A deep dive into the evaluation of the Medicare Benefits Schedule (MBS) Items for Eating Disorders
It’s been over four years since the introduction of specific Medicare Benefits Schedule (MBS) items for eating disorders. In this blog, researchers Matthew Fuller-Tyszkiewicz and Siân McLean explore the impact and offer recommendations for improvement.
In November 2019, the Australian Government introduced 64 new Medicare Benefits Schedule (MBS) items to enhance the level of government-supported care for people living with anorexia nervosa and for people with other eating disorders with complex needs. This initiative recognised the need for more personalised and intensive care, especially for individuals with more severe eating disorder symptoms.
As shown in Figure 1, the initiative supports assessment of eligibility and treatment plan formulation (often called the ‘Eating Disorder Plan’). Eligible individuals are then referred to treatment and can receive up to 40 psychological and 20 dietetic services within a 12-month period. Reviews of progress with GPs take place at around the 10-, 20-, and 30-psychological treatment session mark. At 20-sessions, a specialist review with a psychiatrist or paediatrician also takes place.
Figure 1. Overview of services available through ED MBS items.
Our team were commissioned to evaluate whether the ED-MBS items were meeting their objectives of enhancing access and improving outcomes for individuals living with an eating disorder.
The full evaluation involved a series of interviews and surveys with key stakeholder groups: people with lived or living experience of an eating disorder, people who care for and support those with eating disorders, and health professionals. We also accessed MBS data and clinical case data from GPs supporting treatment under the Eating Disorder Plan.
Across these different components of our evaluation, we gained key insights into what is working well and areas that may be improved to further enhance treatment of eating disorders.
What is working well?
Encouragingly, there was unanimous support that the Eating Disorder Plan promoted symptom improvement. The availability of an increased number of treatment sessions under the Eating Disorder Plan relative to previous supported treatments was seen as key to facilitating symptom improvement.
A carer mentioned that “even if this whole plan is not perfect, there are options, sessions are there specifically for my son to help him get over his eating disorder. For me it’s important and a bit of a relief. I am cautious but I feel I can be hopeful.”
Our review of MBS data revealed that, on average, individuals accessed over around 14 psychological and 6 dietetic sessions, with more than half accessing 10 or more treatment sessions.
We also found that reporting of any mental illness was twice as common for individuals utilising the Eating Disorder Plan than for those utilising Better Access, suggesting that – consistent with intent of these ED-MBS items – the Eating Disorder Plan was providing targeted and more intensive treatment access to those at the clinical end of severity spectrum, with greatest need.
Our survey and interview participants indicated a strong preference for the Eating Disorder Plan in comparison with their views on eating disorder treatment offered via a Mental Health Treatment Plan (Figure 2).
Figure 2. Direct comparison of Eating Disorder Plan and Mental Health Treatment Plan.
Importantly, 60% of survey respondents who identified as carers of someone living with an eating disorder accessed sessions with a health professional without the person they care for present. These sessions were designed to provide better understanding about eating disorders, and to gain insights into supporting their loved one. This consideration of carers was viewed positively in interviews and surveys, and it was acknowledged that carers’ access to these services was enhanced through provisions in the ED-MBS items.
What could be improved?
Despite these encouraging signs, there were also clear indications that improvement in the ED-MBS initiative is needed. Our analysis of service utilisation data suggested that only about one-in-five individuals with an eating disorder were accessing an Eating Disorder Plan. Uptake of services differed by geographic location, income, gender identity, English language status, and age.
About one-third of individuals who received an Eating Disorder Plan did not access any treatment sessions, approximately one in three individuals also needed treatment services beyond the initial 12-month plan, and high rates of discontinuation of service coincided with times when individuals were required to have a review of progress.
In interviews, stakeholders revealed difficulty finding suitable health professionals, including to conduct reviews, and considerable leg work in securing appointments. Interviewees also reported anxiety, confusion about purpose, and concerns regarding cost of review sessions (especially the 20-session specialist review).
For example, a person with lived experience of anorexia nervosa shared her experience of the 20-session review as ‘very unclear and stressful. I don’t know this psychiatrist and I don’t know what they’ll say. It feels like my treatment is in their hands but they don’t know me, what I’ve done and what I need.’
GPs reported difficulties in assessing eligibility when an individual had an eating disorder other than anorexia nervosa. Furthermore, health professionals differed in their reported confidence, knowledge, and skill in providing treatment for individuals living with an eating disorder, though these were higher for health professionals who were Credentialed Eating Disorder Clinicians.
So, what now?
Based on these findings, we made 46 recommendations for how to sustain the positive aspects of the ED-MBS scheme whilst improving upon identified gaps. Emphatically, our recommendation is to continue this scheme at the present number of services, whilst providing additional supports at three key stages of the treatment journey: (1) initiation of services, (2) treatment, and (3) review (Figure 3).
Figure 3. Overview of recommendations.
These recommendations are designed to:
- Enhance health professional availability and preparedness for delivery of high quality care
- Increase community and health professional awareness of these treatment services
- Simplify eligibility assessments, and
- Facilitate more timely and consistent access to psychological and dietetic services to ensure more rapid symptom relief that frees up resources to offer services to more individuals in need.
We are hopeful that the Government will support our recommendations to improve experiences with the ED-MBS items to ensure people with eating disorders are able to access the care and support they deserve.
Written by Matthew Fuller-Tyszkiewicz and Siân McLean, with input from broader team
Learn more
About Medicare Items for Eating Disorders
- Evaluation of the Eating Disorders Medicare Benefit Schedule Items 2024
- Medicare Eating Disorder Plans FAQS
- Eating Disorder Medicare Items – NEDC
- Medicare Items for Eating Disorders – Cheat sheet for GPs
