New reforms could help secure the future of telehealth

Anastasia Tsirtsakis

15/07/2020 4:05:09 PM

Quality and continuity are at the centre of the decision to restrict MBS access to a patient’s regular GP or practice, according to the RACGP.

GP on the phone
Federal Health Minister Greg Hunt hailed the reforms as ‘a major boost for primary healthcare’ after months of lobbying by the RACGP, following growing concerns fragmented care.

The recently announced changes to the temporary Medicare Benefits Schedule (MBS) COVID-19  telehealth items, in effect as of Monday 20 July, will only allow access to a patient’s regular GP or practice.
To be eligible for telehealth, patients must have seen the same GP for a face-to-face service, or another GP at the same practice, in the previous 12 months.
Federal Health Minister Greg Hunt hailed the stage seven reforms as ‘a major boost for primary healthcare’, following growing concerns over pop-up telehealth services offering patients low-value, fragmented care.
The RACGP received positive feedback from members welcoming the changes; however, some GPs have expressed concern about how the changes will be implanted, including those who are particularly vulnerable to COVID-19 and have opted to continue practicing solely through telehealth while they self-isolate. 
Speaking with newsGP, RACGP President Dr Harry Nespolon acknowledged the concerns, but said the reform is a vital step.
‘I understand that some GPs are concerned about these changes and that there may be a degree of inconvenience adjusting to the new telehealth setup,’ he said.
‘However, the changes are absolutely necessary because we need to ensure that patients have continuity of care with their usual GP.
‘This can’t be achieved if patients are accessing opportunistic corporate telehealth pop-up services featuring GPs with no knowledge of the patient’s history or local health services. It may appear to be a convenient solution, but you are very unlikely to speak to the same GP twice.
‘To put it simply – telehealth works best if the GP knows the patient.’
Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform, told newsGP the  changes are a concern ‘for GPs who feel vulnerable and aren’t seeing patients face-to-face’.
‘However, those GPs will still be able to see all the patients who they’ve seen before and, potentially, as those doctors are isolating, new face-to-face patients could be seen by other members in their practice if possible.
‘The patient can have seen any doctor in the practice, and then if there’s a doctor who wishes to provide care via telehealth they can do that once the patient has a relationship with the practice.’
There has also been apprehension for rural and remote patients, for whom there can be a significant wait time to get an appointment through their regular practice.
But Dr Wright is confident the changes will not affect existing telehealth services in these areas. 
‘It’s really important that patients in rural and remote areas can continue to access care,’ he said.
‘These changes don’t impact the telehealth items that already existed for patients in rural and remote areas [prior to the pandemic]. So they’ll still be able to access those services.’
The restrictions, Dr Wright said, represent a return to the originally intended purpose of the temporary item numbers – ensuring continuity of care during the current health crisis.
‘The telehealth items were introduced as part of our effective early response to COVID, and to support patient access to care during the pandemic,’ he said.
‘When they were initially announced they were linked to patients having access to a regular GP or practice, and then when the pandemic reached its peak, telehealth was expanded so that the link to a usual GP was removed.
‘But now, as the use of telehealth becomes more normalised, we’re going back to the setting of telehealth being available through a regular GP or practice. The importance of this is that it’s supporting continuity of care and better coordinated care with patients seeing their regular provider.’

RACGP President Dr Harry Nespolon has acknowledged the concerns about the changes to telehealth, but said the reform is a vital step.

Since the MBS items were introduced in May there has been considerable uptake by patients.
In May alone, around 30% of all GP consultations were conducted via telehealth: 4,255,483 by phone and 129,045 using video.

The total number of face-to-face and telehealth services provided was 12,803,177, a decrease of more than one million services compared to the number of face-to-face services in May 2019. This likely reflects changing patient behaviour and the push for earlier influenza vaccinations in 2020.
‘The availability of telehealth has been a great advance,’ Dr Wright said. ‘We’re learning rapidly where it’s most useful and of most benefit, and the evidence is showing it’s of most benefit to patients who already have a relationship with the practice.
‘So it’s understandable that resources are being focused on that.’
Dr Nespolon agrees.
‘It is clear that telehealth has an important place in general practice, but not if it comes at the cost of fragmented care,’ he said.
‘An existing GP–patient relationship, where rapport has been built via a face-to-face visit and there is knowledge of a patient’s medical history and local services, is central to telehealth’s success both during and, I would hope, beyond the pandemic.’
The new requirements will not apply to areas of Victoria under currently under stage three restrictions, nor to infants under the age of 12 months or people who are experiencing homelessness. Any further exemptions will be considered by the Government as it deems necessary.
While the temporary telehealth item numbers are due to end on 30 September, there has been speculation they could be extended, with Minister Hunt saying he intends for ‘telehealth to be a positive legacy of this crisis’.
The RACGP is among the medical organisations engaging with Government to ensure telehealth is offered beyond the pandemic, and to remain a permanent fixture of general practice.
Dr Wright says the reforms to telehealth are a step in the right direction.
‘What we’re trying to do is ensure that telehealth can continue beyond 30 September in a way that supports comprehensive general practice care, but which is affordable for our health system,’ he said.
‘These changes are potentially part of the solution for guaranteeing ongoing telehealth access for general practice.
‘By removing the telehealth pop-ups, these changes will make funding for telehealth more sustainable.’
As confirmed cases of coronavirus continue to rise in Victoria – 238 on Wednesday 15 July – and new hotspots emerge in NSW, the unpredictable nature of the pandemic means the telehealth model will likely continue to evolve with it, according to Dr Wright.
‘Telehealth is changing as the pandemic affects the ability for GPs and patients to leave their homes,’ he said. ‘Things may change again.
‘The RACGP is continuing to monitor the impact of these changes, and if there are any providers who are adversely affected, then please, let the college know and we will feed them back to the Department of Health.
‘We will continue to advocate for you.
‘We’re just trying to find the best system to allow GPs to provide the highest quality of care for their patients.’
newsGP understands that the RACGP is in ongoing discussions with the DoH, and that the college will continue to keep members updated.
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In order to inform its ongoing advocacy on the retention of telehealth, the RACGP is seeking member feedback on what the change to telehealth will mean for GPs and their patients.

Answers to frequently asked questions related to the new telehealth changes can be accessed on the RACGP website.

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Dr Jo-Anne Joy Zappia   16/07/2020 11:39:52 AM

I think the restriction limiting Telehealth to patients who have attended a practice within the past 12 months is too low. Raising this to 5 years would help patients access a doctor they may not have seen recently but whom they still consider to be "their" GP. Working in a private-billing clinic, I am very aware that many of my patients go to a random bulk billing clinic for what they consider to be simple things like a cold, medical certificate etc and come back to me when they are more worried about their health. That may only be every 3-4 years. In particular, my counselling patients, with whom the relationship is so very important, who have completed their initial therapy, might come back every couple of years for an update depending on life circumstances. It would be awful to have to decline Telehealth for those patients, or insist they attend a FTF visit in-clinic if they (or the doctor) are compromised.

Dr Carol Leanne Lawson   16/07/2020 2:50:37 PM

I agree that 12 months is too low. Many people would not access their GP in a 12 month period, but still consider a particular GP or practice as 'their GP'. Five years (or even 3 years) would be better. In may circumstances, telehealth consultations are safer for doctor or patient or both. It seems a pity to jeopardise patient and doctor safety by insisting on a face-to-face consult simply for administrative reasons.

Dr Vincent Edwin Russell   16/07/2020 7:08:09 PM

These new rules don’t take into account the population of GPs who specialise in certain areas, and are referred patients by other doctors and health care providers. My partner is a GP who specialises in sexual health, is an HIV prescriber, works for a community sexual health clinic, but who herself has had to reduce direct patient contact. Does this mean she will no longer be able to provide Telehealth services for these patients?

Dr Tim Kirchler   16/07/2020 8:57:46 PM

" those doctors are isolating, new face-to-face patients could be seen by other members in their practice if possible." Not much use if you're the only GP in your workplace. Also no help if you have vulnerable patients who haven't seen a GP anywhere in over a year, or are travelling away from home, or are seeing a different GP for complex mental health needs, HIV care, sexual and reproductive health or other clinically appropriate reasons. So many details that haven't been considered in the rush to push through this ill-conceived plan, let alone the added transmission risk it brings!

Dr Tanya Smith   17/07/2020 6:56:31 AM

Thanks for these stats. Analysing them it seems that video consults by so called pop up video services amount to a very low percentage of items claimed. Total video items constituting just over 1% and a lot of these will be by bricks and mortar practices. Blocking these items for the sake of a very generous estimate of .2% of claims is not going to pay for anything long term and in the process has blocked a bunch of new patients getting help from FTF practices as a lot of practices will not see patients without remote consults. This further discriminated against our more transient younger and hard working population. If the RACGP was really concerned about low value items of service claims it would lobby to change rules on medical certification expiring scripts and allow nurse practitioners and pharmacies to do more. This has been a political move and one that is anti progressive in its approach to future primary care.