Workshop: Effective Use of the ‘Prompt’ Procedure for Improving Patient Care and Billing Outcomes. 4 of 4.
3. Practical Application: Identifying Opportunities for Prompts
Incorporating the ‘Prompt’ procedure into daily practice involves evaluating several factors to determine when to prompt GPs for specific services. Nurses play a key role in identifying these opportunities, ensuring that the right prompts are made based on a patient’s history, billing record, and age. Below are three main indicators that need to be considered during the assessment.
Three Main Indicators in Prompt Assessment by Nurses
- Past Medical History
Reviewing a patient’s medical history is essential to identifying potential care opportunities. For instance:- Patients with multiple chronic conditions may require additional support through GP Management Plans (GPMPs) or Team Care Arrangements (TCAs).
- Patients who have previously had health assessments or treatments may benefit from follow-up services, such as mental health treatment plans or chronic disease management reviews.
- Patients with complex health histories may also require preventive services or specialist referrals.
- Example: A patient with a long-standing diagnosis of diabetes and hypertension may need a GPMP renewal or an additional follow-up assessment to manage their conditions more effectively. Prompting the GP based on their medical history ensures timely and comprehensive care.
- Past Billing History
Examining the patient’s past billing records is critical for identifying when to prompt the GP for repeat services or reviews. Nurses can check whether important services, such as Care Plans or Health Assessments, have been billed recently and whether a review is due.- For example, a Care Plan billed six months ago may now require a review or follow-up consultation to ensure that the patient’s management plan is still effective and updated.
- Nurses can track services like Chronic Disease Management (CDM) or mental health care plans to ensure they are re-evaluated within the appropriate time frame.
- Example: A patient with a Care Plan billed six months ago may need a Care Plan Review, which can be identified by looking at their billing history. Prompting the GP ensures that the plan is renewed on time and the practice captures important billing opportunities.
- Age
The patient’s age is critical in determining eligibility for certain health assessments and preventive services. Age-specific services can be prompted to ensure patients receive early intervention or screening for potential health risks.- Patients over 75 may be prompted for a 75+ Health Assessment to monitor their overall health.
- Patients in their 40s may need an Australian Diabetes Risk Assessment (AUSDRISK) to evaluate their likelihood of developing type 2 diabetes.
- Example: A 41-year-old patient may be eligible for an AUSDRISK assessment, a vital tool for early identification of diabetes risk. Prompting the GP ensures the assessment is conducted, potentially leading to preventive interventions and establishing a chronic disease management plan if necessary.
Scenario-Based Training: Recognizing Situations Where a Prompt is Needed
Incorporating these three indicators helps nurses identify key opportunities to prompt GPs:
- Example 1: A patient with multiple chronic conditions could benefit from a GP Management Plan or Team Care Arrangement.
- Example 2: A patient due for a preventive health screening, such as a cervical screening test, may require a prompt based on age and past medical history.
- Example 3: A patient eligible for mental health support who hasn’t yet been offered a treatment plan can be identified based on their past medical and billing history.
When and How to Approach GPs with Prompts
Nurses can make informed decisions about when and how to approach GPs by considering these indicators. Approaching GPs at the right time, with the right information, ensures that the patient’s care is comprehensive and aligned with clinical guidelines while also optimising practice billings.
In summary, nurses can effectively assess when to prompt GPs by considering past history, billing history, and the patient’s age. These prompts ensure timely and appropriate care while benefiting the practice’s financial sustainability.
4. Maximizing Patient Outcomes Through the ‘Prompt’ Procedure
The ‘Prompt’ procedure plays a crucial role in optimising patient outcomes and the financial sustainability of the practice. By effectively prompting GPs, nurses, and allied health professionals, they can ensure patients receive the needed services while identifying opportunities to support the practice’s revenue generation. This balance between high-quality care and financial health is essential for the long-term success of a general practice.
The Relationship Between Patient Care and Financial Sustainability
Providing comprehensive care is right for patients and contributes to the practice’s financial stability. When patients receive the necessary services—whether health assessments, chronic disease management plans, or mental health care—they experience better health outcomes, reducing the need for emergency interventions or hospitalisations.
At the same time, many of these services fall under High-Value Items (HVIs), which attract higher Medicare rebates. By prompting GPs to offer these services where appropriate, the practice can increase its revenue while maintaining a high standard of care. This creates a positive cycle: patients stay healthier, and the practice remains financially viable to continue offering comprehensive care.
Ensuring GPs Are Aware of Services That Benefit Patients While Also Considering Revenue Generation
One key goal of the ‘Prompt’ procedure is to inform GPs of services that will benefit their patients without overburdening or compromising patient care. These services often include preventive care, chronic disease management, and mental health support, all of which can be prompted during patient consultations. When nurses and allied health professionals prompt GPs thoughtfully and respectfully, the right care is provided at the right time.
For example, offering a GP Management Plan (GPMP) for patients with chronic conditions ensures that their care is well-coordinated, leading to better health outcomes. At the same time, the practice can bill for these services, thus improving financial sustainability. Similarly, conducting a Health Assessment for patients over 75 ensures they receive the necessary monitoring and support while contributing to the practice’s billing.
Importance of Documenting Patient Needs Accurately to Support Prompts
Accurate documentation is essential for effective prompts. Nurses and allied health professionals must ensure that they document each patient’s needs, past medical history, and eligibility for certain services. This documentation helps determine when a prompt is needed and provides GPs with the necessary information to make informed decisions during the consultation.
Proper documentation supports:
- Continuity of Care: Ensuring that important patient information is readily available helps GPs provide more effective, long-term care.
- Compliance and Billing Accuracy: Clear documentation allows the practice to bill for services correctly and avoid errors that could lead to rejected claims or audits.
- Patient-Centered Care: When nurses and allied health professionals document patient needs in detail, GPs can offer personalised care that aligns with clinical guidelines.
The ‘Prompt’ procedure maximizes patient outcomes by ensuring comprehensive, timely care while contributing to the practice’s financial sustainability. Accurate documentation and thoughtful prompts help strike the right balance between patient well-being and revenue generation.