1405.1 – MBS Item for Pulmonary Rehabilitation (Re-submission)

New MBS item.

New respiratory GPMP item created to:

• enable GPs to refer directly to a pulmonary rehabilitation program, without the need to additionally complete a TCA
• still allow the GP to use the usual GPMP (item 721) for management of other co-morbidities that can be common in this patient group

PLUS create two new Allied Health MBS items:

• One-on-one (45min) consultation item (suggested price $65) to enable two (2) one-on-one assessments:
  • Initial pre-assessment - The assessment will include (but not be limited to): taking a medical history; testing of functional exercise capacity (six-minute walk test); assessments of health status (Quality of Life questionnaires) and a psychosocial assessment questionnaires; planning exercise program.
  • Final post-assessment – Re-testing functional exercise capacity; assessments of health status (Quality of Life questionnaires) and psychosocial assessment to measure patient outcomes
• Group 1 hr Exercise item (suggested price $25) to enable 16 x 1hr sessions, and permit smaller group sizes due to complexity of patients (maximum 8 participants). Sessions should be offered 2x per week.

PLUS Longer term pulmonary maintenance exercise:

• New Respiratory GPMP review item (similar to 732)
• Group exercise maintenance item (1hr) at a reduced cost ($10), to enable attendance at one session per week, for a total of 16 sessions for those patients with: severe disease; frequent exacerbations; low-socioeconomic status; and/or multi-morbidity. This is important in order to extend benefits of the pulmonary rehabilitation program into the second year. All 16 sessions to be completed within six months of referral.

Eligibility:

Patients would be eligible for Pulmonary Rehabilitation (2 x one-on-one assessments, plus 16 x 1hr exercise sessions over 8 weeks), every 2 years or following hospitalisation for an acute exacerbation, or if a major change occurs in clinical condition.

Pulmonary Maintenance exercise (16 x 1hr sessions; once per week) – annually for those with severe disease, frequent exacerbations, low-socioeconomic status and/or multi-morbidity.

Type: Therapeutic

The diseases relevant to this service are the chronic lung diseases, including: chronic obstructive pulmonary disease (COPD) (which is an umbrella term for a group of diseases including emphysema, chronic bronchitis and chronic asthma that is not fully reversible); bronchiectasis; interstitial lung diseases; and lung cancer.

• PASC meeting: -
• ESC meeting: 5 October 2018
• MSAC meeting: 22 - 23 November 2018

Note: for PICO confirmation, refer to application 1405.