Heart Health Check Update
From 1 April 2019 two item numbers 699 and 177 are available on the MBS to allow GPs and medical practitioners (other than a specialist consultant physician) to conduct a Heart Health Check that lasts at least 20 minutes.
Professional attendance for a heart health assessment by a GP at consulting rooms lasting at least 20 minutes and must includea:
- collection of relevant information, including taking a patient history that is aimed at identifying CVD risk factors, including diabetes status, alcohol intake, smoking status, cholesterol status (if not performed within the last 12 months) and blood glucose
- a physical examination, which must include recording of blood pressure
- initiating interventions and referrals to address the identified risk factors
- implementing a management plan for appropriate treatment of identified risk factors
- providing the patient with preventative health care advice and information, including modifiable lifestyle factors
Who is eligible for the 699 and 177 items?
People not already known to have Cardiovascular disease including:
(a) Aboriginal or Torres Strait Islander persons who are aged 30 years and above;
(b) Adults aged 45 years and above.
What are the potential benefits for having a dedicated MBS item for absolute CVD risk assessment?
- Improved detection of people at high absolute cardiovascular risk; people at high-risk of developing type 2 diabetes; and people at high risk of developing chronic kidney disease.
- Improved management of risk for people who have not developed disease
- Fewer avoidable hospitalisations.
- Better measurement of uptake of preventative health checks
Why were current MBS items insufficient?
General health assessments currently listed on the MBS do not entirely support the systematic assessment of absolute cardiovascular risk due to inappropriate frequency of service, missing key age groups (50 - 74 years) and lack of specificity. Another key element ignored by the current health assessment items is the ongoing care involved in re-assessment of risk, management of moderate or high cardiovascular risk in the primary prevention cohort and ongoing monitoring of risk factors. A dedicated MBS item for cardiovascular risk assessment will help address GP reported barriers to use of the risk calculator; lack of time and therefore, reimbursement for time .
Can practice nurses help the GP perform the item?
- Yes. In line with other Health Assessment items:
Suitably qualified health professionals, such as practice nurses or Aboriginal and Torres Strait Islander health practitioners, employed and/or otherwise engaged by a general practice or health service, may assist general practitioners in performing health assessments. Such assistance must be provided in accordance with accepted medical practice and under the supervision of the general practitioner. This may include activities associated with:
- information collection; and
- providing patients with information about recommended interventions at the direction of the general practitioner.
- See MBS explanatory notes for this reference.
Can the 699 or 177 items be claimed with other items?
- There is no reason why 699 or 177 cannot be claimed with other relevant items when they are clinically necessary. The exception is that the heart health assessment items cannot be claimed if a patient has had a health assessment service in the previous 12 months (see explanatory notes).
- Factsheet developed by the Department of Health states: The heart health check complements the range of MBS items that support rebates for people to discuss their risk of heart disease with their GP, including time-based consultations for preventive health, health assessments, and Chronic Disease Management items
How much will a Heart Health Check cost patients?
It depends on whether the GP offers bulk billing vs private billing.
- If the GP offers ‘bulk billing’ they accept 85% of the fee as the full cost of service. This means that they accept the Medicare benefit as full payment for service. The patient assigns their right to the Medicare benefit to the GP and there are no out of pocket expenses for the patient.
- If the GP offers ‘private billing’ they charge the patient a set fee (which varies across the country), the patient then receives $72.80 back from Medicare. This option involves the patient incurring an out of pocket expense. The patient either pays full amount and then claims back from Medicare or they pay the difference between the Medicare benefit and the total service cost.
Is there another specific health assessment item for Aboriginal & Torres Strait Islanders?
- Yes, health assessment item 715 is available for Aboriginal and Torres Strait Islanders people of all ages.
- It is a broader assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.
- It is available once every 9 months and the schedule fee is higher than 699 ($212.25 with 100% rebate). As with other health assessment items, 699 cannot be claimed if 715 has already been claimed in the previous 12 months.
- This is likely to mean that GPs will opt for the broader and higher paying 715 assessment for their Aboriginal and Torres Strait Islander patients.