Concerns over possible telehealth indemnity gaps

The college has expressed concern that not all medical indemnity insurance policies correspond to MBS telehealth criteria, potentially creating situations where vulnerable patients could miss out on care.
 
RACGP President Dr Nicole Higgins has written to two medical insurance indemnity companies, Berkshire Hathaway Specialty Insurance, which backs a product sold by Tego in Australia, and Medical Insurance Group Australia (MIGA), asking for clarity around their policies towards exemptions to the ‘established clinical relationship’ rule.
 
The correspondence comes amid the backdrop of new Medical Board of Australia (MBA) guidelines, which are due to commence next month, and have prompted insurers to update their coverage.
 
According to the MBA, telehealth ‘is generally most appropriate in the context of a continuing clinical relationship’. This approach is reflected in the MBS clinical relationship requirement, which stipulates that patients need to have had a face-to-face appointment at their regular practice within the past 12 months to qualify for telehealth Medicare rebates.
 
However, a number of exemptions to the requirement also apply under the MBS, which include specific patient cohorts and item numbers.
 
Among the groups for whom the rule does not apply are infants aged less than 12 months, people who are homeless, patients receiving an urgent after-hours service, as well as patients at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service.
 
Patients with a confirmed positive COVID-19 test within the past seven days are also exempt, at least until the end of 2023.
 
Exempted item numbers currently include some sexual and reproductive services, pregnancy counselling services, mental health care and eating disorder management, and smoking cessation counselling.
 
In the letters, which were sent this week, Dr Higgins noted that neither company’s policy currently specifies coverage for clinical care provided by telehealth under those exemptions, and warned over the potential impact.
 
‘This change will have significant implications for equitable access to high-quality healthcare, particularly amongst vulnerable population groups and those located in rural areas,’ she wrote.
 
In a response to the RACGP President, Berkshire Hathaway Specialty Insurance said including all nuances ‘is not always possible in a policy wording’ and that they do not intend to exclude all telehealth consultations involving patients without an established clinical relationship.
 
Noting that their standard wording covers situations such as after-hours services, they also stated they have proactively contacted practitioners and have extended cover for ‘a large number’ who provide telehealth mental health services or healthcare in rural and remote communities.
 
Dr Higgins also noted the college’s preference for telehealth to take place with a patient’s usual GP or practice.
 
‘However, we recognise that under certain circumstances, telehealth with a regular GP where there has been a face-to-face consultation within 12 months is not always possible and access to safe and high-quality care must still be supported in certain situations,’ she wrote.
 
‘GPs inherently understand the requirement of delivering safe, person-centred care, and it is within their scope of practice to provide telehealth consultations under such circumstances.’
 
Dr Higgins drew attention to both the patient cohorts not included in the MBS 12-month relationship rule as well as the list of exempted MBS item numbers.
 
‘Many of these services are exempt from the 12-month rule as they are highly specialised, and patients may not be able to access this type of care from their usual GP,’ she said.
 
‘These exemptions have not been considered in your policy wording update – rather, a significant restriction of cover for all telehealth services will be implemented [including phone and video consultations].’
 
According to Dr Higgins, telehealth is particularly significant for patients in rural and remote communities, especially for Aboriginal and Torres Strait Islander people.
 
‘MBS-subsidised telehealth services improve access to essential GP health services; however, these new restrictions to [medical indemnity insurance] cover may remove access to essential care for those who need it most,’ she wrote.
 
The revised MBA telehealth guidelines were confirmed earlier this year and are due to come into effect on 1 September.
 
The guidelines in particular warn against asynchronous telehealth care in most situations, a stance the college strongly endorsed in its submission to the MBA, and which is now reflected in policies of all medical indemnity insurance companies.
 
MIGA was also approached by newsGP for comment.
 
The RACGP’s guide to providing telephone and video consultations in general practice is available on the college’s website.
 
GPs with queries about their indemnity are encouraged to contact their insurers directly to ensure their practice is covered.
 
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