RACGP view on telehealth is self-serving at best

Telehealth and its various policy and political ramifications was back in the news this week, with the Royal Australian College of General Practitioners (RACGP) again changing its policy position on MBS funding of primary care telehealth, despite previous lobbying efforts to the contrary.

We’ve been critical of the changing position of the college on Medicare-funded telehealth and its fellow travellers at the AMA in the past, but this week we saw a triple backflip with pike as Omicron swept through the land. We have witnessed the medical fraternity going from dead set against telehealth in primary care to agreeing it is essential in a pandemic, but all of this is conditional it seems on doctors’ income not being affected.

Three years ago, it was “telehealth will never replace face-to-face consults”, despite no one ever arguing it would. Then the pandemic struck and telehealth was seen as the saviour, with the GP lobby sensing an opportunity for the many phone calls GPs do every day to finally be paid for properly through Medicare. Good on them – it succeeded. But then private “pop-up” services came around and began to threaten the bottom line, allegedly threatening continuity of care and undermining general practice, and more furious lobbying began. The government caved in, restrictions were introduced, and then Omicron happened.

With general practices now swamped, common sense would say the restrictions on MBS-funded telehealth should be eased to relieve the burden on primary care and allow it to continue its essential day to day work in order to avoid the collapse of the health system. And yet the college still continues to reject the help of telehealth providers, who could take a big load off the back of the profession.

The RACGP’s latest lobbying campaign is to let immunocompromised or isolating GPs to be able to continue working from home and claim consultations on the MBS. Fantastic. Go for it. But the lobbying effort does not apply to patients. As is usual with the RACGP, the policy change smacks more of concerns over GP remuneration than patient access to affordable healthcare. The AMA’s position is no better.

“Telehealth is now a permanent fixture of Australia’s healthcare system, and the 12-month rule is not pragmatic for immunocompromised GPs or GPs in isolation,” RACGP president Karen Price is quoted as saying. “So, if I’m an immunocompromised GP doing my best to help patients with tens of thousands of new COVID-19 cases emerging every day in communities across Australia, I may not be able to use telehealth if the patient has not sat opposite me for a physical consultation within 12 months, even if they did 13 months ago.”

Yes, Dr Price. This is a situation that the pop-up clinics you so vehemently oppose could have helped solve.

“We should be doing all we can to maximise our capacity to see patients via telehealth,” she said, while lobbying against it. “If the individual seeking a telehealth consult is an existing patient of the practice, either via face-to-face or telehealth, let’s provide an exemption from the 12-month rule and let common sense prevail.”

Whether or not the individual seeking a telehealth consult is an existing patient or not, in the middle of a global pandemic, common sense says they should be able to access healthcare easily despite their ability to pay or having a regular GP, which many don’t.

The idea of “permanent” telehealth as a policy success story has taken hold in digital health circles in Australia, despite it being nothing of the sort. Telehealth has been pioneered in the secondary health sector, not in primary care, and has been overwhelmingly successful for outpatients, rehabilitation and in particular for allied and mental health over the past decade or so.

Examples include the various stroke telehealth networks, rehab networks and even things like remote interrogation of cardiac devices. Health services around the country and around the world are looking at how to embed remote monitoring and telehealth in day-to-day health provision. This will have a real impact on patients. Paid phone calls for GPs during a pandemic are more than welcome and should remain permanent, but they are not the revolution in telehealth that the RACGP thinks they are.

That brings us to our poll question for the week:

Have doctors’ lobby groups undermined the roll-out of telehealth in Australia?

Vote here or leave your comments below.

Last week, we asked: Will GPs embrace eReferral technology? The vast majority said yes – 90 per cent to 10 per cent. We also asked why you thought GPs wouldn’t embrace the technology. This is what you had to say.

Comments  

+5 # Oliver Frank 2022-02-12 17:05
"We have witnessed the medical fraternity going from dead set against telehealth in primary care ...". I'm sorry, but that is BS. GPs have been asking and lobbying for years for support for telephone and video consultations. That is why GPs took it up so enthusiasticall y once there was support.
+6 # Peter MacIsaac 2022-02-13 08:12
Prior to COVID, video telehealth has been hampered by medicare policy to primarily restrict telehealth to specialist services in regional/remote areas, with no effective support for GPs to use it (other than assisting in delivering specialist tele_consultati ons). GPs have been delivering largely phone telehealth at no charge to patients for ever (and in the process paying for their own time and skills to do this), so the rapid uptake of phone telehealth, in COVID times, has built on our pre-existing skills and service models. There is incredibly strong evidence that healthcare based on wholistic and comprehensive primary care with continuity of care gives consumers/and health systems the best overall outcomes, so GPs advocating for telehealth to support this is actually in everyones interests. Medicare also has to maintain sustainability as it is the foundation of access to primary care so it is not surprising that the system is working out how to adjust to the changing COVID situation and professional and consumer responses to telehealth. GPs who provide a full service have significant costs (rooms, staff including nursing support, equipment, IT infrastructure) , standalone telehealth services who dont have any of these costs are being reimbursed at the same fee and are not capable of providing face to face care or continuity of care when it is really needed. Who do they think will do that work? The system has to push back on cherry picking where the simple well remunerated work is gathered up and the poorly remunerated hard yards are done by GPs providing a full service. Those who choose to provide a limited service primary care to consumers whether in clinic or by telehealth should perhaps have to accept limitations on their scope of practice and the medicare component of their remuneration.

In my view Pulse & IT should be careful when making editorial comment and headlines, rather than reporting in the traditional sense. Healthcare is complex and it is easy to get out of your depth.
0 # Kate McDonald 2022-02-18 14:36
Have doctors’ lobby groups undermined the roll-out of telehealth in Australia? While we appear to have offended some doctors with our blog, three quarters of our readers said yes. We also asked what the digital health industry should do to fix the situation.

Here’s what you said:

- Industry and Health Consumer Groups need to partner to lobby for permanent access to telehealth services and rebates with the 'usual provider' restriction removed. We don't have the 'usual' workforce to support that policy, now or in the future. I have heard anecdotes this restriction has proven to be particularly challenging for rural/remote, who for decades have benefited from the (relatively) unrestricted support essential to receiving care in these areas.

-Video telehealth should be built into every PMS

- It's not up to digital health to sort out the poor health bureaucracy that we have in this country, let's hope the next federal health minister is better than the last.

- Be more patient

- Recognition that allied health has just as important, if not more important role to play with Telehealth. Doctors are everywhere. Specialist allied health is sparse. Remember Telehealth isn’t just for gps

- Get government to allow bulk billed Telehealth without this 12 month face to face rule

- legislate

- Educate the public

- As a patient I want the convenience of using a Telehealth based service for minor complaints that don't require any significant history so continuity of provider isn't significant while access is. This might be commoditisation of medical services but so be it if fit for purpose, safe and economical.

- Lobby just as hard and gain more members!

- Prevent the AMA from lobbying government for self interest!

- establish central clearing for all matters medical

- Let patients choose who, how and where they want to be seen. Fund video consultants more than the revenue grabbing phone consults. Not just a GP issue, also in our tertiary hospitals. Fund the behaviour we want see for TRUE patient centric care

- Work with RACGP to develop systems that are easier to use for patients and doctors and lobby for better broadband connections to allow these systems to work. Education is also needed on how to connect and use these systems. Currently, bandwidth, connection and user issues at both ends plague greater use of Video based systems. Hence, patients and doctors revert to telephone, which in some areas is also dodgy quality.
You seem to disregard the very strong evidence for better health outcomes from continuity care and the poorer outcomes from convenient adhoc care. If essential adhoc care is provided by Telehealth, then communication back to usual treating practice/practi tioner is essential for safety and better long term outcomes.

- People who don’t have a regular practice or GP should be educated about the benefits to their health in establishing a relationship.

- The digital health industry should work with the RACGP/AMA to ensure telehealth is quality focused, improves GP digital health maturity, etc AND not get involved in ad hoc solutions to make a quick buck off MBS.

- What would fix the situation would be for Medicare benefits to be payable for telehealth provided only at, by or through the one general practice in which the patient is formally enrolled.

- Work constructively with GP associations

- Teach GPs that win-win (a win for GPs and a win for patients) is the best negotiating position with govt. They don't seem to get multi-solving.

- Remove the 12 month requirement - it's unnecessary. Build a good relationship with your patient and continuity of care will emerge from that.

- The problem is government (and society) being blindsided by dominant medical lobbyists, at the expense of other health care providers. Many telehealth programs are only successful at attracting funding when a (male) doctor supports or leads the service.

- Digital Health Industry needs to promote and lobby harder for services lead by other health providers, and highlight what has been happening in terms of power groups have in attracting funding from government or acceptance by the public.

- I agree with you. Phone consults are not telehealth. It is insulting to our intelligence that GPs seem to think that they can convince us that they are. Phone consults should have been available 15 years ago. Video communication is now mainstream. GPs are being deliberately obstructive. And don't even start me on the refusal to use email rather than fax machines!

- Survey consumers. It's their opinion that should matter.

- Continue to fight for collaborative health care. Call me because I've been trying to get this done for the past 20 years!

- Remind the RACGP that they should be about Teaching, Training, Research and Quality and to bug out of "what they see as advocacy".

- This article show a complete lack of understanding of the role of continuity of care in primary health

- Lobby for what patients need, don't support measures that work against patient access

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