Background: The traditional geriatric outpatient model in private practice centres on the geriatrician providing a comprehensive assessment to the GPs who co-ordinates care from goals identified. This has been the model of care since 2007. There are a few private outpatient clinics which have extended this to a targeted team approach in the setting of diagnosis of cognitive impairment conditions. Prior to our practice there were no multidisciplinary geriatric practices offering a team approach away from the hospital funded model of care.
We know the multidisciplinary team management is the ideal model for the older person in hospitals. The GEM model has been extensively reviewed and is used throughout Australia and extends globally.
Change: I set out to bring the multidisciplinary model to private outpatient practice. Comprehensive geriatric assessments leading to targeted allied health interventions recommended for them with the ability to access specialised allied health services under the one group allowing for case conferencing and targeted care. The service also provides support for the carers and education.
As far as I’m aware our practice is the first to do this away from the hospital setting. Our model pivots on patient-centred care and carer support network. The Medicare system is currently in favour of allied health involvement in GP clinics, but this does not extend similarly to the specialist rooms. We have negotiated our way through the system striving to provide care and a needed service for our patients and their support team.
Learnings: Working in private practice is not promoted nor taught in the college curriculum so it requires self-teaching, trial and error, constant review and assessment. Private practice leads to learning experiences with staff recruitment and retention, marketing, and business development. The need to study leadership, IT, accounting, Medicare funding, insurance and billings via different modalities. All specialist clinics have these lessons but when the allied health team is added to the clinic the learning amplifies.
The current Australian health funding model is not set-up for allied health in geriatric specialist clinics eg social worker input is not funded. There have been many lessons and challenges along the way. Managing expectations in private practice and the need for people to ‘invest’ time, money, and support for their own or loved one’s health has been thought-provoking. Whether that is achievable with our current service and resources is something I would like to share.