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Clarity over longer telehealth phone consultations
The new item numbers will be available from Tuesday 19 July, but GPs will not be able to claim for services already delivered.
General practices have adapted to multiple changes to MBS rebates for longer phone consultation items.
On Saturday (16 July), Federal Minister for Health and Aged Care Mark Butler announced that Medicare rebates for phone consultations lasting longer than 20 minutes will be re-introduced for patients seeking advice on the prescription of COVID-19 oral antiviral treatments.
However, GPs will need to wait until Tuesday 19 July for item number (93716) and descriptor details to be published on MBS Online, the Department of Health (DoH) confirmed on Monday.
The reinstatement will last until at least 31 October, and comes after rebates for most level C and D phone consultations were scrapped at the beginning of July. Patients will be able to access a rebate of $76.95 when the service is provided by a GP, equivalent to other time tiered consultation items of the same duration (eg by video or face-to-face).
‘The new temporary MBS items will cover a longer consultation by phone to ensure antivirals are safely prescribed by doctors and ensure as many people as possible can access these treatments,’ Minister Butler said in a statement.
In a statement to newsGP, the DoH said the new items will not be backdated.
‘Existing permanent telehealth items are in place, including video for longer consultations as well as phone for consultations of less than 20 minutes,’ a spokesperson said.
‘Additional health concerns raised by patients may also be considered in the duration of the consultation. Normal Medicare same-day multiple attendance rules apply.’
The DoH also said that patients who are not deemed eligible for the oral antivirals after assessment will still be entitled to the long phone consultation rebate.
‘There is no limit on the number of consultations for patients, though it is important to note that their eligibility for the service is based on a confirmed COVID-19 diagnosis by RAT or PCR,’ the DoH stated.
Given that restriction, the new long phone consult rebate will not apply to patients seeking to check their suitability for the oral antivirals prior to getting COVID-19.
The return of rebates for some longer phone consultation follows a significant expansion of COVID-19 oral antivirals to include all individuals over the age of 70 – and any Aboriginal and Torres Strait Islander over the age of 50 – with a positive COVID-19 test, who is within five days of symptom onset.
The college and the Australian Medical Association were among the groups to highlight how the absence of Medicare rebates for longer phone consultations would hamper GPs trying to prescribe the COVID-19 oral antivirals – particularly for older patients and those living in rural areas.
One of the treatments, nirmatrelvir plus ritonavir (sold as Paxlovid), has a particularly long list of contraindications.
Dr Michael Bonning, who sits on the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), says the change will help GPs.
‘The Government [making] COVID-19 antivirals accessible is fantastic,’ he told newsGP.
‘There are all kinds of complications [from the antivirals] that are more likely as people get older, and that was a really key group for which these new, longer MBS items will make a real difference.’
However, he also called the changes ‘administratively burdensome’ for general practices and queried the original decision to remove them, saying that vulnerable people are being particularly impacted.
‘It’s always going to damage those people who are likely to be less health literate, who have less money to spend on other forms of care,’ he said.
‘It’s always going to be more difficult on those people who are more vulnerable.
‘Was it really that much of an impost to the budget to remove a useful tool that was … being used appropriately and diligently by general practitioners?’
While the oral antivirals look to be having an impact in preventing vulnerable patients from progressing to severe disease, there have been growing concerns about ensuring that the right patients receive the treatment in a timely way.
Dr Rob Hosking, Chair of the RACGP Expert Committee – Practice Technology and Management (REC–PTM), said that, given the high case numbers, many GPs will need to use the new MBS item immediately.
He is also keen to underline the obstacles in attempting longer video consultations.
‘The difficulty is it takes two to video, and the people who we need to video with often don’t have the capacity,’ Dr Hosking said. ‘So we need the telephone [item] numbers.’
RACGP President Adjunct Professor Karen Price said while the return of the long phone consultation Medicare rebate is appreciated, she will continue to advocate for it to be available to all patients.
‘I will say it until I am blue in the face, longer telehealth consultations via phone must be a permanent fixture of our telehealth system,’ she said following the Federal Government announcement.
‘Anything less is not good enough as far as I’m concerned.
‘Until this changes, the status quo is particularly detrimental for people in rural communities, Aboriginal and Torres Strait Islander people, older people and those with disability or limited mobility.’
But even as the RACGP and other medical groups continue to call for change, Dr Hosking is pleased that there has been at least some movement.
‘[The Government has] recognised that it is a problem, and they’ve responded to that,’ he said.
Clarification: This article was updated at 5.20 pm on 18 July, following clarification from the Department of Health. Prior to this update, a department spokesperson had told newsGP that further information on the new telephone item was not expected until at least the following day.
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