Privately practising nurse practitioners' provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey

Abstract

Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. This paper provides data on PPNPs' provision of care subsidised through the MBS and PBS. Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.

The non-medical surgical assistant and inequity in the Australian healthcare system

“…To date some 1,839 NPs practice in Australia, however, despite being eligible providers with access to the Medical Benefits Schedule (MBS), NPs in the private sector of the Australian healthcare system are only able to access four consultation, six telehealth, and no procedural MBS item numbers. 29,30 This significantly curtails NP private practice. 22,30 As many patients have multi-morbidities, medical care is increasingly complex, and even routine surgical procedures can involve significant risks.…”

“…29,30 This significantly curtails NP private practice. 22,30 As many patients have multi-morbidities, medical care is increasingly complex, and even routine surgical procedures can involve significant risks. The optimal surgical team should be assembled for all surgical procedures.…”

“…Distributive injustice is not restricted to the NMSA but affects many NPs in other specialities of private practice in Australia. 30 Regarding the NMSA, the process of allowing access to the MBS is a cost-neutral exercise for the government and private health insurers; as an MSA or an NMSA is used, not both. The NMSA would cost the same as the MSA if given access to the current MBS surgical assistant item numbers.…”

Liability and collaborative arrangements for nurse practitioner practice in Australia

“…Recent research (and experience of the authors) has shown that some MPs do not understand the nature of the collaborative arrangement, reinterpreting it as a supervisory or control relationship. 28 Such an interpretation contradicts the intent of the introduction of NPs initially, 29 and latterly PPNPs, 11 which was to increase access to health services for underserved and marginalised populations through the introduction of a highly skilled nursing workforce that was able to practise autonomously. 30 The persistence of these misunderstandings among some MPs has led to associated concerns about their liability for the actions of NPs and PPNPs.…”

The legitimacy of the nurse practitioner as a non-medical surgical assistant: Historical evidence from Australia

“…This includes ordering investigations, interpreting the results and follow up taking appropriate actions to optimise the care. Tempering the historical and contemporary ability of the NP to deliver innovative care in Australia has been and is, the structure of the healthcare system, limited access to the Medical Benefits Schedule (MBS) and the protectionism of others practising in the space (Currie et al, 2019a;Currie et al, 2019b;D'Antonio & Lewenson (2011); Gardner et al, 2009).…”