Possible service opportunities today

See a list of patients who are coming in for an appointment who may be eligible to have certain service item numbers such as GPMP/TCA and Health Assessments

 

This metric will show you lists of patients who are coming in for an appointment for the time period selected in the filter, and who may be eligible to book services such as Chronic Disease Management, Health Assessments, GPMPs, TCAs, MHTP, the DVA CVC program, or flu, Shingrix, and Covid-19 vaccines. 

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

Practice managers, Receptionist and Nurses can use this metric daily to:

• Print off a daily list for Practitioners to identify patients coming in for an appointment today with potential service opportunities
• Nurses can identify patients coming in for the day ahead who may be eligible for nursing item numbers (10997 and 10987)
• Incorporate this as a daily task into your team workflows 

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To navigate to this metric, go to Clinic Insights > Today's clinic metrics > Possible service opportunities today

 

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

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

This metric looks at the following service opportunities:

 

 1. Chronic Disease Management (GPMPs, TCAs and reviews)

• Item 721 Preparation of a GP Management Plan (GPMP): Eligibility is based on historical billings at your practice. This will exclude patients who have had item 721 billed in the past 12 months and those who have had item 732 (GPMP/TCA review) in the past 3 months.
• Item 723 Coordination of Team Care Arrangements (TCAs): Eligibility is based on historical billings at your practice. This will exclude patients who have had item 723 billed in the past 12 months and those who have had item 732 (GPMP/TCA review) in the past 3 months.
• Item 732 Review of a GP Management Plan or Coordination of a Review of Team Care Arrangements: Eligible patients who have had an item 721 (GPMP) or 723 (TCA) billed at your practice in the past 12 months and based on historical billings may be eligible for an item 732 (GPMP/TCA review). This excludes patients who have had an item 732 in the past 3 months or those who have had an item 721 or 723 in the past 3 months. 
• Item 731 Contribution to a Multidisciplinary Care Plan, or to a review of a multidisciplinary care plan, for a resident in an aged care facility: Eligible patients have had item 731 billed at the practice, but not in the past 3 months.
• Potential patients for new CDM care plan: 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 or have not been billed for a care plan 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.

Nurse item

• Item 10997 Provision of monitoring and support for a person with a chronic disease 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 or 732 billed in the past 12 months. This excludes patients who have had 5 or more 10997s 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. 

 

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 or TCA 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.

Nurse Item

• 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

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. 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.

 

4. 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.

 

5. 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 item billed.

 

6. Vaccines

• Flu vaccine: Eligibility is identifying a patient who has not had a flu vaccine this season (The flu season runs from the start of March to the end of February each year) or is not eligible for a government-funded flu vaccine, had a flu vaccine last season and has not had a flu vaccine this season.

• 1st dose Shingrix: Eligibility shows patients who are coming in for appointments in the chosen date range and are potentially eligible for their first NIP-funded Shingrix vaccine. Under the National Immunisation Program (NIP) this is available for eligible people most at risk of complications from shingles.  

• 2nd dose Shingrix: Patients potentially eligible for their second NIP-funded Shingrix vaccine. These are:
  • Immunocompromised patients whose first dose of Shingrix was between 1 and 2 months ago, and
  • Immunocompetent patients whose first dose of Shingrix was between 2 and 6 months ago

• Recommended or consider COVID-19 Vaccine: COVID-19 vaccine eligibility is based on ATAGI's statement on the administration of COVID-19 vaccines in 2024. 
  Patients who appear in this list may be 'recommended' or can 'consider' a COVID-19 vaccine. For a breakdown of all COVID-19 vaccine patient eligibility types, visit Cubiko's COVID-19 vaccine support cabinet.
  
  

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Key components and filters:

Summary and summary table:

Use the summary tab to help you understand which services your patients are potentially eligible for, and who are due to attend the practice for an appointment for your selected time period. 

Scroll down the page to view the 'Patients with opportunities' table:

Patients with opportunities: This table lists the patients who may be eligible to book for all service opportunities items highlighted above. This list shows patients who have an appointment within the selected period in one summary table - Unless the filter is changed, this will default to the day ahead. 

Whilst this is a summary table of all potentially eligible item numbers, Cubiko also breaks down each item into individual tables for bite size information. These tables can be found in the other tabs on the page.

 

MyMedicare column: This column will show patients who are ticked in your PMS as MyMedicare registered. This is useful to see at a glance, who is registered, and which patients may be eligible for MyMedicare services such as long telehealth consults or CDM. 

Tabs

The tabs along the top will give you the individual tables for each service opportunity highlighted above. Here you will find extra information and filters on the table. For example, you can change the CDM claiming frequency for GPMP, TCA, and reviews based on the Practitioners' billing preferences. 

Date filters

The date is defaulted to show you the appointment today. Select the drop-down to look ahead at patients with appointments as far as next week. Head to the Item optimisation cabinet to look further ahead than next week and also for patients with no upcoming bookings. 

Select Practitioner

Use this filter to look at the data and tables for one Practitioner/Doctor/Nurse at a time.

Toggles

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

Pop-out sidebar

You can access the full list of their possible service opportunities today and pop this out into a sidebar!

This table shows a detailed breakdown of all of the possible item number service opportunities that the patients you are seeing today may be eligible for. 

Use the Open new window button to pop this out into a list in a window that you can drag and resize and have running next to your practice management software. 

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Using the metrics and data in your practice

Print off a daily list for Practitioners to identify patients coming in for an appointment today with potential service opportunities

Management and/or Reception can print this list each morning for the Practitioners! 

The Practitioner can then make the clinical decision to book the patient in for a CDM service, communicate to the reception team and the reception team can schedule the patient!

1. The default date range will be for today. If you are printing ahead, use the date filter to amend.

2. Use the "Select Practitioner" filter to select the practitioner you would like to print the list for. 

3. Scroll down on the summary tab to the "Appointment of patients with opportunities" list and click the "Print preview" button in the filters sidebar. 

*Use the filters to apply any other particular filters for your list before printing. You can also use the tabs at the top of the page to print individual tables for each service opportunity. 

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Nurses can identify patients coming in for the day ahead who may be eligible for nursing item numbers (10997 and 10987)

Check and print this list each morning to identify patients coming in each day that may be eligible for nursing item numbers. 

1. The default date range will be for today. If you are printing ahead, use the date filter to amend. 

2. Use the tabs at the top of the page and select "Nurse items"

3. Here you will find a table for each item number. Use the relevant item you want to identify. Note both of these tables will tell you how many services you have remaining to bill the calendar year and also the last date you billed this item for the patient!

3. Click the "Print Preview" button in the filters sidebar. 

*Use the filters to apply any other particular filters for your list before printing

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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 disease 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. 
• Please read the Department of Health & Aged Care information on Shingles vaccine and NIP eligibility here.

• More information about the recommended dosing of the Shingrix vaccine, find the Australian Immunisation Handbook here.

• Find the Australian Immunisation Handbook recommendations on Zoster (Shingles) vaccine here.

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