The Eating Disorders Items Stepped Model of Care
This is a summary of the steps involved in an Eating Disorder Plan. For complete details, please consult http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/773AA9AA09E7CA00CA2584840080F113/$File/Eating%20Disorders%20Quick%20Reference%20Guide%2029Oct2019.pdf
The ‘stepped model’ for best practice care of eligible patients with eating disorders comprises:
- assessment and treatment planning services;
- provision of and/or referral for appropriate evidence based eating disorder psychological and dietetic treatment services; and
- regular review and ongoing management to ensure the patient accesses the appropriate level of intervention to meet their needs.
‘STEP 1’ – PLANNING (trigger eating disorders pathway) items 90250-90257 and 90260-90263
An eligible patient receives an eating disorder plan (EDP) developed by a GP (items 90250-90257), consultant psychiatrist (items 90260-90262) or consultant paediatric (items 90261-90263).
‘STEP 2’ – COMMENCE INITIAL COURSE OF TREATMENT (psychological & dietetic services)
Once an eligible patient has an EDP in place, the 12 month period commences, and the patient is eligible for an initial course of treatment, up to 20 dietetic services (82350 and 82351) and 10 EDPT (Eating Disorders Psychological Treatment) Services (82352-82383, 90271-90282).
After each course of treatment, the relevant practitioners should provide the medical practitioner who is managing the patient’s EDP (where appropriate) with a written report to inform the review and indicate patient progress and need.
‘STEP 3” – EDR (90264-90269) to CONTINUE ON INITIAL COURSE OF TREATMENT (managing practitioner review and progress up to 20 EDPT services)
A patient must have a review of the EDP by the patient’s managing practitioner. Where another course of treatment is appropriate the patient progress up to 20 EDPT services.
‘STEP 4’ FORMAL SPECIALIST AND PRACTITIONER REVIEW 90266-90269
To continue beyond 20 EDPT services a patient must have two additional reviews before they can access more than 20 EDPT services. One review (the ‘second review’) must be performed by a medical practitioner in general practice (90264-90265) and the other (the ‘third review’) must be performed by a consultant paediatrician (90267 or 90269) or consultant psychiatrist (90266 or 90268). Should both recommend the patient requires more intensive treatment, the patient would be able to access an additional 10 EDPT services in the 12 month period. These reviews are required to determine that the patient has not responded to treatment at the lower intensity levels.
The patient’s managing practitioner should be provided with a copy of the specialist review.
The specialist review by the psychiatrist or paediatrician can occur at any point before 20 EDPT services. The practitioner should refer the patient for specialist review as early in the treatment process as appropriate. Practitioners should be aware that the specialist review can be provided via telehealth (90268 and 90269). A patient must have a review of the EDP (90264-90269), to assess the patient’s progress against the EDP or update the EDP, before they can access the next course of treatment.
‘STEP 5’ ACCESS TO MAXIMUM INTENSITY OF TREATMENT 90264-90269 (continue beyond 30 EDPT services)
To access more than 30 EDPT treatment services in the 12 month period, patients are required to have an additional review (the ‘fourth review’) to ensure the highest intensity of treatment is appropriate. Subject to this review, a patient could access the maximum of 40 EDPT treatment services in a 12 month period. The fourth review should be provided by the patient’s managing practitioner, where possible.