Funding for in-home COVID vaccine assessments ‘inadequate’

Anastasia Tsirtsakis

22/04/2021 4:31:16 PM

GPs have questioned the lack of a dedicated MBS item number for housebound patients.

Hand knocking on front door
GPs say they should be able to co-claim an in-home vaccine suitability assessment alongside general attendance.

More than four weeks into phase 1b of the vaccine rollout, GPs with vulnerable, housebound patients are still unclear about the Federal Government’s billing criteria.
As part of the rollout, 16 new Medicare Benefits Schedule (MBS) item numbers were announced to cover the vaccine suitability assessments.
However, none of the new item numbers are dedicated to in-home vaccinations, nor are GPs permitted to co-claim general attendance without offering an unrelated service.
‘The Government understands that some patients with complex care needs or limited mobility may have difficulties accessing community vaccination locations,’ a Department of Health (DoH) spokesperson told newsGP.
‘Consideration of the best ways to vaccinate these patients, including in-reach services or home visits, is ongoing.
‘Vaccination providers are able to use the same MBS item as for an in-practice vaccine, provided they are willing to provide this service at the same rate.’
Dr Emil Djakic, GP and Deputy Chair of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), says the funding arrangement is ‘woefully inadequate’ and fails to recognise ‘true patient-centred care’.
‘In-home visits are not all that common unless they’re really, really necessary for people who are immobile and where your presence is actually to do something useful,’ he told newsGP.
‘I would have about half a dozen of those [patients] that I know I will visit at home because it’s really not very patient-focused to ask them or their family to load them into a car to bring them in for that vaccine.
‘They shouldn’t be encouraging general practice to do services at a substantial loss.’
Under the current arrangements, GPs can claim the equivalent of a Level A attendance and a double bulk-billing incentive for the first vaccine suitability assessment service, ranging from $30.75–$37.35 depending on geographical location, and the equivalent of a Level A attendance and standard bulk-billing incentive ($24.25–$27.55) for the second service.
Practices that complete two services for the same patient, in a clinically appropriate timeframe, are also eligible for a $10 practice incentive payment.
In comparison, the standard MBS item numbers for a home-visit range from $44.90 for a Level A attendance to $65.90 for a Level B.
Yet despite the time involved, GPs undertaking a home visit to conduct a vaccine assessment are only permitted to co-claim other general attendance items ‘where another GP service is provided that is unrelated to the vaccine suitability assessment item’.
Dr Djakic says this makes it hard to justify the service from a business point of view.
‘The home visit component really should stand in addition to [the vaccine suitability assessment service] to clearly reflect the value of the service and to demonstrate that it should be viable for a GP to leave their office,’ he said.
‘By the time you leave your business, get to your car, drive to the patient, and get the patient to open the front door, there are time-based elements, which clearly are very hard to measure.
‘[But] let’s just assume that it’s even geographically nearby, given we really are obliged to be with that patient for 15 minutes from a reaction point of view, none of those episodes are anything less than half an hour.
‘This means the department wants us to move to a non-patient-centred focus – which is to say, “I’m afraid you’re going to have to come into the clinic and have that done”, because as a private business that would be asking us to specifically go into a service at a guaranteed loss and from my pure business sustainability hat, that’s quite obstructive.’
High-profile GP Dr Kerryn Phelps said her colleagues have been left confused by the funding arrangement and called it out as a Government ‘oversight’.
‘GPs who agreed to be involved in the COVID-19 vaccine rollout have agreed to bulk bill all those consultations, even in private billing practices. So the only remuneration is the Medicare rebate. There is no rebate for home visit for COVID vaccination. An oversight,’ she wrote on Twitter.

Dr Djakic says it is clear the standalone item number has been designed to fit the model of care being delivered in most clinics, where it is organised for a rapid turnover.
‘General practice care isn’t as linear as some other parts of the health service, meaning we’ve got quite a diversity of scenarios and situations … and all scenarios under the planning were very hard to embrace,’ he said.
‘But this … clearly identifies that that wasn’t perhaps considered.
‘The department is obviously really cautious that all of a sudden every GP is going to go jumping into their car and start delivering these vaccines at home for a riotously large amount of money. The fact is the home visit item number isn’t a greatly profitable one anyway; it’s not something you go out of your way to do because it’s going to make your day. You do it because you need to.’
To address this concern, Dr Djakic says the Government could set criteria that also include the option to audit GPs delivering the service.
‘They would just have to put a caveat to say you will be auditable and the definition around viable vaccine at home should relate to demonstrable immobility or impracticability for the patient,’ he said.
‘There are grounds for an inquiry to the department to possibly consider generating one to really address and recognise that, and celebrate the fact that GPs do high value care to these patients who we reach out to at home.’
The DoH said it is working with medical organisations to ‘ensure vaccines can be accessed safely by all Australians’ in general practice.
‘The Government has worked closely with peak GP organisations, including RACGP, AMA, RDAA and ACRRM, to co-design the requirements for the clinical setting for vaccine administration and the suite of Medicare items to support the vaccine rollout in general practice,’ the DoH spokesperson said.
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