Clarity over longer telehealth phone consultations

Jolyon Attwooll

18/07/2022 4:44:00 PM

The new item numbers will be available from Tuesday 19 July, but GPs will not be able to claim for services already delivered.

GP on phone
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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Dr Vito Gaetano Spina   19/07/2022 8:47:26 AM

I know everyone is keen for longer Telehealth consults, ongoing Telehealth consults short and long, but you are all like a baby that has had its pacifier taken away.
Firstly I don’t believe any GP should be doing tele or video health on a patient they have never treated before or at least in exceptional life risking circumstances or in the rural setting. That leaves us all treating patients we know, so the argument that 20 minutes is required to determine if the patient may need antivirals for COVID confirmed infection makes no sense. If they fulfil the criteria which goes like this. “Hey doc, I’ve been unwell a few days and did a RAT which was positive” and the Doc replies, “Ok, we’ll I can see based on your age and history you can have a script for an antiviral medication” . Now that is the first 2 minutes. Another 3 to ask the same questions an ambulance officer may ask on 000 to assess severity and need for hospitalisation and another 3 to explain about the antivirals.

GP   20/07/2022 4:26:38 AM

It takes time to assess and safely prescribe COVID-19 oral antiviral mediations. In real-world settings, nirmatrelvir/ritonavir (Paxlovid) treatment reduces the mortality risk more than molnupiravir (Lagevrio) and is currently the preferred first choice in the community setting (non RACFs). Paxlovid has a number of potential complex and serious drug–drug interactions that can result in severe and/or life-threatening side effects, including reducing the drugs’ effectiveness against COVID-19. It takes more than 2–3 minutes to review past history and medication list, assess for drug-drug interactions (using the Liverpool COVID-19 drug interaction checker), review renal function (patients with reduced eGFR need dose adjustment of Paxlovid), provide dosage and pharmaco-education, and then work out a way to safety get the medication to the patient. The new telehealth Medicare item numbers will continue to support us providing comprehensive and safe time-based COVID-19 oral antiviral mediations phone consultations.

Dr Peter James Strickland   20/07/2022 2:11:53 PM

The RACGP has been duped here. To prescribe anti-virals does not take a long consultation, as the new item number will NOT be pragmatically used with respect to Covid scripts. What has to be "set in concrete" is tele long consultations etc for ALL such consultations ---advice on management of everything a GP has to deal with, and especially in rural areas, OR where the patient is elderly or infirmed, and do not have access to transport at the time of the consultation. This unending problem of government treating and insulting GPs via Medicare rebates has to be fought NOW. The RACGP should tell government that ALL GPs will now charge a basic rebate for a standard consult at $60, and to transfer monies from wasted hospital funding to now GP services --it will save them millions in outpatient ED costs, and attract more doctors into general practice. They pay lawyers etc thousands for basic legal work etc, and pay GPs tens to hundreds for similar essential work. RACGP-- get tough!