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COVID telehealth item numbers set to expire next month


Michelle Wisbey


25/06/2024 4:39:00 PM

The Federal Government is planning to remove level C phone rebates for antiviral consultations and scrap the 12-month relationship exemption.

Doctor helping elderly patient.
MBS item 93716 has been billed more than 300,000 times in the less than two years since it was introduced.

Pandemic-era rules designed to give COVID-19 patients greater access to telehealth and antivirals must remain in place for the ‘foreseeable future’, according to the RACGP.
 
In a letter to Federal Health and Aged Care Minister Mark Butler, sent on Monday, RACGP President Dr Nicole Higgins called on the Government to scrap a plan that would allow several temporary COVID-19 responses to expire on 1 July.
 
This includes the removal of Level C phone consultations for COVID-19 antiviral assessments (items 93716 and 93717) which were introduced in 2022 to assess patient suitability for oral antiviral medications.
 
Since their introduction, these items have been exempted from clinical relationship requirements, meaning patients do not need to have had a face-to-face service in the 12 months preceding the telehealth attendance.

They have also been used widely, with more than 300,000 services claimed between July 2022 and May 2024.
 
In the letter, Dr Higgins raised ‘significant concerns’ about how this expiration will impact GPs and patients.
 
‘The RACGP believes these items must remain in place for the foreseeable future, given the ongoing spread of COVID-19 in the community and the clinical guidelines associated with timely treatments,’ she said.
 
The letter uses a prescription of Paxlovid as an example, pointing out that prescribing doctors need to undertake a significant review of the patient’s medical history, meaning a longer consultation is likely required but should not be conducted face-to-face with a COVID-positive patient.
 
It says despite available Level C general phone items in place for consultations with GPs, these are only available to MyMedicare patients and are not exempt from the 12-month rule.
 
RACGP Expert Committee – Funding and Health System Reform member Dr Emil Djakic told newsGP the decision to keep the measures in place more permanently is a ‘no-brainer’.
 
‘While the label of “pandemic” might not be there anymore, from a patient perspective and a consumer of healthcare perspective, there’s still a level of anxiety and urgency among our population,’ he said.
 
‘We need to be able to assess people and have a discussion about COVID and the relative merits of antivirals, and it would be seemingly unwise to exclude people on the basis of the 12-month law.
 
‘It seems to be a very short-sighted decision to make an almost random housekeeping exercise on Medicare without really thinking about the implications.’
 
According to the college’s letter, more than half of the item 93716 consultations have been with patients aged over 65.
 
Dr Djakic said, especially for older patients, the planned changes risk leaving them feeling ‘vulnerable and isolated’ and unable to access care.
 
‘There are plenty of other areas of the MBS that they probably should be focusing on rather than compromising access to care around the ongoing COVID journey,’ he said.
 
‘Obviously, face-to-face is important for most healthcare, but telehealth is a technology that’s been with us for a long time and COVID created the absolute necessity for it in terms of infection control.
 
‘We’re not against the 12-month relationship rule for the normal run-of-the-mill care, it’s just this is a very narrow band of people, and it is potentially creating a barrier to access that care at the very time they need it most.’
 
A Department of Health and Aged Care spokesperson told newsGP the changes are part of a ‘staged de-escalation of the COVID-19 response’.
 
‘Now that the COVID-19 pandemic is over, COVID-19 pandemic measures have been progressively scaled back as the community and health system reverts to a post-pandemic business as usual environment,’ they said.
 
‘Almost two years later, GPs and patients have had more time to familiarise themselves with the medication and their health risks and needs.
 
‘High risk patients have, in particular, been encouraged to develop an established relationship with a GP, or general practice and discuss their risks and possible treatment options ahead of a possible infection.’
 
The new financial year will also bring with it an end of 12-month rule exemptions for patients with a positive COVID test and those seeking a referral for PCR testing.
 
This is a plan the RACGP labelled ‘highly concerning’ and said it ‘remains inappropriate for patients with COVID-19 to be forced to attend a practice just to be eligible to receive Medicare rebates’.
 
Dr Higgins said this places other patients and practice staff at unacceptable risk.
 
‘With winter now upon us and respiratory illnesses projected to rise sharply in the coming weeks, maintaining access to telehealth rebates for people with COVID-19 is a simple and logical step to reduce the spread of infection,’ she said.
 
‘I strongly encourage the Federal Government to reconsider the decision to end these temporary measures.’
 
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COVID-19 MBS Medicare Benefits Schedule telehealth


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GP getting on with GPing   26/06/2024 10:15:31 AM

You get what you pay for. I can't say I used this item number much but we 'see' plenty of patients for the first time to arrange antivirals and if the complexity is there you need the time for safety. As we are the ones liable for our decisions and the government has no direct skin in this it leaves 2 options the cheap shortcut if they are on any medication to prescribe the less effective antiviral or eat the time, be underpaid (or charge the patient) to give the best clinical outcome. I can't help but hate a system that disadvantages a sicker patient or makes a doctor pay for giving a damn. They know it, we know it.


Dr Pauline Bernadette M Tyndall   2/07/2024 9:51:54 AM

Well said “ GPS getting on with GPing”. Does any one forget the fallout when we have Covid related sick medical, nursing and reception staff . We’ll always be front line Currently many but not all respiratory infections are in the our paediatric population) ; often arrive into the clinic without saying they’ve got URTI like symptoms, no masks and sitting near our vulnerable . patients. when we are up and close (even with masks)) get that cough in the face we can’t claim work cover loss of income. nor Easter burden of covering absence of a colleague GP or practice nurse or receptionist away on unpaid sick leave puts more strain on us all. Additionally agree why elderly cousins were given the easiest Covid antiviral by Telehealth consult: twas time versus best care. Why set guidelines then make it too difficult to achieve?
I’m hone recovering from that nasty virus, worrying about patients, I cancelled this week,
knowing we can’t cover my booking this week. -.