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How scrapped iso requirements impact telehealth


Filip Vukasin


17/10/2022 4:40:24 PM

The end of COVID isolation also means fewer exemptions to the 12-month telehealth rule.

Hand picking up the phone
The telehealth item for COVID antivirals will continue, but most patients will need to have had an in-person appointment with their GP or practice in the past 12 months to claim a Medicare rebate.

In the most recent COVID-19 primary care webinar on, Deputy Chief Medical Officer Professor Michael Kidd highlighted that telehealth item numbers will be tightened alongside the removal of isolation for COVID infection.
 
The level C telehealth item for assessment and consideration of COVID antivirals will continue, but apart from that and some exemptions, patients will need to have had an in-person appointment with their GP (or practice) in the past 12 months in order to claim a Medicare rebate.
 
It means patients with respiratory symptoms or confirmed COVID-19 are no longer able to claim telephone rebates if they have not seen their GP in-person in the past year, unless they are potentially eligible for antivirals.
 
Aside from those seeking an antivirals assessment, the established relationship requirement also does not apply to:

  • children under the age of 12 months
  • people who are homeless
  • patients receiving an urgent after-hours (unsociable hours) service
  • patients of medical practitioners at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service
  • people isolating because of a COVID-related state or territory public health order, or in COVID-19 quarantine because of a state or territory public health order
  • people living in a flood-affected area, defined as a state or territory local government area which is currently declared as a natural disaster area due to flood by a state or territory government.
RACGP Expert Committee – Funding and Health System Reform (REC–FHSR) member Dr Michael Bonning told newsGP he welcomed keeping the telehealth item number for at-risk COVID patients.
 
‘It makes sense that the rebate item for antivirals be exempted from this requirement, to improve equity of access to care,’ he said.
 
‘We know that antivirals are the cornerstone of the [Federal] Government’s plan to manage COVID, especially in those who are vulnerable.
 
‘We want people accessing COVID services – including PCR testing as rapid antigen tests are unreliable in the early phase of illness – and antivirals.’
 
In a COVID-19 Primary Care Update after the webinar, Professor Kidd addressed some of the concerns related to telehealth item number access.
 
‘I also want to acknowledge that the department is aware of concerns expressed by some GPs about telehealth consultations and the existing relationship requirement, following the changes to Public Health Orders in many states and territories that commence this week,’ he wrote.

‘The department is considering the concerns raised and we will have further advice on this shortly.’
 
According to current figures, there have been more than 10.3 million reported COVID cases in Australia since the start of the pandemic and over 14,500 deaths.
 
Ninety-six per cent of these cases (9.9 million) have been registered in 2022 alone, while more than four in five COVID deaths (12,000) have also occurred this year.

However, COVID cases are currently declining, with 36,155 active cases reported in Australia over the past week, compared to 36,242 cases in the previous seven days.

Hospitalisations are reducing too, with an average of 1487 this week, down from 1550 in the previous week. 
 
Dr Bonning said this moment could be maximised.
 
‘During the current ebb in COVID numbers we want to continue to reduce the impact of COVID on the hospital sector,’ he said.
 
‘Ensuring everyone has awareness that these [COVID telehealth] consults can be accessed will help establish behaviours that serve the system well when the next surge of COVID cases come.’
 
But while antiviral consultations are not impacted, the lack of an available telehealth item number for consultations lasting over 20 minutes, unless it is mental health-related, is a lingering concern for GPs.
 
‘We continue to hear from members with regards to this patient rebate being removed from the MBS,’ Dr Bonning said.
 
‘[The] absence of a patient rebate for over 20-minute non-COVID telephone consultations … most significantly disadvantages those people without access to technology or video calling.
 
‘Doctors tell us that access to appropriate rebates, both available item numbers and the quantum of the rebate, need to improve.
 
‘The patient rebate from the MBS is there to support patients to access care and hence without it a group of patients who are often older or more remote are disadvantaged.
 
‘It is something that needs to return to the health system as these items represent a tiny fraction of the consults that are conducted, especially now that the community has opened up.’
 
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