COPD Management Programme

COPD Management Programme – General Practice Service Delivery Service description Patients with chronic obstructive pulmonary disease or congestive heart failure are funded for up to four consultations per annum, which may be nurse-led following GOLD standard and includes:       

  

Annual flu vaccination Smoking cessation advice Promotion of physical activity Development of a CarePlan with the patient is mandatory “Blue Card: Plan for People with Lung Conditions” is completed (cards supplied by the WBOP PHO) Advice for patient self-management including early detection of symptom changes to reduce the risk of exacerbations requiring hospitalisation Provision of additional follow up as required o Consider usage of CarePlus and High Need discretionary funding where available o If home visits are required, use WBOP PHO GP outreach – refer using Health and Wellness e-referral 1 enrolment only per patient will be funded across the WBOP PHO every 12 months To continue to receive care under the COPD Management Programme eligible patients will need to be re-enrolled for a further 12 months Currently no limit to the number of times an eligible patient may be re-enrolled

Eligibility criteria Provider Eligibility 1. Clinician providing COPD Management has completed six hours WBOP PHO COPD education within the last 12 months – excluding education provision sponsored

by Pharmaceutical companies Patient Eligibility 1. Patient is enrolled and funded with the WBOP PHO 2. Diagnosis of COPD confirmed by Spirometry 3. Priority Patients meet one or more of the following: o Any High Needs patient or o Any patient holding a Community Services Card (CSC) or o Newly diagnosed COPD in the last twelve months or o Admitted to hospital in the last 12 months for COPD related issue

Updated January 2021

Claim process Use Best Practice e-referral Community Based - Chronic Obstructive Pulmonary Disease (COPD) as shown below

Please note: An ereferral does not create an invoice in your PMS. For reconciliation purposes manually generate an invoice in your PMS corresponding to the claim amount.

Payment PART ONE:

WBOP PHO COPD Management Programme

If patient has a Pneumococcal Vaccination during the same consultation in which they are enrolled onto the COPD Management Programme, the cost of the Pneumococcal vaccination can be claimed in the Best Practice e-referral.

When completing the Best Practice referral, click a “tick” in Pneumococcal Vaccination box and the $73.76 including GST reimbursement will be included in the claim.

In these cases, Part Two of the payment process below should NOT be undertaken.

•

$184.00 including GST, per person to be paid monthly in arrears upon receipt a WBOP PHO COPD e-referral.

•

$257.60 including GST, per person to be paid monthly in arrears upon receipt a WBOP PHO COPD e-referral which includes a Pneumococcal Vaccination.

OR

Updated January 2021

PART TWO:

Pneumococcal Vaccination Pneumovax23 (23PPV – Sanofi)

Only complete this part of the process if the patient received their Pneumococcal Vaccination on a separate occasion and after the Best Practice ereferral enrolment onto the WBOP PHO COPD programme has been submitted.

A reimbursement of $73.76 including GST, per person for patients on the WBOP PHO COPD Management Programme.

Generate an invoice in your PMS, email to the WBOP PHO: GPSadmin@wboppho.org.nz

Please Note: No patient co-payment is to be charged

Contact your General Practice Liaison Or email your enquiry to the General Practice Services Email: GPSadmin@wboppho.org.nz

Updated January 2021