By Dr Jeannie Knapp.
Overview
The health assessment for people aged 45-49 who are at risk of developing chronic disease provides opportunities to improve health outcomes and to build financial gains for your practice.
Health assessment MBS items are used and practice nurses can contribute to the assessment. The 45-49 year old health assessment can only be claimed once for each patient.
Eligibility criteria
The 45–49-year-old health assessment is for patients “at risk of developing chronic disease”. The decision that a patient is at risk of developing a chronic disease is a clinical judgement made by a GP.
At least one risk factor must be identified when conducting a 45–49-year-old health assessment. Risk factors that the GP may consider 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
- A family history of a chronic disease
Identifying patients and practice processes
Health assessments work best if they are properly planned. Some questions you might want to consider before conducting a series of assessments are:
- Do you have a team member who can identify eligible patients and recall them either using your clinical software or PEN Clinical Audit Tool?
- Do you use a recall/reminder system (such as an SMS service) to invite patients to book for an assessment?
- Have you checked Provider Digital Access (PRODA) to see if the patients have already had a health assessment billed before recalling?
- Do all staff know the booking rules for health assessments? For example: How long with the nurse? How long with the GP?
- What will you charge for the assessments? Offering to bulk bill might provide an incentive for a patient to attend.
- Are all GPs aware of the correct item number to be billed and the billing rules?
- Do you have a template to record the assessment?
What’s included in the 45–49-year-old health assessment?
The RACGP’s Guidelines for preventive activities in general practice (Red Book) suggests a number of areas that should be covered for preventive health in persons aged 45–49. These include the following:
Ask about:
- Smoking, nutrition, alcohol and physical activity
- Possible depression
- Early signs of skin cancer
Measure:
- Weight, height (to calculate body mass index [BMI] and waist circumference)
- Blood pressure
- Fasting lipids
Perform (if appropriate):
- Cervical screen
- Mammogram (dependent on the patient’s individual degree of risk)
Calculate:
- Risk of diabetes using the Australian type 2 diabetes risk assessment tool (AUSDRISK)
- Review fracture risk factors for osteoporosis for women aged ≥45 years of age
- Absolute cardiovascular risk
Medicare health assessment items (include nurses’ time) 
Note: these items can be claimed once only per patient.
- 701: assessment lasting <30 minutes $59.35
- 703: assessment lasting 30–45 minutes $137.90
- 705: assessment lasting 45–60 minutes $190.30
- 707: assessment lasting >60 minutes $268.80
How does this help my business?
Conducting the 45–49-year-old health assessment is a good way to engage your patients and to provide health promotion and prevention messages to them. It may be a useful way to engage with your male patients who do not proactively visit your practice.
Health assessments are a good source of practice income. During the assessment you may pick up on new or existing conditions that are not being managed as well as they could be. This may lead to the patient being recalled to the practice for a GP Management Plan or a Mental Health Treatment Plan, which can improve care for the patients and provide income for the practice.
Completing this assessment also helps to build your relationship and trust with your patients. This may make them loyal patients who are more likely to return to you or your practice for their future care.
Where can I find more information?
Resources for general practice
- The Department of Health has a fact sheet on the health assessment for people aged 45 to 49 years who are at risk of developing chronic disease
- The RACGP’s Guidelines for preventive activities in general practice (Red Book)
- The RACGP’s Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting (Green Book)
- The RACGP’s Smoking, nutrition, alcohol and physical activity (SNAP): A population health guide to behavioural risk factors in general practice provides a framework for GPs to work with patients on lifestyle risk factors
- The RACGP’s Handbook of non-drug interventions (HANDI)
Templates
- Most clinical software is pre-loaded with a 45–49-year-old health assessment template. A template for conducting the assessment is available to download (.rtf, 102KB).
- A similar template is also available from the Department of Health.
HealthPathways Melbourne 
- You can find more information on the content of a 45–49 year health assessment, including referrals advice, on HealthPathways Melbourne.
If you do not have access to HealthPathways please contact: info@healthpathwaysmelbourne.org.au
Disclaimer: This article was provided by Dr Jeannie Knapp. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.
