immunisations and routine health checks, are key to overall population health. Services like flu shots and cervical screening tests ensure patients receive necessary preventive care while boosting practice revenue through HVIs. - Home Medicines Reviews (HMRs)
Home Medicines Reviews help patients, particularly those on multiple medications, manage their treatments. By reviewing the patient’s medications and ensuring they are appropriate and safe, these reviews enhance patient care and generate valuable rebates for the practice. - CDM Follow-up Service by Nurses (Item 10997)
Nurses are vital in ongoing care for patients with chronic disease management plans. Under Item 10997, nurses can bill for follow-up services, such as monitoring and reviewing the patient’s progress, creating another valuable HVI for the practice. - Australian Diabetes Risk Assessment (AUSDRISK)
The AUSDRISK tool assesses a patient’s risk of developing type 2 diabetes within the next five years. This assessment helps identify at-risk patients, particularly those over 40 or with specific lifestyle and family risk factors. By prompting GPs to offer this assessment, nurses ensure early intervention for at-risk patients, which can lead to developing a GP Management Plan for those at high risk. This, in turn, improves patient outcomes and provides an additional billing opportunity for the practice(Ausdrisk).
How Prompting GPs for These Items Ensures Necessary Services and Boosts Practice Billings
Nurses and allied health professionals can be critical in identifying patients who may benefit from HVIs and prompting GPs to offer these services. For instance:
- A nurse may notice that an elderly patient is due for a health check or that a patient with multiple chronic conditions would benefit from a management plan.
- A patient who has not received a mental health treatment plan may require one based on recent consultations.
- Patients at high risk for type 2 diabetes, identified through the AUSDRISK assessment, could benefit from a management plan to prevent or manage the disease.
By reminding GPs of these opportunities, the practice can deliver more comprehensive care while optimizing billing opportunities. HVIs represent a dual benefit: improving patient care outcomes and contributing to the practice’s financial stability.