Heart health check items added to the MBS

• From 1 April 2019, MBS heart health check items (699 and 177) allow GPs and medical practitioners to conduct comprehensive heart health assessments.
• The items fund one heart check per patient in a 12-month period, if other health assessments have not been claimed in that 12-month period. Appointments should last at least 20 minutes.
• Assessments must include taking patient history, aimed at identifying cardiovascular disease risk factors, conducting a physical examination, and as required initiating interventions, and implementing a management plan.
• Absolute cardiovascular disease risk must be calculated, using a validated calculator. The Australian absolute cardiovascular disease risk calculator is recommended.

On 1 April 2019, two interim ‘heart health check’ items (699 and 177) were introduced to the Medicare Benefits Schedule.¹

They allow a GP or medical practitioner to conduct one heart health assessment per patient (in a consulting room) lasting at least 20 minutes, every 12 months.¹

The new items fund a comprehensive assessment of CVD risk, identification of physical or lifestyle-related risks and implementation of a preventive health care plan to improve cardiovascular health.^2,3

The interim items will be reviewed and evaluated over the next 2 years to help inform their effectiveness and any future improvements.¹

Who can claim items 699 and 177?

Item 699 is for GPs.⁴ Medical practitioners, not including specialists or consultant physicians, working in general practice can claim item 177.⁵

Section 19AA of the Act outlines eligibility requirements for GPs and medical specialists to claim Medicare benefits.⁶

See MBS Online for GP and medical specialist eligibility requirements.

The prevention and treatment of heart disease is a major focus of the Australian government.¹

The new items complement existing MBS items that already support patient–doctor health discussions, including time-based health assessments and chronic disease management items.¹

However, existing health assessment items have age restrictions that exclude people aged 50–74 years, and may only offer a one-off service and not require CVD risk calculation.⁷

See Other time-based health assessments below for associated information.

The new items will allow patients with CVD, or at risk of developing CVD, to access a heart health assessment.^2,3

Modelling by the Heart Foundation suggests that the new items have the potential to prevent 42 heart events every day over the next 5 years.⁸

Will the changes affect current health services?

The changes will effectively allow more time, at least 20 minutes, for health professionals to specifically assess cardiovascular health.^1,2,9

The new items encourage health professionals to determine a patient’s absolute CVD risk and facilitate ongoing management based on CVD risk level.²

Patients will potentially benefit from earlier identification of CVD, and more timely and appropriate medical intervention.^1,9

MBS items 699 and 177 must include the following, all with appropriate documentation:^4,5

• collecting relevant information and taking patient history to identify CVD risk factors, including diabetes status, alcohol intake, smoking status, cholesterol status (if not performed within the last 12 months) and blood glucose levels
• conducting a physical examination (blood pressure must be recorded)
• initiating interventions and referrals to address identified risk factors
• implementing a management plan for appropriate treatment of identified risk factors
• providing preventative health care advice and information (including advice on modifiable lifestyle factors).

A patient’s absolute CVD risk must be calculated, using the Australian absolute cardiovascular disease risk calculator.^2,3

The Heart Foundation advises that calculators embedded in GP clinical software can also be used to calculate and record absolute CVD risk.⁷

The new heart health check items are intended to identify CVD in people not yet known to have CVD.^2,3

This includes Aboriginal or Torres Strait Islander people aged 30 years and above and other Australians aged 45 years and above.^2,3

Items 699 and 177 can be claimed once per patient in a 12-month period. They cannot be claimed if a patient has had another health assessment service in the previous 12 months.^2,3

See MBS explanatory note AN.14.2 and AN.7.29 for further details.

Other time-based health assessments

There are four other time-based health assessment items that can be provided by a GP or medical practitioner. These items are summarised in Table 1.^2,3,10,11

These items may be used in the following situations:^2,4,10,11

• type 2 diabetes risk evaluation for people aged 40–49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool
• health assessment for people aged 45–49 years (inclusive) who are at risk of developing a chronic disease
• health assessment for people aged 75 years and older
• comprehensive medical assessment for permanent residents of residential aged care facilities
• health assessment for people with an intellectual disability
• health assessment for refugees and other humanitarian entrants
• health assessment for former serving members of the Australian Defence Force.

The health assessments should generally be undertaken by the patient's 'usual doctor'.^2,3

In 2017–18, 1.2 million Australians (4.8%) had CVD.¹² Conditions affecting the circulatory system were attributable for 27% (43,447) of all deaths in Australia in 2017.^12,13

However, CVD is largely preventable and Australian and overseas guidelines recommend a comprehensive risk assessment to enable effective management of identified modifiable risk factors.¹⁴

Absolute CVD risk is the numerical probability of a cardiovascular event occurring within a 5-year period. It is categorised as low (< 10% risk), moderate (10%–15%) and high (> 15%).¹⁴

An absolute CVD risk assessment is recommended for Aboriginal or Torres Strait Islander people aged 30–74 years and other Australians aged 45–74 years.^14,15

The RACGP recommends adding 5% to the calculated 5-year risk score (when using the Framingham Risk Equation) for Aboriginal and Torres Strait Islander people living in communities where local risk factor prevalence rates and CVD incidence rates are high (such as remote areas).¹⁵

Assessment of CVD risk is more accurate when based on multiple risk factors rather than an individual risk factor, because the cumulative effects of multiple factors may be additive or synergistic.¹⁴

Lifestyle support, such as weight management, smoking cessation and increased physical activity, is recommend for people at all risk levels. Blood pressure-lowering and/or lipid-modifying medicines may also be required, depending on a person’s blood pressure and risk level.¹⁴

Completing an assessment

The National Vascular Disease Prevention Alliance has developed the Australian absolute cardiovascular disease risk calculator and Guidelines for the management of absolute cardiovascular disease risk.

Health professionals can also find information in the joint RACGP/National Aboriginal Community Controlled Health Organisation (NACCHO) National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

MBS items 699 and 177 explanatory notes advise that these resources can be used to complete a heart health assessment.^2,3

Information on evidence-based preventive activities in Australian primary care can also be found in the RACGP Red Book.

Before a health assessment is undertaken, patients (and/or their carers or representatives) must be given an explanation of the assessment and its likely benefits.²

They must consent to the assessment and consent must be noted in the patient's records.²

The Heart Foundation have of a number of useful consumer resources on heart health and CVD, including information on heart health checks and heart attack risk factors.

Patients can also read NPS MedicineWise’s Heart disease and stroke risk – what can be done?

The Heart Foundation has developed an MBS heart health factsheet and flowchart. The flowchart outlines a clinical approach to absolute CVD risk assessment and how to identify eligible patients without existing CVD.

NPS MedicineWise has also developed information on Absolute cardiovascular risk in clinical practice and the therapeutic topic on Managing lipids.