North East Valley DGP eNews

No 1422: July 9, 2014
eNews is a weekly electronic newsletter sent to all GP practices (with email addresses) within the NEV catchment. The aim is to provide up to date information relevant to GPs and to disseminate the latest activities and resources from the division. All feedback and enquiries welcome and should be addressed to Patty Marshall. You can also visit our website at: http://www.nevdgp.org.au/.
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In this issue:

Editorial                                                Is Practice Nurse time included in time-based billing for Health Assessments? - ambiguity and uncertainty remain, with a DOUBLE-TWIST exposed in the ‘BACKFLIP’   

Professional Development                 CPD events   

Information Management                  Medical Director, Best Practice & General Computer Tips

Items of interest                                  Time-Based Health Assessments and Nurse Time - AMA still concerned about lack of clarity, GP Network News

News for Practice Staff                       Infection Prevention and Control Standards, New Minimum Wages from July 1, 2014

Positions vacant/wanted                  

Fun stuff                                              

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A Word from the Editor

Is Practice Nurse time included in time-based billing for Health Assessments? - ambiguity and uncertainty remain, with a DOUBLE-TWIST exposed in the ‘BACKFLIP’ 

On Tuesday July 8, 2014, the AMA has moved to try to sort out the ambiguous mess with regard to the inclusion of nurse time in the billing of time-based health assessments.

 

The case so far:

Early last week Medicare, through its” Health Professional News” announced that “it is only the time that the billing medical practitioner spends with the patient that determines the choice of item number” (our emphasis) and that “this information supersedes any contrary MBS itemisation advice that may have been provided to you by the Department of Human Services prior to this notification”.

This retracts the previous explicit advice from Medicare 1 May 2010, issued at the time to clarify billing procedures for the restructured Health Assessment items.

In other words, the time spent by nurses in assisting the preparation of a health assessment no longer counts towards the applicable item number!

 

This, of course, caused a great uproar as many practices structured their quality of service delivery for the item and based their business modelling for the employment of nurses for their time in the preparation of time-based health assessments.

 

Then came the so-called backflip on July 4 which stated:

“No changes have been made to the regulations or the items descriptors for these health assessments (our emphasis). The existing legal requirements governing MBS items 701-715 are that a practice nurse may assist a GP with performing the health assessments. Assistance by a practice nurse, such as collecting information and providing patients with information about recommended interventions, must be provided in accordance with accepted medical practice and under the supervision of the medical practitioner. The time spent by the GP is one consideration but not the only consideration. . . GPs are expected to continue to use their judgment in deciding which Medicare item to claim for health assessments, taking into account the time spent with the patient, the level of complexity and any assistance provided by a practice nurse”.

 

This, however is entirely ambiguous as the phrase used by Medicare, “No changes have been made to the regulations or the items descriptors for these health assessments.” is totally misleading and should be of no reassurance because the MBS regulations, item descriptors and explanatory notes never referred to nurse time contributing to the time-basis for the items. Nowhere does it state that nurse time can be used!

Furthermore, Medicare Item Interpretation Hotline continues to advise that the time spent by nurses in assisting the preparation of a health assessment no longer counts towards the applicable item number.

 

Fortunately the AMA has taken up the case with the department under the heading “AMA moves in to sort out practice nurse mess” found at: https://ama.com.au/ausmed/ama-moves-sort-out-practice-nurse-mess

We reprint their article in full for your information (see in Items of Interest below) and strongly encourage you to read it in full while waiting for definitive conclusion to this messy situation.

 

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Continuing Professional Development

Minor Surgery for General Practitioners

Saturday 19 and Sunday 20 July at Skills Laboratory, RACS Skills & Education Centre, Royal Australasian College of Surgeons, Corner of Spring Street and Lonsdale Street, Melbourne.

This program aims to enhance the surgical skills required for minor surgical procedures most likely to be carried out by GPs in rural or remote settings where specialists are not readily available.

For more information and registration click here.

 

STI Contact Tracing for General Practice

ThinkGP invites you to take part in this activity looking at the role of the GP in contact tracing for patients testing positive for an STI. The module explores the responsibility of the doctor after a patient is given a positive finding for a sexually transmitted disease, and increases the doctor's confidence in discussing the subsequent importance of completing contact tracing with their patient. It also names resources that can support patients and providers when undertaking contact tracing, and identifies where a doctor can seek support for providing contact tracing.
Click here to participate in the activity.

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Information Management

Medical Director Tip - What to do about “Nurse time” in time-based health assessment templates

In today’s editorial it is explained that the use of nurse time in time-based health assessments needs further clarification, despite an apparent backflip last Friday on this issue. This impacts on which template you use and how to fill it in. Until there is further clarification from the Department with its discussions with the AMA, it is suggested that you do not document nurse time on whatever template you use.

 

This week’s MD problem - Correcting “Reason for Visit”

Question: Is there any way I can take out an incorrect reason for visit without deleting the entire consultation please?

Answer: You are able to change Progress Notes on the same day they were created. But, even if you go back into Progress Note and delete the “Reason” from the current Progress Notes, the incorrect “Reason” still remains in the “Reason for contact” column of the previous Progress Notes. So, just deleting the “Reason” from the current note doesn’t help. So, we have to look at alternatives. There are two ways of doing this and both involve correcting the mistake in the day(s) after the Progress Note has been incorrectly completed (i.e. by selecting a previous Progress Note)

Using Append:

1.      Click once on the incorrect Progress Note and then click on the Append button and in the Append notes window type in “Correct ‘Reason for contact’ should be xyz”.

2.      Click on Save.

Note: The original “incorrect reason stays in place and you can only see the appended note when you open that previous Progress Note. So, not a great solution!

Deleting and re-creating previous Progress Note

In this process you are going to re-create a previous note and delete the incorrect one.

1.      From the previous Progress Notes, double click on the one that contains the “incorrect” reason.

2.      Highlight all the note and press Control + C to copy its contents. Close that Progress Note.

3.      Return to the current Progress Note and highlight and delete the existing info – today’s date and user name.

4.      Paste in the “old” Progress Note (Control + V).

5.      Click on the Reason button and select the correct Reason for contact from the coded list

6.      Change the “Consultation date” to the date of the Progress Note that contains the “incorrect” reason. Press Control + S just to be sure you have saved that Progress Note.

7.      Return to the list of previous consultations, click once on the “incorrect” Progress Note and press the Delete button.

 

Best Practice Tip - LetterWriter – Switching between LetterWriter and the patient screen

This can be handy if you want to refer to your notes while in LetterWriter, or maybe even copy and paste some information between the patient screen and LetterWriter.

1.      Open a LetterWriter template

2.      Press Control + Tab and this will take you back to the patient screen.

3.      Pressing Alt + Tab again will return you to LetterWriter.

Of course you can switch between the two (or three, as you can also go to the front screen of BP) by clicking on the BP icon in the Taskbar at the bottom of the screen and clicking on which part of BP you wish to go to – Main screen, Patient screen or LetterWriter.

Hint Number 2: Please refer to the Medical Director hint for what to do about “Nurse time” in time-based templates.

 

Best Practice problem - How to add a provisional diagnosis

Question: Back in the days when I used Medical Director there was a check box where I was able to add a differential diagnoses when I was in the current progress note. I cannot find the equivalent in BP.

Answer: This is a little confusing because you don’t do it by clicking on Diagnosis, or Reason for visit in Today’s Notes. Rather, you go to Past history and then click on the Add button – a Provisional diagnosis checkbox is added to the Past Medical History window.

BP has been notified of this “not quite logical” way of adding the differential (provisional) diagnosis and have very obligingly added it to their “to fix” list.

 

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Items of Interest

Time-Based Health Assessments and Nurse Time – AMA still concerned about lack of clarity

We re-print here, in full, the statement from the AMA, where the President, Associate Professor Brian Owler has accused the Department of “extraordinary mismanagement” on the issue of claiming for nurse time in the preparation of time-based health assessments.

 

“The AMA is meeting with Government officials later this week to resolve the mess created by the Health Department over arrangements for GPs to conduct health assessments.

AMA President Associate Professor Brian Owler accused the Department of “extraordinary mismanagement” of the issue, which cast doubt on long-standing health care arrangements and potentially put the jobs of practice nurses at risk.

Early last week the Department caused alarm when it advised that the time spent by practice nurses on health assessments would no longer be included in the Medicare Benefits Schedule item – only the time spent by the supervising medical practitioner with the patient would be covered.

The change fundamentally undermined an arrangement that had become standard in general practices across the country since 2010.

A/Professor Owler warned the alteration could have a “devastating impact” on the practice nurse workforce and undermine the cooperative work between doctors and supervised practice nurses in providing health assessments.

He said many practices had hired nurses specifically to conduct health assessments, and the rule change threatened what was a vital service, including visits by practice nurses to elderly patients in residential aged care facilities and those still living at home, as well as assessments for young children and the disabled.

Uncertainty about the status of practice nurses deepened later in the week when the Department issued a clarification that only added to the confusion.

The Department issued advice that “a practice nurse may assist a GP with performing the health assessments”.

But A/Professor Owler said the update was vague and unclear, and the Department needed to state in plain English that GPs were allowed to include the time spent by practice nurses in completing health assessments.

He said the Department’s attempt at a clarification had only made things murkier, leaving general practices unsure of what they could do when processing health assessments and keeping practice nurses on edge about their future.

A/Professor Owler said just a simple re-wording of the latest advice from the Department was needed to allay fears and give doctors, practices and nurses much-needed certainty.

He said that in its advice the Department should state that: ‘The time spent by the GP and the practice nurse is one consideration, but not the only consideration’.

“This change will ensure that general practice can continue to provide high quality preventive health care,” A/Professor Owler said. “It will also provide greater job security for practice nurses and ease the administrative burden on practice managers.”

Senior AMA officials will push for the clarification to end the confusion and uncertainty when they meet with Department officials later this week.

A/Professor Owler said the episode was an unnecessary and unwarranted distraction for GPs, practices and nurses from what they were there to do – look after their patients.

“GPs need greater support, not greater hurdles, to provide care for their most needy patients,” he said.

 

GP Network News

This week’s edition can be found here.

 

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News for Practice Staff

Infection Prevention and Control Standards

The RACGP has released the 5th edition of the Infection Prevention and Control Standards for general practices and other office-based and community practices. The Standards can now be downloaded for free on the RACGP website.

 

New Minimum Wages from July 1, 2014

You can find the updated minimum wages and allowances on the Fair Work website using their "Pay Tools".

 

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Positions vacant/wanted

Please note: only new ads or resubmitted ads will be posted here. All other ads can be found on the website

 

Positions vacant

Doctors

Bundoora - Female GP with Mandarin/Cantonese speaking skills wanted to work part-time in a DWS position. Tel: 0433 155 451.

 

Carlton - Full Time/Part Time VR GPs wanted (flexible hours). We are a group of female medical practitioners running a high-quality, family-orientated general practice, with a practice manager, practice nurse and allied health personnel onsite (podiatrist, dietitian, psychologist and women’s physio) plus on-site pathology. The practice is fully computerised and accredited. Phone 9380 4655, Email carltonmedical@bigpond.com, Web www.carltonmedicalcentre.com.au

 

Greensborough Road Surgery is currently seeking a Full-Time GP, approx 8 sessions pw. A position is available for an enthusiastic GP to join our team in a modern, well-equipped 10-doctor practice, offering high-quality care in an experienced and supportive environment. Private billing, computerised, 2.5 full-time nurses, (clinical CVC, and CDM.)  Contact Ann McCormack (03) 9435 0711 or email grs@grs.net.au or see www.grs.net.au

 

Northern Suburbs - Modern and well equipped practice seeking full time VR GP's, great support from nursing and allied health, in house pathology.  Partnership available for the right candidate.  Genuine enquiries most welcome.  Please contact Medprac@outlook.com.

 

Reservoir - Summerhill Medical Centre is seeking Full Time/Part Time VR GPs (flexible hours) to join a well-established practice of over 18 years. The practice is going through an unprecedented growth and is located in an ideal location only 15min from the CBD and in a shopping complex that will soon have Aldi, Coles, Kmart and IGA.  Excellent remuneration of 70% plus. The practice is computerised and accredited. Phone John on 0403 178 141 or email - summerhill@iinet.net.au.

 

West Heidelberg - GP wanted to join a solo GP practice, part time or full time. Please call 0435 815 187 or email lathaherath@hotmail.com.

 

Practice Staff

Bundoora - Div 1 Nurse to work part-time (Tuesday and Thursday) in a busy Practice. Good remuneration and friendly environment. Tel: 0433 155 451.

 

Craigieburn - Experienced Practice Nurse required for busy medical centre.  Two days per week, additional hours may be available.  Fully computerised practice. Award rates. Contact Leanne craigieburncentralmedical@gmail.com.

 

Northcote - Division 1 Nurse. An old, established, solo, fully computerised practice with warm and friendly atmosphere is seeking a Division 1 Nurse to work Monday, Wednesday and Friday from 9 am to 1 pm - total 12 hours. Salary: Award Rates. Contact details: Neelam Berera on 0411 196 940 (mobile).

 

West Heidelberg - Div 1 GP nurse wanted to join a solo GP practice. Initialy 22 hours per week. Please call 0435 815 187 or email lathaherath@hotmail.com.

 

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Humour

Continuing our new education humour section

 

Mondegreens – this week we move into “Mondegreens” which are best described as a sort of aural malapropism. Instead of saying the wrong word, you hear the wrong word or words. A mondegreen is generally used for misheard song lyrics, although technically it can apply to any speech. Programs such as “Spicks and Specks” have used mondegreens as part of the show.

 

Here are some examples:

•"There's a bathroom on the right."

   Real Lyric: "There's a bad moon on the rise."

   Bad Moon Rising, Creedence Clearwater Revival

 

•"Excuse me while I kiss this guy."

   Real Lyric: "Excuse me while I kiss the sky."

   Purple Haze, Jimi Hendrix

 

•"Dead ants are my friends; they're blowin' in the wind."

  Real Lyric:  "The answer my friend is blowin' in the wind."

  Blowin' In the Wind, Bob Dylan

 

•"I'm a pool hall ace."

   Real Lyric: "My poor heart aches."

   Every Step You Take, The Police

 

•"Just brush my teeth before you leave me, baby."

  Real Lyric:  "Just touch my cheek before you leave me, baby."

  Angel of the Morning, Juice Newton

 

• “We didn't start the fire, It was always burning, Said the worst attorney”

Real Lyric: “We didn't start the fire, It was always burning, Since the world's been turning.”

We Didn’t Start the Fire, Billy Joel

 

I'll never leave your pizza burnin'.

Real Lyric: “I'll never be your beast of burden.”

Beast of Burdon, The Rolling Stones

 

Origin of the word “Mondogreen

The term “mondegreen” was originally coined by author Sylvia Wright, and has come to be quite widely used. As a child, Wright heard the lyrics of The Bonny Earl of Murray (a Scottish ballad) as:

Ye highlands and ye lowlands, Oh where hae you been?

Thou hae slay the Earl of Murray, And Lady Mondegreen

It eventually transpired that Lady Mondegreen existed only in the mind of Sylvia Wright, for the actual lyrics said that they "slay the Earl of Murray and laid him on the green." And to this day Lady Mondegreen's name has been used to describe all mishearings of this type!

 

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And remember

 

            Acupuncture is a jab well done.