Patterns of delivery of dietetic care in private practice for patients referred under Medicare Chronic Disease Management: results of a national survey

Abstract

A national survey was used to examine patterns of delivery of dietetic care for patients referred to private practitioners under Medicare Chronic Disease Management (CDM). This asked dietitians about referrals from general practitioners, patient management, fees charged and patient billing. There were 356 (47%) Australian private practice dietitians who responded to the questionnaire; 330 (94%) were Medicare providers. They described a counselling-type service and inability to complete initial patient education within funded consultation time. Many provided a longer consultation than was reported as being funded by Medicare. Fees for initial appointments were generally higher than the scheduled Medical Benefit Scheme fee of AU$56.25 (median $80), requiring patients to pay a fee gap. For review appointments, two of every five dietitians bulk-billed or charged an identical fee ($47.85). Providers communicated by written reports (as required under Medicare policy). There was little evidence of team-based chronic care management. The dietetics Medicare CDM process should mirror other counselling-type Medicare services which provide for both longer and more frequent consultations and higher payment. System integration between dietitians and general practitioners is required to achieve true collaboration and team care of chronic disease patients.

What is known about the topic? Medicare ‘Chronic Disease Management’ program allows eligible patients with chronic or complex medical conditions subsidized consultations with accredited dietitians in private clinics. We know little about how this program is delivered by GPs and dietitians.

What does this paper add? This paper reports data on a first evaluation. Surveyed dietitians viewed chronic cases as complex and described barriers to their practice imposed by Medicare policy.

What are the implications for practitioners? Changes in Medicare CDM policy and dietetic practices are required to achieve true collaboration and team care of dietetic patients with chronic diseases.