General practitioner access to MRI

ACC is taking a phased approach and eventually, ACC wants to offer this access to all GPs but it is important to start off (first stage/2018) with organisations which can mobilise through existing IT platforms. The plan is to work up the distribution through the identified PHOs (Pinnacle, Pegasus, Compass, ProCare) and follow that with implementation in other PHOs (stage 2/2019 onwards). 

GPs through community practices provide the medical home of the client and coordinate much of their health care. GPs are familiar with using diagnostic tests and considering the wider health conditions in planning care. GP practice management systems allow for monitoring of MRI use and electronic referral. It's a good place to start. 

Physiotherapists are the experts in primary care treatment of musculoskeletal injuries. However, the current IT infrastructures used to administer access are not sufficiently robust across most physio clinics. ACC envisions tighter integration across primary care and ultimately shared care planning. 

Clients will pay a co-payment as usual for their first visit BUT their follow up visit to the GP to discuss the outcome of the scan and plan their rehabilitation will not have a co-payment at this stage. There is no co-payment for the HTI itself.

Yes. GPs in our proof of concept have shown that with some specific training at the outset, they are well equipped to manage the clinical pathway and decision-making.

No, only MRI scans are included. CT scans are outside of the scope of this programme.

Clients will experience a more streamlined, coherent support from their GP when they present with injuries that are not resolving with usual care. It is our expectation that clients will have access to specialist care more quickly when they need to and will feel confident going to physio for active rehabilitation on the advice of their GP.

For uncertain diagnosis or consideration of surgical management specialists are certainly the appropriate choice. However, many injuries can be managed in primary care with the right resources and access to appropriate care. Pathways jointly developed by specialists and GPs in the programme support patient care. 

This was an important issue to understand for the proof of concept but it seems that the pathway actually prevents some unnecessary referrals to specialists and probably contributes to “better value” specialist clinics. We have not seen the specialists inundated with clients worried about unexpected findings on their scan. 

So far, GPs in conjunction with radiology colleagues have been managing the conversations about the results of the scan.

Orthopaedic, sports medicine and neurosurgical specialists contributed alongside radiologists and GPs to the development of the pathway. NZOA, the knee society, the spinal society and the shoulder and elbow group have provided feedback and important suggestions for pathway improvement. The pathway is a “living” document. 

This was also an important issue to understand for the proof of concept (PoC). The PoC has shown that the ability to have results returned in a timely manner enables GPs to be able to make management decisions without having to reassess, re-confirm patient circumstances and spend significant time following up (as their patient assessment is still very recent). This is best for the patient journey and outcome and as such GP feedback from the PoC has been that the ability to utilise MRI has offset any additional time required. 

The claim form is available on Pegasus World, alternatively a request can be made to Service Desk. The final form has to be filled and then faxed to Pegasus.

The clinical pathway is not for acute injury, so usually there has had to be approval first. There has had to be an x-ray in the pathway first funded by ACC so this also usually is preceded by approval.

No, the claim has to be accepted prior to referral for MRI, usually the time period in the clinical pathways is enough to get the claim accepted. Currently, the patient has to inform the GP if the claim has been accepted.