Item Optimisation overview

The Item Optimisation cabinet looks at your whole database of patients with a potential service opportunity inclusive of those with an appointment and without a future appointment.

Use the cabinet to identify a list of patients potentially eligible for specific services. Review the list with the patient's practitioner and proactively contact these patients to schedule appointments for the services to be completed.  

Practice managers, Receptionist and Nurses can use this cabinet weekly to:

• Identify the service opportunities items you would like to extract patient lists for
• Export your list to discuss with the relevant Practitioner
• Contact the patients to schedule an appointment 

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To navigate to this metric, go to Clinic Optimisation > Item Optimisation

The sections included in this article are:

• Understanding the metrics and data
• Key components and filters
• Using the metric and data in your practice
• Additional resources

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Understanding the metrics and data

Within this cabinet, you will find a metric for each below item. These are broken into key areas. Click through to each metric to filter and see your full potentially eligible patient list. 

Eligibility is based on patient demographics and previous billings of face-to-face, telehealth, telephone and non-VR item numbers at your practice. 

 1. Chronic Condition Management (CCMPs and reviews)

• Item 965 Preparation of a Chronic Condition Management Plan (CCMP):
  Eligibility is based on historical billings at your practice. 

  This excludes patients who have had an item 721 (GPMP) or 965 (CCMP) in the last 12 months and those who have had an item 732 or 967 (CCMP Review) or equivalent in the last 3 months.

• Item 967 Review of a CCMP: 

  Eligibility is based on historical billing at your practice. Looking at whether a patient has been billed an item 965 at the practice in the past 18 months or an item 967 in the past 18 months, and either of those items was billed more than three months ago. This list excludes patients who have had an item 967 in the past 3 months.

• Potential patients for new item 965 (CCMP)*: Eligibility is based on patients with an underlying condition (listed in the patients' active past history and observations) who have either never had a care plan (GPMP, TCA or CCMP) or have not been billed for a care plan/review in the last two years. 
  Broadly, our search function looks at Blood cancer diagnosis (within the last 5 years), Bone marrow transplants (within the last 2 years), Chronic liver disease, Chronic renal failure, Coronary heart disease or failure, Diabetes, Haemoglobinopathies, High BMI, Neurological condition, has transplant and immunosuppressant and Non-haematological cancer diagnosed in the last year.

• Move CDM to CCMP (965): All patients on existing Care Plans will need to be transitioned over to a new CCM plan (965) after July 1st 2025, in order to continue to move forward with future Care Plan reviews (967). Eligibility is based on historical billings at your practice. This metric is showing patients who have had a CDM plan billed (721, 723) in the last 2 years, and excludes those patients who had any CDM billing (721, 723, 732) in the last 3 months. 

   

 

2. Health Assessments

There are four time-based MBS health assessment items: 701 (brief), 703 (standard), 705 (long) and 707 (prolonged). The following categories of health assessments may be undertaken by a medical practitioner (other than a specialist or consultant physician) under these items:

• 75 + Health Assessment: This metric shows the number of 75+ patients who have not had a 75+ Health Assessment billed at your practice in the last 12 months. Over 75 health assessments can be performed every 12 months, so make it an annual re-occurring appointment for your patients. It can be a great idea to coincide the health assessment appointment with the patient's birthday as an easy reminder! 
• 40-49 Diabetes Risk Health Assessment : This metric shows the number of patients who may be eligible for a 40-49 Diabetes Health Assessment. Patients are eligible if they have had an AUSDRISK assessment in the past 3 months were scored in a high-risk range (12+) and are between the ages of 40-49 (inclusive) or 15-54 (inclusive) for Aboriginal and Torres Strait Islander people. Patients who have had a 40-49 Diabetes Health Assessment in the past 3 years are excluded from this list. 
• 45-49 Health Assessment: This metric shows the number of patients who may be eligible for a 45-49 Health Assessment and have not had a Health Assessment billed since they turned 45. A patient is eligible for a 45-49 health assessment if they have a risk factor that puts them at risk of developing a chronic disease. This will exclude patients who have been on a GPMP, TCA or CCMP in the past.
  

   

  Risk factors may include, but are not limited to:

  • lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol use;
  • biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; and
  • a family history of chronic disease.

  Cubiko looks at these risk factors from the patient file in Best Practice to identify patients who may be eligible for a 45-49 years Health Assessment.

Medical practitioners providing a health assessment for Aboriginal and Torres Strait Islander people should use MBS Item 715. This MBS health assessment item has no designated time or complexity requirements.

• Item 715: This metric shows the number of Aboriginal or Torres Strait Islander (ATSI) patients who have not had an ATSI Health Assessment (item 715) in the last 9 months.

Heart health assessment item 699:

• Item 669 Heart health assessment provided by general practitioners and medical practitioners: This metric shows the number of patients eligible for item 699 who have not had any Health Assessments in the past 12 months. 

 

3. Other potential eligibilities

Nurse Items

• Item 10997 Provision of monitoring and support for a person with a chronic condition by a practice nurse or Aboriginal and Torres Strait Islander health practitioner: Eligibility is based on the patient's billing history at the practice and has had items 721, 723, 732 or an item 965 or 967 billed in the past 12 months. This excludes patients who have had 5 or more 10997s this calendar year
• Item 10987 Follow-up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of a Medical Practitioner, for an Indigenous person who has received a health assessment: This metric shows the number of patients who have had an item 715 billed in the past 12 months and have not had 10 x item 10987s this calendar year
  
  

As with other patient lists in Cubiko, ultimately, it is the Practitioner's decision whether a patient is eligible for a particular type of service. 

 

Item 731

Contribution by a general practitioner (not including a specialist or consultant physician) to a multidisciplinary care plan for a resident in RACF or a patient being discharged from a hospital (or a review of such a plan prepared by another provider). 

In Cubiko, patients who may be eligible for an item 731 are patients who have previously had an item 731 billed (including Telehealth, Telephone, and non-VR item number equivalents), but not in the past 3 months. 

 

Medication management reviews (MMR's)

Eligibility is identifying patients that have been previously billed an item 900, 903, or equivalent DVA or non-VR item more than 12 months ago (irrespective of current medications) or are currently on 5+ medications.

*Patient eligibility based on 5+ medications is only available for customers on Halo and requires clinical consent.

 

Mental health care treatment plans and reviews (MHTP and reviews)

• Mental Health Care Treatment Plan: Eligibility is based on historical billings at the practice, having had previous MHTP item billings. This excludes patients who have had an MHTP item billed in the past 12 months and those who have had a review of an MHTP item billed in the past 3 months. 
• Review of Mental Health Treatment Plan: Eligibility is based on historical billings at the practice, having had previous MHTP item billings. This excludes patients who have had an MHTP in the past 4 weeks and those who have had a review of an MHTP in the past 3 months.

 

DVA CVC program

Eligibility is identifying DVA Gold and White Card holders who (based on historical billings) may have a chronic disease and have not had a CVC item billed in the past 90 days. Patients are deemed as possibly having a chronic disease if they have previously had a Chronic Disease Management or Chronic Condition Management item billed.

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Key components and filters:

Possible patients

See the number of patients who may be eligible for the service/item number:

Possible item billings

See the value of billings that could be made from the patients who may be eligible for the item number:

Date

Use this filter to filter lists via all patients, patients with upcoming appointments or No appointment booked! By default, it will show all active patients. 

Select Practitioner

If you are looking at patients with an upcoming appointment you can select the practitioner to filer via the "Next appt with" section OR if you are looking at patients with No upcoming appointment you can filter via "Usual Doctor" if actively selected in your Practice Management software or Last seen doctor:

 

 

Toggles

Use the toggles in the filters to filter down the patient lists further:

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Using the metrics and data in your practice

 

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1. Identify the service opportunities items you would like to extract patient lists for

This cabinet is broken down into categories. 

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2. Once you have selected the item, click through to filter your patient list

By clicking into an item heading, you will find detailed information on potential patients for each service and a full list of patients:

Use your filters to identify patients with upcoming appointments over a period of time OR "No appointment booked"

You can then filter the list down via Practitioner:

Change the billing frequency and use the toggles to filter the list to look at:

Active patients with 3+ appointments in 2 years, and choose to include or remove RACF patients, patients under 18 years old, and MyMedicare registered patients. 

You may also like to toggle on to include patients that have been billed a 965 in the last 12 to 18 months in addition to those that have had a 965 billing prior to 18 months.

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3. Export your list to discuss with the relevant Practitioner

Once you have applied the relevant filters click the small download arrow on the top right-hand side of the patient list. This will export your filtered list into a CSV format. You can then select your download on your computer and print this list for review with the Practitioner. 

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4. Contact the patients to schedule an appointment 

Be sure to use our forecasting tool below to ensure you have the capacity to book these patients for these services. You may choose to contact patients via:

• Bulk SMS - Our patient lists in Cubiko provide the INTERNAL ID, which can be used by third-party software applications that integrate with Best Practice, to enable sending of SMS to these patients (such as Automed and HotDoc).  For more information on how to download a .CSV file from Cubiko,  click here.
• Letter
• Phone call
  
  

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Incorporate this as a daily task into your team workflows 

• Review the Service opportunities workflows for each category (for example Chronic Condition Management)
• Review the workflow templates for your team here!

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Additional resources:

• More information about 715 health assessments can be found on the Department of Health and Aged Care website here.
• Use this link to The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) to estimate a patient's risk of getting type 2 diabetes in the next 5 years for your 40-49-year-old diabetes health assessment.
• The Heart Foundation has created a Toolkit for General Practice to help integrate Heart Health Checks (item 699) into routine patient care.  You can access this Toolkit here.
• More information about the DVA CVC Progam and how to implement this in your practice can be found on the DVA website here. 

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