Today's profession: Views and practices of private practice dietitians re Medicare Chronic Disease Management program

Aim: To explore private practice dietitians' experiences of Medicare Chronic Disease Management allied health program operations, particularly regarding workplace environments, patient management practices and acceptance of the program. Methods: A cross-sectional national survey was administered electronically in 2008. All private practice members of Dietitians Association of Australia were invited to participate. A 38-item questionnaire asked about referrals, patients, fees, billing and participant demographics. Descriptive statistics, chi 2 and Spearman's rank order correlation coefficient were used for analysis (if P < 0.05). Results: There were 356 (47%) dietitian participants; 94% were Medicare providers. Most (75%) worked in private practice < 20 hours per week (median 12.0) and half (47%) in sole practices. Medicare referrals made up 0-100% of their practices. Patients were seen as complex because of their chronic conditions. Many dietitians reported inability to complete initial patient education within funded consultation time. Consultation time was often increased and patients were required to pay more than the scheduled fee. Fees were lower for follow-up consultations. Dietitians' acceptance of the Medicare-Plus Chronic Disease Management program was low. Conclusion: Current Medicare policy arrangements provide insufficient initial consultation time for counselling; and available frequency of follow-up consultations is low. As a consequence, eligible patients have limited access to low-cost dietetics services. The results support a need for review of the Medicare-Plus Chronic Disease Management policy for dietetics interventions and alignment with other counselling services to better meet the needs of providers and also of patients with chronic conditions and diet-related risk factors.