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Last-minute hotspot reprieve but GPs say uncertainty is impacting care


Jolyon Attwooll


8/10/2021 4:57:54 PM

Melbourne GPs can conduct longer phone consultations for at least another week after an eleventh-hour extension to Commonwealth-designated hotspots – but a looming deadline means the picture is less clear in NSW. 

GP on the phone.
An MBS number for telephone consultations longer than 20 minutes was introduced for hotspots in mid-July.

The hotspot classification for COVID-19 outbreak zones in Victoria has been extended for another seven days, allowing longer telephone consultations with patients in those areas to continue.
 
However, GPs say the lack of certainty is hindering their ability to provide care in parts of the country that have been most affected by the pandemic.
 
An MBS number for telephone consultations longer than 20 minutes was introduced for hotspots in mid-July for GPs treating patients in areas with rapidly rising COVID-19 case numbers.
 
The MBS number also exempted patients from needing to have had a face-to-face consultation with the GP or at the relevant practice within the past 12 months.
 
Hotspot classifications are designated by Australia’s Chief Medical Officer Professor Paul Kelly and were due to expire at 11.59 pm on Thursday 7 October for most Victorian local government areas.
 
However, the Department of Health (DoH) hotspot page was not updated until late Friday morning, leaving some Melbourne-based GPs unsure as to whether the longer consultations would still be funded.
 
Adding to the anxiety is the fact that the DoH undertook a widescale compliance campaign earlier this year related to GPs incorrectly billing telehealth consultations, which last month reportedly led to practitioners voluntarily repaying $689,000.
 
A DoH announcement published on Friday – the day a record 1838 new cases were announced for the state – confirmed a week-long extension until 14 October.
 
For Dr Todd Cameron, who runs three Melbourne practices, the length of time is ‘disappointing’ and he said GPs would welcome greater certainty while the outbreak continues to grow.
 
‘Extending it by a week when you have got the highest daily numbers ever recorded to be blunt is just ridiculous,’ Dr Cameron told newsGP.
 
He also said that longer video consultations – which are funded regardless of hotspot status – are often not possible.
 
‘The people that need the most care typically have lower socio-economic status, so they are less likely to have English as a first language, they are less likely to have a good, broadband internet connection or data plan, they are less likely to have a smartphone,’ he said.
 
‘It’s often couched as a lack of willingness of doctors to deliver video, but it’s not that at all, it’s patient demand.’
 
Moreover, Dr Cameron believes the pandemic has further complicated primary care, which has increased the need for longer consultations.
 
‘You’re providing normal care, but every second patient wants to talk about COVID and vaccines as well, or how they are doing with their mental health,’ he said.
 
‘If you take a survey of GPs, they would say care at the moment is longer, and more complex, and there are also more logistical difficulties.’
 
The longer phone consultations were reinstated in July as the Delta outbreak became more embedded, particularly in New South Wales.
 
The MBS rebate applied to patients in a Commonwealth-declared COVID-19 hotspot or in isolation or quarantine due to a state or territory public health order.
 
According to its MBS schedule listing, the item can include ‘taking a detailed patient history; arranging any necessary investigation; implementing a management plan; and providing appropriate preventative health care’.
 
The newly introduced Medicare item was processed a total of 197,813 times from July to August, according to the most recent statistics provided by Services Australia. The majority were in NSW, which was the state with the most active Delta cases in the country for that six-week period.
 
In total, 126,253 claims were processed in NSW during that time.
 
Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform, said the MBS item has played a fundamental part in managing health during recent restrictions.
 
‘These telephone item numbers have been crucial to GPs providing complex care to patients during the peak lockdown,’ he told newsGP
 
‘GPs need certainty that these numbers are continuing. The ongoing lack of clarity makes it difficult for us to plan how we are going to provide the care for our patients.’
 
A large number of council areas in NSW are currently declared hotspots, with that status due to expire next Monday (11 October). No announcement had been made for those areas at the time of publication on Friday 8 October.
 
A DoH spokesperson told newsGP Professor Kelly ‘undertakes regular review of areas declared hotspots for Commonwealth purposes’ but would not say if GPs will receive more warning in future or give any indication as to whether NSW hotspots will be extended.
 
The pandemic has proved to be a significant catalyst for telehealth, which became a permanent feature of the health service last November. However, rebates for Level C and D telephone consultations were previously cut from the MBS on 30 June this year.
 
Dr Wright said patients from culturally and linguistically diverse backgrounds, from rural and remote areas, as well as Aboriginal and Torres Strait Islander people, are more likely to require telephone consultations.
 
‘The college has already advocated that telephone consults have a place, particularly in the absence of video,’ he said.
 
‘Many patients prefer to use the telephone and limiting patient access to those services is not in anyone’s interest.
 
‘The pandemic isn’t over, there’s a lot of chronic disease care that needs to be caught up with, and patients need to be able to access care in the most appropriate way, and sometimes that is through a longer telephone consult.
 
‘This isn’t the time to be putting up barriers for patients accessing appropriate care.’
 
An up-to-date guide on the recent changes to telehealth items is available on the RACGP website.
 
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Dr Peter James Strickland   9/10/2021 1:39:10 PM

Telephone consultations should have been part of Medicare from the beginning. The amount of free 'consultations' I did on the phone over 45 years plus and received NO payment would have made any lawyer etc laugh at such apparent stupidity! Advice on results and treatments, prescriptions for patients, advice on dose changes and treatments for hospital or NH patients etc would have probably compensated me partially for the losses in super in the last GFC!! A lawyer asked me once at a conference about how much I got paid for all these parts of my professional medical practice -- he laughed, and told me he charged $300/hour, or part-of for ANY advice by phone that involved writing or research, and $2,500/day for court appearances, and that was in the 1980s! GP fee rebates by Medicare for their primary care remains ridiculous compared to the amount Medicare puts into hospitals --bring on the revolution!