ALLIED HEALTH MEDICARE REFERRALS (AHMR)
The current Allied Health Medicare Referral (AHMR), formerly called an EPC, can only be issued to you by your GP. These referrals are for patients with a chronic medical condition such as diabetes or those who have complex care needs.
A maximum of five rebates of $53.80 from Medicare can be given in a calendar year.
Your GP can issue anywhere from one to five visits on your AHMR. These visits DO NOT expire. We prefer that they are used within a three year period, but essentially they will be valid until all visits showing on the AHMR have been used. Therefore, if you use your five visits in the calendar year - three with podiatry and two with physio and you still have a total of five on your podiatry AHMR with three used, the other two visits will carry over to the next calendar year to be used then. You do not require a new AHMR for podiatry in the new calendar year.
Your GP will need to do a GP Management Plan (GPMP) and Team Care Arrangement (TCA) which will take some time to complete so please allow extra time for this to occur. Many practice nurses are able to complete the details with the GP signing off on the referral.
A minimum of three practitioners are required to be listed on the TCA. These would include your GP and any allied health professionals you need to see such as a podiatrist, diabetes educator, dietitian, physiotherapist, exercise physiologist, osteopath, etc. The five visits can be spread across five different allied health services or given to just one or two services - whatever your GP deems necessary for you to continue maintaining your health.
Specialists can be listed on the TCA as one of the three or more medical practitioners, but specialists do not require an AHMR. The AHMR is for Allied Health professionals only. Therefore, your five visits are only for Alllied Health practitioners, not specialists.
Please note that Bunny Upathumpa no longer requires to be listed on the AHMR. As Bunny now has her Masters Degree in Nurse Practitioner and is a specialist diabetes educator, she has her own Medicare item numbers and does not require the AHMR. This means that no visits are required to see Bunny and you are able to come to see her without this referral for your rebate.
Practitioners based in hospitals can be listed on the TCA but do not require to be listed on the AHMR as one of the five visits as they are covered by government funding.
An AHMR can be issued at any time during the duration of the TCA. Your GP will not need to do another TCA or GPMP when you require another AHMR if the TCA is still valid. For example - if your TCA is valid for 12 months and you are given two visits on your AHMR to your podiatrist and you use both of them within six months, you could then see if you are able to obtain another two or three visits on a new AHMR without your GP having to do another TCA.
Your GP needs to sign, date and note the number of visits allocated to each allied health service.
If your GP decides that you require two or more services from the same practice, the name of the practice can go in the section for Name (middle of the sheet) and no address needs to be included.
If you only require podiatry and not a specific practitioner, then only "Podiatry" would be required in the Name section and again, the address section can be blank. This is very beneficial if you travel and want to see practitioners in more than one practice or city but also if your preferred practice has more than one practitioner. That way, any of the podiatrists at that practice could see you - especially beneficial if you have an emergency and your preferred practitioner is away and a locum is in place or if your preferred practitioner is booked out and you are unable to wait. This way you will still receive your rebate and don't have to wait for an appointment.
Most allied health practices are private practices but there are also bulk bill practices. If your preferred provider bulk bills, you will not be out of pocket at all and your provider will either charge you the $53.80 and you will get a rebate of $53.80 or they will charge Medicare direct. If your preferred provided is a private practice such as Qcity Podiatry and Healthcare, you will be charged the consult fee and then you can claim back the rebate of $53.80. Medicare usually deposits the rebates back into your account the next or following business day.
The Allied Health Medicare Referral information is the same for Indigenous as Non-Indigenous Australians. However, for Indigenous Australians who require more visits to their allied health professional in the calendar year than the five, they can be allocated a further five visits by their GP under item number 81340 for podiatry (different AHMR form). The current Medicare rebate if you have an AHMR is $53.80.
REMOTE AREA PODIATRY
From 2009 until 2012 inclusive Allan travelled to a number of remote communities in East Arnhem Land — namely Numbulwar, Gapuwiyak, Ramingining, Milingimbi and Yirrkala. These communities are all reached through Nhulunbuy at the Top End of the Northern Territory. Allan made two to three trips a year to assist the NT Health Department in providing podiatry care to residents of these outlying communities. He travelled by light aircraft to most of the remote areas except Yirrkala which is only fifteen minutes by road from Nhulunbuy. As well as providing podiatry care, Allan was also able to help the nurses and staff at the centres to continue basic foot care during his absence. Very few podiatrists travel to remote areas in the Northern Territory or Western Australia and so limited care is available to these communities.
In 2013 Allan ceased to do consultations in remote communities of East Arnhem Land in order to concentrate on his own podiatry business and to also enhance the education and promotion of foot care in the Northern Territory. He presents at two Footcare Conferences a year to promote and assist with Northern Territory foot care - one in Alice Springs and the other in Darwin.
TOP END FOOT CARE - EVERY PROBLEM UNDER THE SUN
Numbulwar is a community of approximately 1,000 residents, a one and a half hour flight south of Gove on the Gulf of Carpentaria. The town is set amongst the sand hills and is hot and dusty. It has a school, supermarket (milk $3.25/lt and petrol $2.80/lt), a health clinic but no doctor. The clinic has several Aboriginal health workers whoa re truly terrific. The non-indigenous staff
In both Gapuwiyak and Numbulwar Allan worked with the Chronic Disease team and we worked through the Diabetic patient list. Whilst Allan screened the lower limb and dealt with the thick toenails, corns and leather like calluses, the Chronic disease nurse looked at
are also fantastic, living in the community for several years at a time. You have to be committed to work here. The money is not the carrot. The nearest town of any size, Katherine, is several hundred kilometres drive away. The staff at the clinic are very talented with broad skills. Whilst the normal health checks go on during the day, there is a never-ending stream of patients who have chest pain, spear wounds as well as skin infections and headaches. It is just like any emergency department at any hospital except without the back up of fancy gear and specialised staff. Even a simple x-ray requires chartering an aircraft to fly the patient to Gove and back. Cultural mews are complex and confusing to visitors.
The Indigenous people have lived in the region for many thousands of years. Whilst they may not be known to most of us outside of East Arnhem, the band Yothu Yindi hail from here. Unfortunately, many health problems exist and one of the greatest chronic diseases facing these communities is Diabetes.
The East Arnhem region is a vast area. Travel by road is mostly restricted to the dry season (May to October) and the distances are huge over the unsealed roads. Fortunately Mission Aviation Fellowship (MAF) provides a heavily subsidised flight service across the Top End. The aircraft used are mainly Airvans to provide a sort of air taxi service. They are built for service, not comfort. There is no air conditioning and sitting in the cockpit on the runway before takeoff when it is 33 degrees C with 98% humidity is an experience.
Between 2009 and 2012 Allan travelled to the East Arnhem Region in the Northern Territory to provide podiatry services in the remote Aboriginal community of Numbulwar and Gapuwiyak. He had first visited these communities in July 2009 and the response was so positive that he was invited back. Blood Sugar Levels, weight and other risk factors. We aimed to have an Aboriginal Health Worker with us and all three of us then worked on an education program to try and reduce the risk factors in each Diabetic patient. It was also my aim to train the Health Workers in podiatry skills as it is important to leave skills behind for ongoing care.