Findings from the evaluation of the Eating Disorder Medicare Benefit Schedule (MBS) Items

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Recently, the Australian Government Department of Health and Aged care released the Evaluation of of the Eating Disorders Medicare Benefit Schedule Items 2024. La Trobe and Deakin Universities, with partners from Flinders University, Monash University, and Western Sydney University, were commissioned by the Australian Government Department of Health and Aged Care to conduct the independent evaluation.

The Eating Disorder MBS items is an important initiative in the stepped system of care aimed to increase access to evidence-based treatment and stepped care for people experiencing eating disorders. Below, we provide a summary of the evaluation and important actions that we can take to increase and enhance access to the MBS items.

What are the Eating Disorders MBS items?

The MBS items for Eating Disorders, also known as an Eating Disorder Plan (EDP), was introduced in 2019 in response to recommendations from the Eating Disorders Working Group of the Medicare Review Taskforce. The objective of the items is to provide specific support through Medicare subsidised services for people with anorexia nervosa and for people with bulimia nervosa, binge eating disorder, or other specified feeding or eating disorders who also have complex needs.

The items include:

  • Initial assessment of eligibility
  • Treatment plan preparation and referral for treatment by a medical practitioner
  • Provision of up to 40 psychological treatment services by a mental health professional
  • Provision of up to 20 dietetic health services by a dietitian
  • Review of treatment progress by a general (or other medical) practitioner at or before the 10th, 20th, and 30th psychological sessions, and
  • a specialist (psychiatrist or paediatrician) at or before the 20th psychological session.

Subsidised services are intended to support a person-centred, stepped care approach to eating disorder treatment.

Why was the review of the MBS items conducted?

The purpose of the evaluation was to assess "if the Eating Disorders MBS items are meeting the needs of people experiencing an eating disorder, people caring for someone with an eating disorder, health professionals providing eating disorder services under the items, and the Australian Government".

The evaluation sought to:

  1. Examine the utilisation of the Eating Disorders MBS items

  2. Examine the relationship between the Eating Disorders MBS items and other related MBS items

  3. Consider whether the Eating Disorders MBS items have improved access to treatment services

  4. Determine if the Eating Disorders MBS items improve patient outcomes

  5. Develop recommendations to inform the ongoing success of the Eating Disorders MBS items

In line with the original intent of the initiative and broader principles for public funding of health services, the evaluation explored if the items i) deliver affordable and equitable access to best practice eating disorder services, ii) are delivered by a skilled health workforce with the requisite knowledge and experience to identify, assess, and contribute to the treatment of eating disorders, and iii) provide value for individuals and for the Australian Government.

What were the key findings from the evaluation?

The key finding of the evaluation was "unequivocal support among people with lived experience of an eating disorder, people caring for someone with an eating disorder, and health professionals that the Eating Disorders MBS items are a substantial improvement on previously available Medicare services for eating disorder treatment".

Evaluation outcomes to support this include:

  • People who had received treatment through an EDP reported significantly lower levels of eating disorder symptoms after treatment compared with prior treatment
  • People received a higher number of psychological sessions than was previously available through the Better Access Mental Health Treatment Plan (MHTP) initiative
  • Having a higher number of treatment sessions was associated with significantly greater eating disorder symptom improvement, satisfaction with treatment, and perceived helpfulness of treatment for recovery
  • People with lived experience of an eating disorder and carers felt that an EDP was superior to MHTP for providing access to knowledgeable providers and multidisciplinary care
  • Carers valued involvement in the treatment process, and this supported understanding and competency to provide treatment support
What were some of the identified barriers or challenges to accessing the MBS items?

There were a number of evaluation findings that suggest changes be made to the MBS items to enhance the support provided to people experiencing an eating disorder. These include:

  • There is generally low awareness of the initiative by health professionals, people experiencing an eating disorder, and carers
  • Uptake of the Eating Disorder MBS items was lower for people experiencing bulimia nervosa, binge eating disorder, and atypical anorexia (under OSFED) than those with anorexia nervosa. This could reflect an underrepresentation of those who meet the high-risk criteria accessing an EDP
  • GPs may find it more difficult to determine eligibility for the MBS items for those people with non-underweight presentations
  • Access to treatment and number of treatment sessions received was lower among people living in regional and remote areas, males, people with lower education and income levels, people who spoke a language other than English, and people of First Nations background
  • Barriers to accessing treatment through an EDP include cost, wait times, and finding mental health professionals and dietitians experienced in eating disorders (through lack of availability and size of workforce)
  • Accessing a specialist review at or before the 20th psychological session may cause some people to drop out of treatment
  • A small number of clinicians are providing most of the treatment sessions, and around half of all services were delivered by inexperienced providers.

These findings supported the identification of complementary strategies to implement over the short- and long-term. Please see recommendations below.

What are some of the other findings from the evaluation?

We have included below some of the other, more detailed, findings.

Utilisation of the MBS items

  • Approximately 1 in 5 people experiencing an eating disorder access Eating Disorder MBS items
  • Common reasons for not accessing an EDP include limited knowledge of the initiative, difficulty in accessing an EDP, difficulty in identifying, and accessing suitable services
  • The strongest reason people experiencing an eating disorder do not seek help is that they believe the problem is not severe enough
  • 80% of people accessing an EDP are in major cities
  • Around 25% of people waited longer than 27 days to access treatment under an EDP
  • The average number of sessions accessed is much lower than the threshold of 40 psychological sessions and 20 dietetic sessions. People accessed around 14 sessions of psychological treatment, and around 8 sessions of dietetic intervention.
  • 1-4% of people accessing an EDP accessed all psychological sessions, 5-9% accessed all dietetic sessions
  • Cessation of treatment peaked at the 10th, 20th, and 30th psychological treatment sessions, coinciding with review sessions being due

Relationship between EDP and other MBS items

  • More than 50% of people who used the Eating Disorders MBS items also accessed other MBS/PBS services, including the Better Access initiative, GP visits, PBS medications for mental health concerns, and psychiatric treatment sessions.
  • Around 50% of carers use MBS-based psychological treatment services for their own mental health and wellbeing
  • Accessing treatment under the Better Access initiative increased the chance a person accesses an EDP by 3x

The role of healthcare professionals in treatment pathways

  • Given the often complex presentations, GPs require longer sessions to complete the assessment, develop the EDP, and make appropriate referrals
  • Referrals to Mental Health OTs and social workers is low compared to referrals to psychologists

Based on these findings, what do the reviewers suggest we do to enhance the initiative?

What recommendations are made?

A number of recommendations are provided which aim to enhance a person's access and experience across all points in the EDP process. We have included some of the key recommendations here, and encourage you to read pages 125-152 of the report if you would like further detail.

Raising awareness

  • Create clear, consistent, and accessible information about EDPs for people seeking treatment and their families/supports, and health professionals

Improving access to EDPs

  • Simplify and streamline the the process for determining eligibility criteria for people experiencing an eating disorder that don't meet the weight status criterion
  • Remove the need for GPs to make an eating disorder diagnosis for those with other eligible eating disorder diagnoses
  • Remove the requirement for a specialist review at or before the 20th session, and instead implement this at the 10th session and only in the case of little or no progress against treatment goals. A case conference should be held at the 20th session with the treatment team and specialist in the case of slow/no progress towards goals.
  • Reduce cost of treatment through bulk billing, with a specific focus on parts of Australia with lower socioeconomic status

Support for families and carers 

  • Make directed, carer-related, eating disorder-specific psychological services available for families/supports under an EDP to support them in their carer roles
  • Implement actions that will assist families and carers to be more involved in their treatment. 
  • Promote resources and services available for carers which support their own mental health and wellbeing

Support for the workforce

  • Upskilling GPs to be able to identify signs of an eating disorder, complete a comprehensive assessment, make a diagnosis, create an EDP, make referrals, and provide care coordination throughout treatment
  • Upskill mental health professionals and dietitians to provide evidence-based eating disorder treatment
  • Create consistent, online templates for GPs, mental health professionals, and dietitians to use in the creation and provision of an EDP
  • PHNs to support the development, promotion, and dissemination of available training and resources for GPs, including updating HealthPathways with local referral pathways

Building the workforce

  • Provide incentives for clinician to access appropriate training and ongoing supervision. For example, offering a higher rate of rebate for Eating Disorder MBS items to Credentialed Eating Disorder Clinicians and the provision of funding for supervision

Improving access to coordinated care

  • Case conference items be expanded in scope to allow for the mental health professional and dietitian to organise the case conference (removing this sole responsibility from the GP)
  • Explore the possibility of introducing care coordinator roles outside of the GP role

Supporting the provision of evidence-based treatment

  • Retain access to up to 40 psychological sessions and 20 dietetic sessions
  • Promote the importance of weekly sessions
  • Promote telehealth as a viable option for treatment
  • Clinicians to monitor eating behaviours and body image at each session to optimise outcomes and enhance the benefit of review sessions
  • Continue to review emerging evidence and make changes based on accumulated evidence to treatments approved for use by practitioners under the EDP
  • Introduce single session interventions for those people who need to wait longer than four weeks to commence treatment

There are actions that we can take now to to improve the system, and others will take longer to decide, develop, and implement.

What can you do now to support people experiencing an eating disorder to access an EDP?

Support for GPs

There are several free resources available that can help a GP to understand and use the EDP and provide care coordination across the multidisciplinary team. 

Support for people experiencing an eating disorder and families/supports

Support for mental health professionals and dietitians providing treatment

We have collated these resources on our Eating Disorder Treatment and Management Plans webpage.

NEDC will continue to provide our members with updates on the MBS items and rollout of information, resources, and supports for people seeking treatment and health professionals. If you aren't yet a member, you can sign up here for free.


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