News

Government restricts telehealth MBS access to a patient’s regular GP


Anastasia Tsirtsakis


10/07/2020 11:45:11 AM

The RACGP has welcomed the Federal Government’s decision, which comes after months of strong college advocacy.

Dr Harry Nespolon
RACGP President Dr Harry Nespolon is ‘very pleased the Government has listened to the concerns of our GPs’.

Patients will now only be able to access telehealth services under the Medicare Benefits Schedule (MBS) through their regular GP or practice – where they have been an active patient within the past 12 months – or through a referred non-GP specialist.

RACGP President Dr Harry Nespolon welcomed the reform, which will ensure both convenience and appropriate high-quality care for patients.
 
‘I am very pleased the Government has listened to the concerns of our GPs,’ he told newsGP.
 
‘When the RACGP pushed for telehealth to be funded under Medicare, our intention was always that these services would strengthen the GP–patient relationship – that is, with their regular GP, who can also offer face-to-face consultations when needed – and to ensure continuity of care.’

The changes, which won't apply to infants (under 12 months old), homeless people, or people living in COVID-19 hot spots, were announced on 10 July and follow months of the RACGP lobbying the Government on behalf of GPs across Australia.

The college has been particularly concerned about the rise in low-value pop-up telehealth services, including Instant Consult promoted by Chemist Warehouse.
 
Priceline pharmacies have also offered a service called Script Now for several years, which result in some patients obtaining a prescription without consulting a GP.
 
The RACGP cautioned the public against using services disconnected from their regular GP or practice, highlighting the increased risk for inappropriate practice and fragmented care.
 
Dr Nespolon said the telehealth businesses that emerged during the pandemic ‘completely undermine’ the high-quality services offered by general practices across the country, and misdirected Government funds.
 
‘Something had to be done,’ he said.
 
‘At the RACGP we recognised the threat these businesses posed to both health outcomes of our patients, as well as to the viability of traditional family GP clinics, particularly those in rural and remote communities.
 
‘Our current health crisis has reaffirmed the significant and integral role that general practice plays, and the last thing we need is practices shutting their doors.’
 
The RACGP was part of efforts that led the Government to first announce $669 million in funding for telehealth in March at the height of the coronavirus pandemic, fast-tracking years of reform in a matter of weeks.
 
Patients and practice have since embraced telehealth, making it easier for the community to access high-quality and personalised care when and where it suits them.
 
The newly restricted access to telehealth means patients will be able to continue to discuss their ongoing health and wellbeing with a GP who knows them, their circumstances and their history.
 
The college has highlighted the particular benefits this offers for vulnerable patients, including the elderly and those with chronic disease, as well as offering accessibility to those who would normally have to travel hours to see their GP.
 
It has been speculated that the telehealth item numbers will become a permanent fixture of general practice beyond the 30 September deadline and pandemic, when the current program is due to expire.
 
A spokesperson for Federal Health Minister Greg Hunt said in May that the Minister was engaging in planning a ‘long-term future’ for telehealth, and was seeking advice from the Australian Health Protection Principal Committee.
 
Dr Nespolon said the RACGP will continue to lobby for the rebates to be made permanent.  
 
‘The RACGP is strongly in favour of retaining telehealth and telephone consultations beyond the COVID-19 pandemic,’ he said.
 
‘In a time of crisis, general practice has shown its ability to adapt and with the use of technology overcome barriers of accessibility, while keeping our patients safe.
 
‘We hear GPs concerns and the college will continue engaging in robust dialogue with Government.
 
‘Our advocacy is far from over.’
 
Log in below to join the conversation.

In order to inform its ongoing advocacy 
on the retention of telehealth, the RACGP is seeking member feedback on what the change to telehealth will mean for GPs and their patients.



continuity of care general practice telehealth



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Dr Christopher Michael Bollen   10/07/2020 2:42:04 PM

Good news on this direction. How will "usual GP" be recognised by Medicare? And if the Medicare computer can recognise "usual GP" for Telehealth, why can it not recognise "usual GP" for health assessments and GPMP/TCA?


Dr Stuart Anderson   10/07/2020 2:48:11 PM

Could we get clarification from the RACGP:
- is it 'the regular practice' (which would make sense) rather than one specific GP who may want a day off now and then?
- how is this determined?


Prof Constance Dimity Pond   10/07/2020 2:48:39 PM

Just wonder how "regular GP" is defined? IN our practice which is extended hours, we share patients across practice doctors and the 7 days.


Dr Andrew John Booker   10/07/2020 3:25:47 PM

Agree totally to stop fragmentation.
I think an exemption for rural and remote persons,
whether living or FI-FO, needs to be considered - geographic location is complex and many rural communities run on "locum medical staff and no such "regular GP" exists.
Perhaps a " regular practice" might suffice for these cases


Dr Kerryn Leanne Rae   10/07/2020 3:30:51 PM

I work as women’s health GP, and work with the patients regular GP to manage specialist women’s health issues- eg Menopause ,PCOS, PMS,CHRONIC PELVIC PAIN. How will this affect my access to Telehealth item numbers ?


Dr Tim Kirchler   10/07/2020 3:36:03 PM

How will this affect GP services in headspace centres? We see many young people who don't have a regular GP or who rarely see a doctor at all.


newsGP   10/07/2020 3:36:44 PM

Article updated 3.35pm 10/07/2020
"Patients will now only be able to access telehealth services under the Medicare Benefits Schedule (MBS) through their regular GP or practice – where they have been an active patient within the past 12 months – or through a referred non-GP specialist."


Dr Gerard Donald McLaren   10/07/2020 3:47:09 PM

Good questions above re defining 'regular' but the essence is brilliant, even for rural, in both GP and specialist practice. Shonks on the periphery are to be excluded! Continuity of care should remain the focus.


Dr Saman Tariq   10/07/2020 3:53:32 PM

Great initiative by the Govt.


Dr Tim Kirchler   10/07/2020 4:51:32 PM

Here is the announcement - https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/continuous-care-with-telehealth-stage-seven

I agree with the reaction against "pop-up" Telehealth clinics, but as per my and Dr Rae's comments above, there are these and potentially other areas where GPs providing special services to vulnerable patients will be affected, and access to needed care will be adversely impacted by this poorly considered change.


SD   10/07/2020 5:12:11 PM

I am wondering what will happen to a new practice in regional Victoria that has just set up and is offering telehealth and face to face consultations. They will have many many patients which they have not seen face to face before during their telehealth consults.
The rule should offer relaxation for the practices in regional areas that are newly set up and are offering telehealth in small regional towns with their GP offering face to face as well at the same location during the week.


A.Prof Christopher David Hogan   10/07/2020 5:28:02 PM

Great effort.
Now if we can just deal with the Larry & Lariette Loopholes and Charlie & Charlene Cherrypickers in these & other areas.


SD   10/07/2020 6:38:28 PM

It’s a very good move. Just needs some more clarifications such as what about RFDS which fills in the gaps and provides GP services to regional towns with services run mainly by locums.


Dr Tahir Fasih Arshad   10/07/2020 6:45:48 PM

Why our college is not advocating to stop the plan of pharmacies mafia from issuing scripts without seeing Gps or Doctor? I request then we should raise the voice that if pharmacy are trying to invade the GPs domains then we should also be allowed to open our own pharmacy by GPs.


Dr Al-Falah Abdul-Aziz Dhanji   10/07/2020 7:21:39 PM

It’s going to be difficult for reception to say to patients that they cannot have teleconsults unless they have been a patient for 12 months, even though they may have become “regular” patients.


Dr Ariane Miranda Cullen   11/07/2020 12:42:38 AM

Great idea to cut out abuse of the system and keep patient continuity of care alive, but agree with colleagues above re certain situations esp newly set up practices, rural and remote etc
Thanks RACGP and Harry!


Dr Mahathir Mohammad   11/07/2020 7:19:42 AM

Great decision. Now those businessmen can stop these pop up shops. Was totally unethical for them to set up those pop up script generating programs. If not soon we will have swipe ur medicare card vending machines printing out scripts in the supermarket. Thank you RACGP.


Dr Chih Chan Yao   11/07/2020 8:04:07 AM

In the same way of thinking, can a GP go to do a home visit for non regular patient.
If you do a telehealth for free, not billing medicare, is that alright?


Dr Ashraf Farah   11/07/2020 8:44:46 AM

The same should apply to Chronic disease management plans.
I know it does but Medicare honours payments to any GP who does a care plan even on a first visit to a GP who is not the patient's regular GP .


Dr Philip William Ousby   11/07/2020 11:45:24 AM

This line amongst the exemptions (with some confusing language) appears in the media relase to indicate links to usual GP and Practice are enough.
"Requiring COVID-19 video and telephone services are linked to a patient’s usual GP or practice will support longitudinal, person-centred primary health care, associated with better health outcomes".
Philip


Dr Simon Oon-Teong Ooi   11/07/2020 1:57:24 PM

Doctors with a good therapeutic relationship with their patients should not fear Telehealth Pop-Up's. This is an over-reaction.
Improve your game and your patients will stay with you.
This is limiting patients' choice to find the doctor who may be a better match.
A patient should have the freedom to choose a doctor.
I have chosen to only do Telehealth consultations for personal reasons.
And this affects my ability to see new patients.
And my earning capacity.
Not well thought out at all.
I will be seeking advice from my MDO.


Dr Reshmi Sheheli   11/07/2020 6:39:57 PM

This attempt might sound ok to restrict pop up prescription type service but the Drs who are doing Telehealth due to their health condition or family situation will be impacted by this generalisation. Also people in the rural and remote areas where there is a long wait to see Dr , they were greatly helped by Australia wide Telehealth by GPs.


Dr David Zhi Qiang Yu   11/07/2020 8:02:19 PM

Please make the Telehealth permanent fixture of general practice beyond the 30 September.


Dr Daming Chi   11/07/2020 8:38:05 PM

Good move.
But what happens to some one who is not regular to any clinic?


Dr Gobind Singh Duggal   11/07/2020 10:43:55 PM

My understanding when patient is not able to contact his so called regular GP, patients should be able to call on more than one practice for day to day medical needs, and should have acces to GP clinic other than so called regular GP, a concept loosing merrits because regular GP's are too busy to accomodate their patients, wait for appointment is longer than a week is oftwen the case


Dr Ayanthi Sonali Rodrigo Goonewardene   12/07/2020 11:56:08 AM

I am eternally grateful to Dr Harry Nespolon in advocating for the restrictions on Telehealth items. Fragmentation of care by the ‘quick fix’ tech companies/ pharmacies were starting to erode holistic patient care provided by GP clinics.


Dr Ayanthi Sonali Rodrigo Goonewardene   12/07/2020 12:33:09 PM

From what I understand, any new patient should be seen face to face with a baseline examination! Follow up consults can be via Telehealth! Why is this so hard? It’s impossible to continue ‘seeing’ a patient only via Telehealth when essential examination findings will be missed & misdiagnosed! ...If anyone is doing only Telehealth due to COVID risk, why not ask a colleague at your clinic to do the initial consult? ... why are we letting tech companies/ pharmacies take over General Practice? I’m thankful for RACGP for doing the right thing- for us & our patients!


Dr Alistair Vickery   12/07/2020 12:40:21 PM

There are a number of situations where this one blanket rule disadvantages both patients and GPs in this time of CoVID19. The new rule assumes every patient has attended a regular practice within 12 months, this is not the case for very many healthy patients who may not see a GP for many years but now have viral respiratory symptoms and need advice or management. For the next many years this will be common and F2F put at risk vulnerable patients and health staff.
The second scenario is sub-specialty GP (women’s health, psychological services, chronic pain, addiction, sexual health, aged care, palliative care etc) these important service groups should either be exempt from the new GP Telehealth rule or have access to specialist Telehealth item numbers
I note both of these issues have been raised above but there has been no public response that I can find. GP is complex, varied and continuity of care needs to be protected but as always there are valid wort exceptions for quality care


Dr Emmanuel   12/07/2020 12:49:39 PM

I wish Dr Harry can continue in this role for the foreseeable future
smart move!


Dr Ayanthi Sonali Rodrigo Goonewardene   13/07/2020 8:21:20 AM

From what I understand, any new patient should be seen face to face with a baseline examination! Follow up consults can be via Telehealth! Why is this so hard? It’s impossible to continue ‘seeing’ a patient only via Telehealth when essential examination findings will be missed & misdiagnosed! ...If anyone is doing only Telehealth due to COVID risk, why not ask a colleague at your clinic to do the initial consult? ... why are we letting tech companies/ pharmacies take over General Practice? I’m thankful for RACGP for doing the right thing- for us & our patients!


Dr Chandrika Sivapalan   13/07/2020 11:38:36 PM

Fundamentally this is all about money not about patients.Who cares if the the patient gets an appointment on that day for a consult or not Many Gp haavev picked up so many missed diagnosis by the so so-called fancy Family GPS ranging from AF to Aortic stenosis and so forth just on a visit to pick up scripts when their beloved FGPs were on holidays.Well then GPS will have to inform clients to visit the practice if they cannot get an appointment with their regular practice.Patients come first not the doctors income .I do understand Pharamacies and pop up clinic are coming up stealing business .Patients suffer all because of a few greedy medical entrepreneurs .May be other gps could offer one month supply of scripts only for non reg patients.This is so poorly to punish patients especially during this pandemic .


Dr Tanya Smith   17/07/2020 7:05:44 AM

Think RACGP could no a lot more to assess low value quality consults across all GP practices not just target a very small minority of providers who have billed approx .2% of consult items in the last few months. The companies mentioned by RACGP and AMA have not been audited for low value care as indeed neither has anyone else. It’s all a political move to make it look like quality is a priority but am afraid not evident in what I have seen working in multiple types of practices.