Approve the 14 Recommendations.
We ask WHY NOT?
There have been some changes in relation to the MBS, and what we understood to be the Determinations underpinning the Collaborative Arrangements. We are currently working with the MBS team to seek clarity on changes that have occurred to the Determinations since 2010, and hope to provide you with a further update on this imminently.
A bit of history:
In 2010, the ACNP and its members were consulted widely, as were consumers and other ‘stakeholders', in relation to changes to the Health Insurance Act to allow patients of NPs to access MBS and PBS rebates. Alongside this sat the Determination (brought in at the last minute after the amendment to the Act was already made) that Nurse Practitioners had to have a Collaborative Arrangement with a Medical Practitioner to enable these financial benefits for our patients. During the consultation, and at the time of the launch of these changes to the Health insurance Act, we all received extensive advice and education on these Arrangements, including the fact that they would sunset and cease to apply in 2020, if not removed sooner. At that time, the Health Insurance Act did not mention the Collaborative Arrangements, therefore the sunset would be effective, and MBS and PBS access would remain.
What are the Collaborative Arrangements?
The Collaborative Arrangements under the Determination wholly and solely relate to the patient being able to access MBS rebates for Nurse Practitioner services, and PBS subsidies for medicines prescribed by a Nurse Practitioner, although PBS access for patients of Nurse Practitioners is still quite limited.
Additionally, this also means patients may pay more out of pocket for visits to specialists, or for diagnostics, when referred by Nurse Practitioners. In addition to being required to pay more for their medicines, often their medicines do not count towards their safety net. The Safety Net protects our most vulnerable Australians. While solutions to such problems are often a big challenge, we have the answers to the MBS issues. The report of the Nurse Practitioner Group as part of the MBS review has already made 14 recommendations, and the ACNP fully supports all of them. We backed up the well researched and evidence based recommendations of the NPRG with even more evidence, and these recommendations were also widely supported by other health professions and consumers.
Unfortunately, we have now discovered further Determinations in 2015, and 2018 that tie the Collaborative Arrangements to directly to the Health Insurance Act until 2030. We are currently seeking answers as to how this could have occurred without consultation, or even notification to those affected. Ultimately, had the sunset date not been extended, our patients would have lost access to MBS and PBS, due to the change in 2015, that we were never advised of. Last week, after receiving conflicting information about the sunset deferral, we searched more widely for legislation and determinations, and that was how this was discovered, we were never advised of it at any stage.
The ACNP is now gathering more information, and will circulate this, with fact sheets, and our plan to address this, to members, health professional groups and consumers as soon as possible. The answer for fixing the PBS restrictions is not so easy, but we need to continue to advocate for our patients.
Of course we are hopeful that the MBS review will deal with these issues, and many others, that negatively impact on our patients access to NP services, especially those already struggling with access to care, and struggling with the cost of care. The government has given a further two year timeline now for completion of the MBS review, naturally we are not accepting of this given the evidence-based report of the NPRG was finalised in 2018, and the ACNP and numerous stakeholders have shown very strong support for all of the recommendations.
The Way Forward:
It is time to put a stop to the interference, the negativity, and the fear that has led to the impediment of the Nurse Practitioner profession in Australia. Australia should have thousands more Nurse Practitioners already in place, providing care for people all across Australia. We have already provided evidence over and over; we have an outstanding record of quality and safety.
Stop asking us to justify WHY the barriers to NP practice should be removed. Show us the evidence - WHY NOT?
You can help Nurse Practitioners stand up and say NO MORE to this out dated legislation.
Check this page for updates as we receive further information in relation to these issues, and refine our plan of approach.
For now, please spread the message:
SUPPORT PATIENT CHOICE:
1. Remove the Collaborative Arrangements.
2. Stop the disadvantage for patients via the Medicare Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS).
3. Engage with us - consult us on legislative changes and other changes that affect our profession, practice and our patients.
Nurse Practitioners will continue to stand up in the interests of their patients and for those who choose to see a Nurse Practitioner. For them we will not compromise
You can help Nurse Practitioners stand up and say NO MORE to this out dated legislation, and to these unnecessary restrictions. We know that many of your patients have had enough too. When we explain the limitations to our patients, and the reasons for the extra costs, they frequently express their frustration:
- I want my right to choose my health care provider! I can choose a GP or an NP, I should not be penalised.
- If there is a Nurse Practitioner providing all of the health care in my area, I have to pay more, how is that fair?
- Why do I have to pay more for my medicines when I see a Nurse Practitioner?
Suggested Twitter Text:
The #Collaborative #Arrangements for #NursePractitioners (#NPs) are penalising #patients for their choice to see a #NP with the most disadvantaged of our community members left most vulnerable. Remove Collaborative Arrangements. GregHuntMP #supportpatientchoice
Support Patient Choice. Remove Collaborative Arrangements. Approve the 14 Recommendations. We ask WHY NOT?
If you have any questions, or would like any assistance please contact the ACNP National Office on 1300 433 660.
To claim a Medicare rebate for the cost of seeing a Nurse Practitioner, this requires a financial arrangement between a doctor and the nurse practitioner. This doctor is not required to be involved in your care, or even to know you. If there is no financial arrangement (called a collaborative arrangement) in place, or it is not applicable at the time of your consultation, there is no Medicare rebate for you as the patient. With the sudden change to the legislation, and no communication with Nurse Practitioners, there could be many situations arising where you will have to pay the full cost of your consultation.
Nurse practitioners have always known this legislation governing the financial side of your consultation would sunset (cease to exist) on 1/10/2020, and many have these financial arrangements with a medical practitioner expiring around this time. Due to the fact that there was no consultation or communication with us, it is likely that it will take time for arrangements to be reinstated. The ACNP is trying hard to communicate with all Nurse Practitioners affected.
There are additional concerns in rural and remote areas where Nurse Practitioners already have a lot of challenges in making these Arrangements, and often this impacts on whether services are available in the community at all. We are deeply concerned about the most vulnerable members of our community at this time.
We believe that it is your rebate, and your choice should be respected. We also believe you have the right to access care. We are fighting hard to have this condition removed.
You may also pay more for your medicines, as access to the Pharmaceutical Benefits Scheme for prescriptions written by Nurse Practitioners is limited, and many have subsidies again have conditions that mean you need to pay for a private prescription at full price. This also means they do not count towards your safety net, which protects you if you have complex health needs, or are otherwise at disadvantage, from incurring a lot of expense in relation to your medicines.
The ACNP is happy to help anyone with questions in relation to these issues. Please contact us at firstname.lastname@example.org or call 1300 433 660 during business hours.