By Dr. Anthea Fursland
Australians with an eating disorder are about to gain greater access to Medicare reimbursed evidence-based treatment. This is an enormous step forward and will benefit many people with eating disorders. A huge amount of work has gone into this change, and we have to thank the National Eating Disorders Collaboration and Federal Health Minister Greg Hunt for their courageous actions in facilitating this increased access.
We know that eating disorders are particularly complex, since they exist at the interface of medical and mental health. We know that many people with eating disorders suffer in silence, never seeking help – because of shame, confusion, fear or hopelessness. We know that most people who do receive treatment receive outpatient therapy. We know that there are evidence-based treatments which benefit many.
We know that medical symptoms can have lasting effects such as bone loss, dental erosion and brain changes, and that both medical and psychiatric symptoms can have lasting effects such as poor performance at work/studies, reduced self-esteem and loss or deterioration of relationships. We know that early intervention is crucial in halting the mental, physical and social deterioration. We know that early change predicts the likelihood of recovery/symptom reduction.
We know that evidence-based treatments, which advocate early change, are recommended across the board by respected specialists in eating disorders. We also know that very few mental health clinicians offer evidence-based treatments, and that many people have been “in treatment” for years, without any focus on symptom change, while their mental and physical health continue to deteriorate.
Implicit and even explicit in the new changes to Medicare is that the increased access to care means access to treatment that is eating disorder-specific and conducted by practitioners who are suitably trained in evidence-based therapy. However, at present there are no criteria to ensure or monitor this.
Immediate challenges to the eating disorder field include:
What are the changes?
From November 1, 2019, a new suite of 64 Medicare Benefits Schedule (MBS) items will be introduced to support a model of best practice evidence-based care for patients with anorexia nervosa and other eligible patients with eating disorders.
These changes are relevant for medical practitioners (including a GP, a psychiatrist or paediatrician), and eligible Clinical Psychologists and Psychologists, Occupational Therapists, Social Workers and Dietitians.
This is ALL that has been confirmed, but various organisations have been involved in negotiations with Medicare, so everything below is subject to change/confirmation.
What does this mean?
From November 1, 2019, people with anorexia nervosa and other patients who are eligible* will be able to access more care than the current amount of up to 10 for mental health sessions and up to five sessions for dietetics. They will be able to access up to 40 psychological sessions and up to 20 dietetic sessions in a 12-month period.
*Eligibility criteria are determined from the government’s explanatory notes available here: https://gallery.mailchimp.com/ce93a8232809a8991d86defc6/files/6e0a0628-7c82-4c1b-a434-fdd6358fee7b/Eating_Disorders_Explanatory_Notes_as_at_15_October_2019.pdf
‘Eligible patient’ defines the group of patients who can access the new eating disorder services. There are two cohorts of eligible patients.
The eligibility criteria for a patient is:
Practitioners should have regard to the relevant diagnostic criteria set out in the Diagnostic and Statistical Manual of the American Psychiatric Association – Fifth Edition (DSM-5). Practitioners can access the Eating Disorder Examination Questionnaire at https://www.credooxford.com/pdfs/EDE_17.0D.pdf.
How will it work?
Those who are eligible will be able to access up to 40 sessions with Clinical Psychologists and Psychologists, Occupational Therapists and Social Workers (those who have a Medicare number – i.e., are registered as Medicare providers). As a first step, people must go to their GP and ask for psychological treatment for their eating disorder.
If people DO meet criteria for the new eating disorder pathway, treatment will proceed as follows:
Best practice evidence-based care
The changes to the Medicare system have been made so that people with eating disorders receive “best practice evidence-based care”. What does this mean?
“Evidence-based care” refers to treatments that have been researched, with results published in peer-reviewed scientific journals. They are regarded as the first-line treatments for eating disorders, as they have been shown to be beneficial. These treatments tend to have a manual to guide the clinician, and these treatments require specialist training. The trainings should be at least two days’ duration, with adequate opportunity to practice skills, so that the clinician is able to apply these skills when treating people with eating disorders.
A recent publication from the government Health Insurance (Allied Health Services) Amendment (Eating Disorders) Determination 2019 https://www.legislation.gov.au/Details/F2019L01315) sets out the following requirement for allied health services:
…. an eating disorder psychological treatment service must involve the provision of any of the following mental health care management strategies:
A further publication Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019 sets out requirements and fee schedules for medical practitioners https://www.legislation.gov.au/Details/F2019L01318.
What should people with an eating disorder be requesting of their GP?
When requiring eating disorders treatment, people need to ask their GP and/or referring practitioner (psychiatrist or paediatrician) for: