Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians’ private practices

Abstract

Objective This study explored private practice dietitians’ perceptions of the impact of the Australian Chronic Disease Management (CDM) program on the conduct of their private practice, and the care provided to patients. Methods Twenty-five accredited practising dietitians working in primary care participated in an individual semistructured telephone interview. Interview questions focussed on dietitians’ perceptions of the proportion of patients receiving care through the CDM program, fee structures, adhering to reporting requirements and auditing. Transcript data were thematically analysed using a process of open coding. Results Half of the dietitians (12/25) reported that most of their patients (>75%) received care through the CDM program. Many dietitians (19/25) reported providing identical care to patients using the CDM program and private patients, but most (17/25) described spending substantially longer on administrative tasks for CDM patients. Dietitians experienced pressure from doctors and patients to keep their fees low or to bulk-bill patients using the CDM program. One-third of interviewed dietitians (8/25) expressed concern about the potential to be audited by Medicare. Recommendations to improve the CDM program included increasing the consultation length and subsequent rebate available for dietetic consultations, and increasing the number of consultations to align with dietetic best-practice guidelines. Conclusions The CDM program creates challenges for dietitians working in primary care, including how to sustain the quality of patient-centred care and yet maintain equitable business practices. To ensure the CDM program appropriately assists patients to receive optimal care, further review of the CDM program within the scope of dietetics is required. What is known about the topic? The Australian CDM program is designed to facilitate patients to receive subsidised multidisciplinary care for CDM. Dietetics is the third most utilised allied health profession within the CDM program. What does this paper add? This paper demonstrates that dietitians experience challenges in providing services to patients using the CDM program, including pressure to keep fees down, high administrative load, difficulties accessing clear information on compliance requirements, and face barriers to providing best-practice care to patients with chronic disease. What are the implications for practitioners? Changes to the Australian CDM program are required to help dietitians provide health care in line with best-practice guidelines for CDM, and sustainable business practices.