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Longer phone consultations not part of telehealth extension


Matt Woodley


27/04/2021 4:48:52 PM

Medicare support for phone consultations longer than 20 minutes will end after 30 June, provoking a strong response from the RACGP.

Female doctor putting the phone down
The decision to remove patient rebates for longer telephone consultations will especially impact female GPs and their patients.

Patients will only be able to access Level C and D telephone rebates from the Medicare Benefits Schedule (MBS) until the end of the financial year, despite the RACGP strongly advocating that they remain available to general practice.
 
The clarification comes after Health Minister Greg Hunt recently announced the scheme’s temporary extension until 31 December, in an effort to allow the Federal Government to work with peak bodies to ‘co-design permanent post-pandemic telehealth’.
 
However, RACGP President Dr Karen Price told newsGP she is disappointed the Government did not heed calls from the college to maintain MBS support for longer phone consultations in the extension and said vulnerable patients will be impacted most.
 
‘Many of the patients who benefit the most from telehealth are also the most disadvantaged when it comes to internet connectivity and reliability,’ she said.
 
‘By not allowing these patients to access fully-funded longer telephone consultations with their GP, we risk leaving them behind – not only during a once-in-a-generation pandemic, but for the years beyond.
 
‘I urge the Government to reconsider this position when drafting the framework of the long-awaited permanent solution to telehealth that this country desperately needs.’
 
Dr Price added that the decision will particularly impact female GPs, who on average provide longer consultations than their male counterparts, and their patients.
 
‘We believe this is a gender blind approach to policy,’ she said. ‘It does not take into account the impact this will have on women’s health services, mental health patients who require much more than a 15 minute consultation, and rural and remote women seeking assistance.
 
‘This is a blunt policy that does not recognise the complexity of the work that GPs do.’
 
An RACGP literature search conducted earlier this year found that while face-to-face consultations remain the ‘gold standard’, telehealth is a suitable alternative for many types of patient interactions, including for follow up care or chronic disease management for regular patients.
 
And while more research is require into the benefits of video over phone consultations, patient outcomes were generally comparable, with no consistent differences in patient mortality or patient satisfaction.
 
It also found that technical problems with video consultations are common and that infrastructure issues need to be addressed before the technology can become part of mainstream primary care.
 
These issues, combined with patient unfamiliarity and lack of comfort with using videoconferencing technology, have also meant that telephone consultations were used more frequently.
 
Aside from impacting on patient care, Dr Price said the decision to not fund longer telephone consultations will likely end up costing more money in the long-term.
 
‘From an economics perspective, we have argued strongly that while there has been a marginal increase in total general practice services following the introduction of telehealth, no one knows what the appropriate service level is during and post a pandemic,’ she said.
 
‘There have been well-documented increases in demand for mental health services, as well as some service shift from emergency departments to general practice, along with patients wanting to catch up on important appointments that were skipped last year as a result of the pandemic.
 
‘We know prevention is better than cure, in terms of both patient outcomes and healthcare costs, and that no other specialisation provides better preventive healthcare than general practice.
 
‘It’s time to support GPs so we can continue to help provide a brighter and healthier future for all Australians.’
 
The Department of Health has been contacted for comment.
 
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Dr Jaqueline El-Masry   28/04/2021 7:43:20 AM

I’m a Female GP in Melbourne.

I am surprised that video conferencing is being so easily dismissed. My practice had a recent death of a patient who had a phone consult, and it seems her condition was not ‘seen ‘ well. Seeing a patient’s face and body language tells a lot more than listening to the words and trying to read the nuances of voice quality.

I’ve also used the ‘share screen’ function on videoconferencing to share results, or share diagrams, or discussing use of medications eg ventolin, or devices if discussing contraception.

Quality of care is being jeopardized.

I have several patients with mental health issues, or English as a second language, and this is not 20 minute medicine. I see less numbers of patients because of that. I believe this is the case with most female GPs, and there is a larger proportion of females in Family Medicine, who have longer consult times.

We are still practising medicine, just through a different medium.


Dr Henri Gustav Becker   28/04/2021 9:24:58 AM

the government is destroying general practice and it won't be us the most affected it eventually be the patients .We have no power over the government decisions , because , unlike some other countries we and our patients are dependent on a single payer and unlike some other countries we do not have a union or syndicate with a legal power of going into strike .
May be it is time to consider a fund which will allow the GPS to suspend temporarily non urgent services and get some attention.


Dr Ian   28/04/2021 11:31:05 AM

The phone consultations are great and ought stay forever for they encourage follow up as regards how are patients feeling reporting to patients on results and checking in on depression and other challenges .
The long consults ought also stay for better care and to check whether a patient understood instructions and for social interaction as well society needs it .
Full exam seeing the patient is better sometimes and sometimes critical and the Medicare benefit favours this .
Racgp and GPs job well done - keep plugging away .


Dr Peter James Strickland   28/04/2021 11:51:55 AM

The first thing is that gender should NOT be brought into consultation length as Karen Price has inferred. Male and female doctors possibly do work at different rates, but males deal with more complex workers compensation, surgery, orthopaedics and diagnosis, whereas female doctors spend more time on women's health and psychological consultations. However, all doctors work at different rates, but after 50 plus years of experience males work more full-time, and as such have more experience in actually getting to a diagnosis and treating problems quicker than females. As well, some male specialists I have seen work too quickly, and as such do NOT support the emotional sides of their patients' health, whereas the female specialists are much better here in general. Controversial, you bet! But true.


Dr Samantha Ann Bryant   28/04/2021 2:08:37 PM

So close contact for covid risk is greater than 15 mins in close environment together.
So the most at risk consultations longer than 15mins are allowed in person but have been taken away from safer telephone/Telehealth consultations . So this just demonstrates how the government really values GPS and the work they do. They DO NOT. And more patients will end up at emergency departments and mental health services and calling ambulances which apparently are already over stretched with their care services. It is very disappointing that GPS keep stepping up for their communities and the government fails to value their input in any real meaningful way often.


Dr Henry Arthur Berenson   28/04/2021 5:16:23 PM

I have no problem with shorter telephone consults, however access to longer video engagement with patients allows complex issues to be addressed with facial feedback that enables adequate assessment of the patient's response. I have not been able to achieve that during a phone call.


Dr Peter JD Spafford   28/04/2021 7:02:51 PM

Phone consults should never have been at the same rebate (and I stress rebate) as face to face. So this is a misdirected attempt by the Government to rationalise spending on that sector. If they just reduced the amount of rebate per item it would make more sense.


Dr Muhammad Hafizei Muhammad Nasir   28/04/2021 11:30:49 PM

Just an anecdote, possibly inadequate to argue with but to emphasize my point, let me share this. A friend works in an industry supplying items for NDIS clients. When he visited a house to deliver, the client has already 4x working wheelchairs and is being delivered a powered, new one. It was quoted to client (essentially NDIS ought to eek this out) quite higher than what manufacturer is charging. Now, don’t get me wrong as I recognize the funding system is there for good reasons. But could I then ask, why take the money from doctors - the good guys? Or are we not.