Hunt agrees to restrict MBS funding for telehealth to usual GP or practice

The federal government has agreed to restrict Medicare-subsidised telehealth services to a patient's regular GP or medical practice, beginning next week.

Temporary MBS items for telehealth were introduced in March to try to help reduce community transmission of COVID-19, especially for high-risk patients, but were later expanded to become general in nature with no relation to diagnosing or treating COVID-19. They are due to expire in September.

Posted in Australian eHealth

Tags: Telehealth, COVID-19

Comments  

+2 # Donald Rose 2020-07-14 07:50
The changes haven't been totally thought through. They do take the corporate providers out of the picture but forget the usually younger patient who attend infrequently. Corporates have no role in this space and have done huge damage but getting rid of them has come at a price, especially for vulnerable doctors only able to work from home.
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+2 # Dave Wain 2020-07-14 08:46
* Anybody who has not seen a doctor in 12 months - not supported
* Anybody who has changed place or residence and cannot attend previous GP - not supported
* Doctors who have done the right thing and not had face-to-face consults with patients - not supported
This rule change, while I understand the reasoning, has not been well thought out and seems rushed.
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+2 # Andrew Baird 2020-07-14 21:09
Patients will be disadvantaged because telehealth services and phone services will not be eligible for Medicare benefits in the following situations.

• Very vulnerable patients who require consultation with a GP by telehealth or phone who have not had a face-to-face consultation in the previous 12 months. For example:
o patients who attend Headspace
o senior school students
o patients who attend Sexual and Reproductive Health Clinics.
• Patients whose consultation with the GP, or at the GP’s practice, in the previous 12 months, was by telehealth or phone service due to the COVID-19 pandemic.
• A GP’s or practice’s regular patients who have not attended a face-to-face consultation in the previous 12 months.
• New patients who have difficulty attending a face-to-face consultation.
• New patients who prefer a telehealth consultation to a face-to-face consultation.
• Patients living in regional, rural and remote areas who have not had a face-to-face consultation with the GP, or at the GP’s practice, in the previous 12 months, and who would have to travel a long distance to access GP care.
• Patients who attend new practices that have not yet built up a patient base or practice population.
• Patients who attend GPs who do not do face-to-face consultations during the pandemic for personal health reasons (for example, GPs who are immunocompromis ed and GPs who have respiratory disorders).
• Patients with mental disorders who have been receiving GP mental health care by video or phone may no longer be able to access this through Medicare - unless they have attended the GP, or the GP's practice, for a face-to-face service, in the previous 12 months.
• Patients who develop mental disorders needing initial treatment on or after 20 July will be unable to access Medicare benefits for GP mental health care by video or by phone without a face-to-face service with the GP, or the GP's practice, in the previous 12 months.
• GPs who provide Focused Psychological Strategies (level 2, MHST) will only be able to provide mental health care by video (items 91818 and 91819), or by phone (items 91842 and 91843), for patients whom they have seen face-to-face in the past 12 months, and for patients who have attended other doctors in the GP's clinic for a face-to-face service in the past 12 months. Medicare benefits will not apply for video or phone consultations for new patients who have been referred to the GP from outside of the GP's practice.
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+2 # Lynne Everett 2020-07-15 10:51
And you can add to this list Indigenous people living in remote communities whose Primary Health Care is predominantly provided by nurses and AHWs. Some of these communities never see a doctor; many of them only see locum doctors doing FIFO work. A significant number of people in such communities may not have a consult with a doctor in any particular year.
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0 # Andrew Baird 2020-07-15 13:47
Thank you very much, Lynne, an excellent and important point. This is a specific example of the 'new patient' issue, as Indigenous people living in remote communities are essentially 'serial' new patients under this requirement for 'previous consultation with same GP or at same practice within previous 12 months'.

A possible way around this would be if the locum doctors count as belonging to the same 'practice' - eg, if they are working for the same FIFO agency (regarding an agency as a 'practice' may be a moot point).

Indigenous people who live in remote communities are also unlikely to be eligible for Medicare benefits for the pre-COVID-19 GP telehealth items for people in remote areas (Monash 6 and 7). The item numbers are: 2463,2464, and 2465. It's very unlikely that they will meet the requirement for three (yes, three!) F2F consultations in the previous 12 months with the same GP.

What's your experience of GP telehealth (video) with Indigenous people living in remote communities?
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0 # Lynne Everett 2020-07-15 15:02
We're lucky enough to have our own GPs, but a significant number of our patients don't see a GP at least once a year. We have had Telehealth consults with specialists for some time now, but until recently have never used this for consults with our own doctors when they're not in community. I would imagine that trying to keep track of how often every individual has seen a doctor in the last 12 months means that it's not even worth considering MBS claiming and may indeed have been a factor in our never setting this up for our own doctors.
In common with other Aboriginal Medical Services that cover multiple communities with multiple doctors it's also the case that some of the patients who have seen a doctor three times in a year won't have seen the same one -- and I have no idea if we count as a "practice" as we're Community Controlled.
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0 # Andrew Baird 2020-07-15 15:38
Thanks Lynne. Community Controlled services count as a practice. If you bulk-bill patients, you can get details of all of their Medicare services (date, item) from Medicare, or from patients' My Health Record (now that this is opt-out). It's not satisfactory that there is a requirement for 3 previous consultations with the same GP (or practice) for eligibility for items 2463-5.

Do you think there could be a role for GP telehealth in your service? What about the practicalities - broadband, computers, smartphones, webcams, etc?
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+1 # Lynne Everett 2020-07-15 15:56
Well we're doing it now -- none of our doctors has been in community for quite some time now. The clinics have iPads and smartphones and we're mainly doing phone consults but not exclusively. Internet connection can be an issue, especially with video consults, and security concerns arise with video consults as well. And yes, we can easily access claims status within Communicare but it's crazy that we should have to be checking to see if a service is eligible for MBS based on how many times they have managed to see a doctor who isn't available every single day and has to make up for that when they are physically in community.
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0 # Andrew Baird 2020-07-14 21:19
Telehealth (video) services and phone services are important and valuable for providing care in general practice. There are concerns that such services provided by Pop-up telehealth businesses are inappropriate and low value. In their ongoing discussions with the Government about telehealth and phone services, the AMA and the RACGP should promote patient-centred , continuing care, and aim to ensure that access to telehealth in general practice is equitable for all Australians. ACRRM should be involved in the discussions with the Government about telehealth and phone services.
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