Be wary of organisations circumventing telehealth criteria: RACGP

Anastasia Tsirtsakis

27/07/2020 4:29:59 PM

Services are reportedly trying to blindside GPs and side step recent MBS reforms to telehealth.

GP on the phone
Telehealth reforms were introduced by the Department of Health on 20 July, following RACGP lobbying to reduce fragmented care in general practice.

‘It’s a fairly sad situation from my perspective because it’s abusing trust. This is a blatant attempt to bypass the rule.’
That is Associate Professor Charlotte Hespe speaking to newsGP about recent attempts by telehealth-only services to circumvent the new telehealth Medicare Benefits Schedule (MBS) criteria.
A letter one such service sent to GPs, seen by newsGP, requests that practices give their permission for the provider to offer their patients telehealth, and in turn access to the COVID-19 item numbers under MBS.
The letter indicates that healthcare is being offered under the guise of a medical deputising service, solely for after-hours care. However, the service has since been linked to a sister service offering telehealth 24 hours a day, seven days a week.
Associate Professor Hespe, who is Chair of RACGP NSW&ACT, knows of six GPs who signed the letter, under the impression their patients would only be accessing after-hours care, who have since reneged on the agreement.  
‘They’re absolutely going out of their way to misrepresent themselves,’ she said.
‘By and large, GPs are trusting and wanting the best for their patients. So you read it [the letter] and that’s how you interpret it, and you sign it.
‘[But] the intent is that they can do telehealth for any patient, anywhere, 24 hours a day, using their telehealth platform.
‘They’re making use of sending letters to doctors on the basis that it’s for the best of communication purposes, when in fact that’s not the case at all. It’s actually about being able to further their business model and take work away from those practices.’
The pushback comes in the wake of telehealth reforms introduced by the Department of Health (DoH) on 20 July, following RACGP lobbying to reduce fragmented care in general practice.
For patients to access Medicare-subsidised telehealth, GPs are required to have an existing and continuous relationship with a patient, who has had a face-to-face service in the previous 12 months.
Exceptions include infants under 12 months of age, people experiencing homelessness, general practice services being accessed from an Aboriginal medical service, or patients in areas under stage three restrictions, such as Metropolitan Melbourne and Mitchell Shire.
Approved medical deputising services with permission to provide services for and on behalf of the patient’s usual general practice also have access.
The Federal Government’s decision to expand MBS telehealth items numbers during the coronavirus pandemic gave pre-existing telehealth services access to the MBS, and also saw a proliferation of pop-up telehealth services, raising concern over low-value care.
‘With [Medicare-subsidised] telehealth, it obviously then opened up a much bigger population of patients who couldn’t afford or wouldn’t pay [for telehealth], and so they’ve sort of marketed themselves widely, and they don’t want to lose that income,’ Associate Professor Hespe said.
‘So they’re not actually thinking about the patient at this point, it’s all about the income. They’ve seen that pot of gold and thought, “How dare you take that from us?”
‘It was never about delivering a service for a patient; it was just about generating income.
‘I get that – what business owner isn’t thinking about your profit and your margin? But, I’m sorry, when it’s being paid for under the insurance of Medicare, it does matter.
‘Medicare is there as an insurance policy for all Australians to be getting the best quality healthcare. It’s not about just providing the pot of gold to a business opportunity.’
While telehealth has proven to be a useful tool during the pandemic, Associate Professor Hespe says it is important to remember that it is just that – ‘A tool for enabling better access and continuity of care’ –where a patient’s regular GP or practice is also available for a face-to-face appointment if necessary. 
‘Most people would recognise that if you’re looking at the full suite of how you want to be looked after in general practice, you wouldn’t ever be looking at telehealth being the only way you access healthcare,’ she said.
‘If patients want to pay for telehealth outside of Medicare, they’re absolutely entitled to. But what we’re fighting for is that Medicare-funded telehealth be linked to continuity of care with your regular GP.’
The DoH’s decision to restrict access to telehealth has been welcomed by some GPs, while others have suggested it is solely financially driven.
Associate Professor Hespe says finances do come into the equation, but only to ensure the future of telehealth, so patients are able to continue to access high-quality care through their GP.
‘We’ve been waiting for [telehealth] for a long time, and we want it to actually be utilised as the fantastic tool that it should be,’ she said.
‘The finances here are that Medicare is not a bottomless pot of money, and we have to recognise that.
‘If it’s seen as a bottomless pot and just goes out everywhere, then no-one’s going to be able to access it because it will be cut off.’
The RACGP has raised concerns regarding these letters directly with the DoH and cautions all GPs to be wary of entering into any agreement with organisations that may be seeking to circumvent the intent of the most recent changes to the MBS telehealth items.
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Dr Julian   28/07/2020 7:58:52 AM

I think we should call out the pharmacy groups pushing this. Both Priceline and Terry White on The Northern Beaches in Sydney were handing our long standing patients cards to call the “1800 Free Doctor” for their scripts. Like the pharmacy over 65 And chronic care flu jabs, such a pull away from the hard work we are doing to make every interaction make a difference in chronic care management. Great work by the RACGP to stop this and their refocus on advocacy for us all!

Dr Irandani Anandi Ranasinghe-Markus   28/07/2020 8:56:38 AM

Totally agree with Charlotte. It is sad that there are unscrupulous people out there waiting to take advantage of such situations to make a buck. Bonafide GPs end up getting a bad name and actually getting in trouble because we are ultimately responsible for our billing - not the company we work for. We have come to a point where just being a good clinician is not enough- we have to take responsibility for the income we generate from our work and ensure it is all legitimate. I know there’s got to be a timeline for continuity of care but there are unusual situations of a well known patient to you since childhood is really needing your care in these difficult times but has lived elsewhere for a while and is now needing your care for an issue you are very familiar with from the past and have a good knowledge of past history. What happens then? Are such patients not eligible for a rebate on telehealth?