Long phone consultations end in NSW with hotspot change

GPs in New South Wales are no longer entitled to do most longer phone consultations as part of the Medicare Benefits Schedule (MBS), after the state’s ‘hotspot’ status ended late on Sunday night.
 
The designation is adjudicated by the Chief Medical Officer Professor Paul Kelly, who confirmed that all areas in NSW would no longer be viewed as hotspots from Monday 18 October, only hours before the regularly updated status was due to expire.
 
The announcement published on the Department of Health (DoH) website cited reaching the 80% vaccination target as a trigger for rescinding the hotspot status.
 
Analysis by newsGP, however, suggests that almost half of the local government areas (LGAs) in NSW have not reached 80% double-dose coverage. Of the 128 LGAs in the state, 63 were below 80% fully vaccinated in figures current as of October 17, mostly in regional and remote areas.
 
It means the MBS item number re-introduced in July to allow telephone consultations lasting longer than 20 minutes for patients in the areas most affected by outbreaks are no longer valid in the state.

A DoH spokesperson told newsGP ongoing telehealth arrangements ‘remain under consideration’ by the Federal Government but would not be drawn on whether longer telephone consultations are likely to be reinstated in full.
 
Aside from funding longer telephone consultations, it had also exempted GPs from needing to have had a face-to-face consultation with the patient within the past 12 months – a requirement of other telehealth MBS numbers introduced during the pandemic. 
 
The only exception allowing continued use of the hotspot number is for patients in quarantine or isolation, or who are themselves in a hotspot elsewhere.
 
The RACGP has consistently called for longer telephone consultations to stay within the MBS, particularly for communities with high numbers of COVID-19 cases, and is continuing to advocate for a medium-term solution as Australia transitions to living with COVID.
 
The MBS item number (92746) has been well used by GPs in NSW and Victoria, the states most affected by the Delta outbreak since it took hold in June. There were 126,253 claims processed in NSW during July and August, the latest months for which figures are available from Services Australia.
 
Video consultations longer than 20 minutes will still be funded through MBS items at least until 2022, although GPs have regularly raised concerns that the technology is often inaccessible to many of the most vulnerable patients.
 
Longer items for telephone mental health consultations will also remain until at least the end of the year.
 
For Dr Michael Tam, a Sydney GP and Conjoint Senior Lecturer at the UNSW School of Population Health, the timing could be problematic. He again mentions that more disadvantaged patients are often less likely to access video telehealth.
 
‘For people seeking care, they are either going to miss out or there will be a very sudden push back to face-to-face in-person care,’ he told newsGP.
 
While he welcomes a move to more ‘business as usual’ in NSW, he warns against limiting the use of the MBS item number too early.
 
‘I have some concerns about the pace of the return. We have recently reached 80% fully vaccinated but nonetheless there are still significant residual populations who are not fully vaccinated,’ he said.
 
‘The removal of access to these services has come fairly quickly in the recovery from the outbreak, particularly with the relaxation in some of the restrictions.
 
‘It is expected that case numbers will rise, so I wonder if the removal of these items is premature.’
 
Hotspot status also allowed the Commonwealth to provide personal protective equipment (PPE) from the national medical stockpile, a change Dr Tam says could also impact general practice.
 
‘Access to PPE wasn’t terribly good in the first place, but anything is welcome,’ he said.
 
The only remaining areas that still have hotspot status are all in Victoria, including all of metropolitan Melbourne as well as the Mildura local government area.
 
Several parts of Tasmania were also temporarily designated as hotspots due to a snap, three-day lockdown over the weekend, but that status is due to end at 6.00 pm on Monday 18 October.
 
Meanwhile, hotspot status for the majority of the Victorian local government areas is currently scheduled to end this Thursday (21 October) after late extensions were granted earlier this month.
 
However, if the DoH follows the same approach as for NSW – when hotspots status ended following 80% of double-dose vaccination coverage being reached – then they are likely to be extended again.
 
According to CoviDBaseAU, one of the most accurate vaccination and COVID-19 tracking websites, Victoria is likely to reach 80% double-dose coverage on October 30.
 
The majority of MBS numbers specifically geared towards COVID-19 telehealth will remain in place until the end of the year.
 
These include MBS numbers 91890 and 91891 for phone consultations less than six minutes and lasting 6–20 minutes respectively. The latter in particular has been heavily used, with 5,701,442 MBS items processed over July and August alone.
 
Federal Health Minister Greg Hunt in April confirmed most telehealth item numbers – with the exception of longer telephone consultations – would continue until 31 December after they were adopted swiftly at the beginning of the pandemic to help safeguard access to care.
 
That stance on longer phone consultations was reversed in mid-July as the seriousness of the Delta outbreak became clear.
 
The April announcement also signalled the likely continuation of telehealth beyond the end of this year, saying the Government was working with ‘with peak bodies to co-design permanent post pandemic telehealth as part of broader primary care reforms.’
 
An up-to-date guide on the recent changes to telehealth items is available on the RACGP website.
 
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