Nurse practitioners should be given access to Medicare items for HbA1c tests for diagnosis and monitoring of patients with diabetes, according to recommendations by the MBS Review Taskforce
A report from the Taskforce’s Nurse Practitioner Reference Group recommends that HbA1C test items currently restricted to requesting by GPs be widened to enable patients with diabetes to access MBS rebates for procedures performed by an nurse practitioner.
The recommendations apply to Item 73839: Quantitation of HbA1c performed for diagnosis of diabetes in asymptomatic patient at high risk; and Item 73840: Quantitation of glycosylated haemoglobin performed in the management of established diabetes.
The move “would improve access to timely, appropriate diagnostic and therapeutic procedures as patients would not have to wait to see a GP to receive these services and a rebate,” the report says.
“This would avoid unnecessary duplication and fragmentation of care for patients of nurse practitioners working within their scope of practice, who are functioning as an alternative to a medical practitioner.”
The report says the lack of MBS rebates for procedures such as HbA1c tests performed by Nurse Practitioner can increase out-of-pocket costs for patients, perpetuate inefficiencies through duplication of care, and blur care accountability.
“Duplication, delays and inefficiencies can be created when a patient is referred to a medical practitioner for a procedure in order to be able to access the MBS rebate to which they are entitled,” it notes.
The Nurse Practitioner Reference Group has also recommended creating a new MBS item for longer Nurse Practitioner attendances to support the delivery of complex and comprehensive care lasting longer than 60 minutes, including for patients with diabetes.
In its rationale for the change, the Group cites this example of diabetes care:
“A specialist diabetes Nurse Practitioner would require over 60 minutes with a patient to download and interpret data from a continuous blood glucose monitor then initiate treatment changes, including patient education. Similarly, starting a patient on an insulin pump routinely takes more than one hour.”
The recommendations of the Group have been circulated for consultation with stakeholder groups until 19 May 2019, and a final decision on whether to adopt the proposals will rest with the Federal Minister for Health.