17 Nov 2022

MBS clarity needed to boost long COVID care: RACGP

17/11/2022 3:05:51 PM

Medicare flaws must be addressed to help mitigate the ‘far reaching’ impact of long COVID, a college submission to Parliament has said.

GP consult with older lady
The system is not set up for the best care for long COVID, according to the RACGP President. (Image: Craig Moodie)

The RACGP has called for MBS inadequacies to be addressed to allow the best possible care for patients with long COVID.
In a submission to the Parliamentary Inquiry into long COVID and repeat infections, the college identifies hesitancy surrounding MBS item numbers as one of several factors detracting from optimal support for patients.
‘The impacts of long COVID are far reaching and cannot be underestimated,’ the RACGP submission states.
Stressing the need for coordinated GP-led care, the submission says confusion among GPs over the use of MBS item numbers 721 (GP Management Plan) and 723 (Team Care Arrangements) is hampering care.
According to the definition of the item numbers, they apply to ‘a patient who suffers from at least one medical condition that has been present [or is likely to be present] for at least six months or is terminal’.
‘Due to the presentation of patients with long COVID earlier than six months from initial illness and the unknown sequalae of long COVID and likely recovery time, there is some hesitancy in utilising these item numbers,’ the submission states.
‘[This reduces] patient access to early, subsidised and coordinated multidisciplinary care, and the opportunity to reduce the burden of disease.’
While askMBS advised that use of the items ‘is essentially a matter for the GP to determine using clinical judgement’, the college says ‘the unique circumstances’ of long COVID means further clarity is needed ‘to provide surety to clinicians and … access to appropriate services for patients’.
RACGP President Adjunct Professor Karen Price also believes the system is skewed against the type of care required for long COVID.
‘The current Medicare rebate structure disincentivises GPs spending longer amounts of time with patients with multiple, complex conditions,’ she said.
‘Long COVID patients with other chronic illnesses fall squarely into that category of patient and this further highlights the need to reform the system by increasing rebates for longer consultations so that GPs can take the time to really get to the bottom of what is going on.’
According to the college, greater access to subsidised allied health services should also be provided to allow the effective treatment of the condition.
‘Long COVID patients with other chronic illnesses have often already exhausted their five subsidised allied health sessions, limiting their access to appropriate care,’ the submission noted.
The submission also included a number of other recommendations, including greater funding support for long COVID clinics with a focus on allowing equal access for patients in rural and remote communities.
The condition also needs to be more clearly defined, the RACGP contends. While noting that the World Health Organization (WHO) has given a clinical definition, the college says there ‘remains a lack of a formal agreed definition of long COVID, which has created uncertainty for patients and clinicians’.
Echoing the calls for more localised and detailed data made in the Inquiry’s opening public hearing, the RACGP also drew attention to the embryonic nature of evidence and the need for more information to inform clinical care.
‘The prioritisation and synthesis of emerging international research on this topic, and grading of this research to provide guidelines, is a crucial undertaking to enable healthcare providers to best manage initial COVID illness and long COVID,’ the submission reads.
‘Key to developing this understanding is research into long COVID and repeat COVID infections, with an increased focus on the Australian context.’
It says Australia’s highly vaccinated population and low initial case numbers make the country distinct from the US and UK, where large outbreaks took place before vaccines became available.
The correlation between vaccination and long COVID, the link between repeated infections and the condition, as well as the impact of antiviral treatments and different variants, and different care regimens are other gaps in current knowledge that the college says need attention.
The RACGP also believes more funding for primary care research would support the effective management of long COVID.
Less than 1% of National Health and Medical Research Council (NHMRC) funding goes to primary healthcare projects, the submission states, with a similar proportion allocated to primary care in the Medical Research Future Fund (MRFF) 10-year plan.

‘We need to be able to rapidly generate evidence from primary care where the majority of healthcare is undertaken, and this would facilitate larger studies relevant to long COVID,’ the college states.
‘However, without data on its prevalence and severity we cannot know the true cost of the illness on individuals and their communities.’
Professor Price, in the meantime, called for a detailed long-term plan.
‘While it’s vital we do everything possible to help long COVID patients in the here and now, we must also look ahead because this public health problem is not going away anytime soon,’ she said.
Submissions to the inquiry close on Friday 18 November. Further details are available on the Inquiry website.
The RACGP also has resources about caring for adult patients with post-COVID-19 conditions on its website.
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