MBS telehealth reform extended to medical deputising services

Approved medical deputising services (AMDSs) will only have access to the COVID-19 telehealth items under the Medicare Benefits Schedule (MBS) if they have a formal agreement in place with a general practice to provide services to its patients.
 
And patients will only be eligible to obtain a service through an AMDS if the practice has provided, or arranged, at least one service for the patient in the past 12 months.
 
The AMDS will be providing services for and on behalf of the patient’s usual general practice.
 
The new requirements are part of the Health Insurance (Section 3C General Medical Services – COVID-19 Telehealth and Telephone GP Attendances) Amendment, in effect from today, 20 July, with the intention of ensuring greater continuity of care during the COVID-19 pandemic.
 
Dr Nathan Pinskier, member of the RACGP Expert Committee – Practice Technology and Management (REC–PTM) and President of the General Practice Deputising Association (GPDA), welcomed the reform as a great move for patients and the profession.
 
‘The inclusion of medical deputising as the extension of the practice for and on behalf of the regular practitioner is an appropriate move,’ he told newsGP.
 
‘Otherwise doctors and practices will be having to provide their own after-hours.
 
‘It would also be creating a risk for deputising doctors whereby they couldn’t do telehealth services. We [would] then have to go and see the patient face-to-face where it may not always be necessary, and that creates a potential infection control risk as well.
 
‘I want to actually thank the RACGP for its strong advocacy in ensuring that medical deputising was included in the ongoing MBS telehealth item numbers. It’s a great outcome for the industry.’
 
The stage seven telehealth reforms are a return to the original eligibility criteria for the government-funded items when they were introduced in March, requiring an existing relationship between the practice and patient, with that patient having seen the GP or another health professional at the practice within 12 months of access to the telehealth service.
 
The loosening of this original requirement saw the emergence of entrepreneurial pop-up telehealth services, providing consultations to patients anywhere around Australia without a physical presence and unconnected to a patient’s regular GP.
 
‘That was, I think, probably an unintended consequence of the item numbers,’ Dr Pinksier said.
 
‘In our view that is an inappropriate model, doesn’t allow for continuity of care, [and] it creates clinical risk and undermines the fabric of traditional general practice.’
 
The inclusion of approved AMDSs as part of the new reforms is to be an extension of the care provided by a patient’s regular GP or practice after hours, for care that cannot be reasonably delayed until the next working day.
 
Without the amended legislation, Dr Pinksier said while access to telehealth may be convenient for patients, granting open access without the need for an established relationship is ‘problematic’.
 
‘It’s easy and simple to pick up the phone … because the service is there,’ he said.
 
‘But in terms of best practice, continuity of care, that’s problematic in terms of them writing a note back to the regular practice. They don’t have a relationship – how do they do that? So clinical handover is disrupted, and that may lead to clinical risk and adverse outcomes.
 
‘We have a requirement under our accreditation to send a clinical encounter note back to the practice the following day. So you’ve got that continuity of care – we’re acting as an extension of the practice, not competing with it.
 
‘It’s a better model; we are part of the practice, in effect.’
 
Answers to frequently asked questions related to the new telehealth changes can be accessed on the RACGP website.
 
The RACGP has also developed a series of telehealth resources for guidance.  
 
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after-hours MBS medical deputising service telehealth