DoH clarifies that expanded 80/20 rule now in place

Matt Woodley

26/07/2022 4:37:22 PM

The RACGP has received confirmation that the 80/20 rule was extended to telehealth services on 1 July, despite having previously understood that it would be deferred until October.

Doctor picking up the phone
The 80/20 rule restricts the number of professional attendance services clinicians can claim over a 12-month period.

On 30 June, Federal Minister for Health and Aged Care Mark Butler announced a last-minute delay of incoming MBS claiming rules that would restrict the number of telehealth services that GPs could provide.
‘I am deferring the compliance arrangements that were due to take effect tomorrow. Those compliance arrangements were essentially based upon a particular ratio of telehealth consultations as a part of, particularly, a GP’s day,’ he said.
‘I don’t think it’s appropriate that those compliance measures start tomorrow, as the former government had decided they would, given what GPs and patients are dealing with right now.’
At the time, the RACGP welcomed the deferment, believing that it would apply to both the new 30/20 prescribed pattern of service rule, as well as an extension of the 80/20 rule to encompass telehealth services.
However, when scanning the Department of Health (DoH) website, RACGP staff identified that the MBS fact sheet had been updated, explaining that while the 30/20 rule had indeed been delayed for three months, implementation of the 80/20 rule went ahead as planned.
Subsequent RACGP enquiries have since confirmed the expansion of the 80/20 rule, which President Adjunct Professor Karen Price told newsGP is ‘incredibly disappointing’.
‘At a time of record COVID hospitalisations, untold community spread, and a devastating rebound flu season, the number of patients GPs can treat is being restricted due to government compliance action,’ she said.
‘As Minister Butler himself conceded, now is not an appropriate time for new compliance measures.
‘We should be expanding access to general practice services, particularly those that can be conducted safely in the context of an ongoing respiratory pandemic.
‘GPs are the backbone of Australia’s health services and need to be supported to continue with their community saving work.’
Aside from her disappointment at the decision itself, Professor Price also said the ensuing confusion is an inevitable result of late announcements communicated via press conferences instead of official channels.
‘I cannot stress enough how important it is that we receive clear, timely communication from health authorities, especially when they are making significant decisions that can have a profound impact on the way care is delivered,’ she said.
‘General practices need time to adjust, and providing these updates earlier also helps to avoid unfortunate situations like this, where incorrect information has been given to GPs.
‘We care about our patients and many of us have been trying to provide as much care as we can under incredibly trying circumstances.
‘I would hope the department takes this into account when reviewing any cases where a GP unintentionally has strayed outside prescribed pattern of service rules due to the confusion this poorly communicated, last-minute change has created.’
Prior to the rule coming into effect, RACGP Vice President Dr Bruce Willett wrote to Federal Health Secretary Brendan Murphy, urging him to delay the implementation of both new compliance measures.
In addition to referencing the ‘problematic’ impact such changes could have on general practice services during a time of high respiratory illness in the community, he also said a review is needed to ensure the measures are fit for purpose and accurately reflect the new telehealth environment.
‘While we acknowledge that the prescribed pattern of service rules are designed to deter misuse and corporate malfeasance, GPs should not be punished, and their wellbeing put at risk when they are doing their best to care for their patients,’ he wrote.
‘Most GPs continue to do the right thing, despite the many changes to telehealth rules and bureaucratic interventions into medical practice, without having a clear understanding of the need for these rules and how the benchmarks have been determined.
‘We strongly urge the department to heed our advice and use this opportune time to defer and review the 80/20 and 30/20 prescribed pattern of service rules as matter of urgency.’
Professor Price says the college’s position on the need for a review remains unchanged.
‘These are important policy settings, but members don’t have enough clarity on why they are in place, nor how the department arrived at these numbers,’ she said.
‘The pandemic has changed so much of the way that healthcare is delivered in this country. We need to ensure that whatever compliance measures are in place reflect the current context.
‘We apologise for the confusion caused by the way this update was originally communicated to members, and will continue to advocate for a pause on the application of both the 80/20 and 30/20 rules to telehealth consultations so that a review can take place.’
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Dr Raymond Weng Yat Yeow   27/07/2022 1:11:56 AM

".......RACGP Vice President .... wrote to Federal Health Secretary Brendan Murphy, urging him to delay the implementation of both new compliance measures...."
Obviously this RACGP lobbying fell on deaf ears .....

Dr MT   27/07/2022 6:36:15 AM

It is a horrifying news to know that the rule 80/20 will apply from 1/7/22. . The DoH obviously does not appreciate GP hard work.
I really think RACGP have to raise public awareness about this unfair treatment to GPs. I really think we should go on strike and walk off job one day . GPs are under enormous pressure from both government and patients. We don’t have support.

Dr MT   27/07/2022 6:59:17 AM

I am calling RACGP to take action, calling all GPs to go on strike. We need to raise public awareness about this issue. Patients do not know about the 80/20 rules. Patients thought GPs are not working hard and not caring. Patients are not aware of restrictions on GP, not even pathological referral restrictions such as Fe study, TSH, Vit D.
We should go on strike, let Minister of Health Mark Butter know, let media and general public know
Sincerely yours

Rural GP   27/07/2022 5:33:09 PM

The 80/20 rule is where a GP " bills Medicare for more than 80 services a day for 20 or more days over the course of a single year", I know General Practice is a broad church and the doctors at most risk would be likely treating the most needy. But I am also aware that telehealth services are mostly single item number claims.
Can we ask : just how many GP's might be affected by this ruling ?. I am not sure how relevant this is and do we want it to become a defining issue for the RACGP and strike? An equitable MBS might solve the issue.