Patients denied care due to telehealth rule uncertainty

Jolyon Attwooll

5/05/2022 6:25:56 PM

The RACGP President is urging for patients to be prioritised amid concerns about confusion surrounding the 12-month rule exemption.

Elderly lady on telehealth call
Rules surrounding the use of telehealth have fluctuated considerably since the pandemic began.

Patients who have COVID-19 have missed out on telehealth care due to confusion over the rules, the Department of Health (DoH) has been told.
Under the rules, a patient must have an existing relationship – in precise terms, to have had a face-to-face appointment within the past 12 months – within a general practice to be eligible for bulk-billed telehealth by a GP at that practice.
In the face of the pandemic, however, there is also an exemption to the rule in place with the requirement waived for patients in isolation with confirmed COVID-19.
The DoH has acknowledged that patients with COVID-19 or confirmed close contacts have reported being denied care or being charged privately without receiving a Medicare rebate for telehealth appointments.
COVID-19 patients have reportedly informed the DoH GPs referred to the ‘existing relationship’ requirement as a reason for not providing a Medicare rebated service.

RACGP President Adjunct Professor Karen Price says she has also heard of widespread confusion among GPs and general practice staff.  

‘We’re getting reports from doctors, patients and medical defence organisations … [of] requests for clarification on this issue,’ Professor Price told newsGP.

‘When doctors are struggling to interpret rules, that is not a good system.’

In the context of COVID-19, unrestricted access to telehealth services is available to patients who are:

  • confirmed cases in isolation – either through a PCR test or rapid antigen test; typically seven days’ isolation in most jurisdictions
  • in isolation due to being a close contact of a confirmed COVID-19 case – this will be happening much less than previously, given that governments in Victoria, NSW and ACT have all removed mandatory isolation rules for non-symptomatic close contacts
  • in quarantine – again, the number of people in quarantine has now dramatically reduced with the lifting of the most travel restrictions. However, the rules vary state by state and quarantine requirements remain in place in some places – for example for unvaccinated Australians returning from overseas to Western Australia
  • potential cases awaiting the outcome of a PCR test.
There are also other exemptions for some patients outside of the COVID-19 setting, including for people experiencing homelessness and babies aged less than 12 months.

However, COVID-19 patients who have been admitted to hospital or are being treated through the Hospital in the Home system are not eligible for unrestricted telehealth care.

GPs using an exemption to the existing relationship requirement need to record ‘appropriate justifications’ when claiming, according to the DoH – for example a record of a positive PCR test.

The rules surrounding exemptions for the 12-month rule for telehealth treatment of patients who report COVID-19 through rapid antigen tests are less clear.

The college is currently clarifying the detail of processing telehealth exemption claims for patients with COVID-19 with the DoH and Services Australia.

For Professor Price, the imperative of giving the best possible care should be at the heart of any approach.

‘We don’t want this to get in the way of actually serving the public with healthcare,’ she said. ‘I can’t stress it enough – patients must be looked after, that is our first calling as physicians.’

The RACGP President also underlines the importance of a common-sense approach to compliance and believes that some GPs may not be seeing COVID-19 patients via telehealth due to concerns about the Professional Services Review (PSR).

‘What we don’t want in our medical practice system is that GPs are afraid to see patients because they’re worried about compliance,’ Professor Price said.

‘We’ve suggested very strongly to the regulatory bodies that we need to have an educative process and not a punitive one. We’ve certainly been advocating for that very strongly.

‘You would think there would be some common sense and reasonableness based on this, and I would hope that’s the approach the Health Department will take.’

The DoH has acknowledged that the changes to telehealth eligibility are likely to have created some confusion.
Professor Price says she has been pleased to see recognition that doctors have been working under challenging circumstances with frequent rule changes.

The 12-month rule first came into force in July 2020. The direction is designed to stop opportunistic pop-up clinics from supplying telehealth services and fragmenting care provided with an existing GP or practice.
Earlier this year, Professor Price wrote to the DoH to request an exemption to the 12-month rule for immunocompromised GPs and GPs in isolation to allow them to continue treating patients.
Telehealth was widely introduced at the beginning of the pandemic, with the DoH confirming the arrangements would be made permanent last year.

Following the spiralling case numbers caused by the Omicron variant, the Federal Government has deferred until July a rule designed to cap the number of telehealth phone consultations GPs can carry out.
The latest MBS fact sheets on telehealth are available on the MBS website, as well as the latest ‘existing relationship’ guidelines.
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Dr Ailsa Mary Carole Laidlaw   6/05/2022 8:15:04 AM

The 12 month rule is unnecessarily restrictive. Extending it to 3 or 5 years would allow infrequent patients of a practice while still stopping the "pop-up " clinics.
It is a typical example of Canberra bureaucratic overreach. All federal health department staff dealing with general practice should be mandated to spend a week in General Practice. Then, perhaps, they would stop terrorising GPs with their extreme rule impositions.

Dr Suzette Julie Finch   7/05/2022 12:30:40 AM

Agreed, I was thinking this exact sentiment today. Bureaucrats should have to have recent ground level experience of the situation they are legislating on. Management 101 - you can't manage what you don't understand.

Dr Simon Oon-Teong Ooi   10/05/2022 6:49:20 PM

It wasn't bureaucrats who wanted this rule; it was insecure GP's who were afraid of loss of income. As an immunocompromised GP, I've had to work at another clinic for income.
Stupid rule. Scrap it please, Karen Price.

Dr Naomi Ruth Fraser   14/05/2022 7:56:09 AM

Telehealth is not a great way to provide quality primary health care but it serves a purpose. I think it should be used more widely to help our regional GP’s in areas with a doctor shortage. Now that there are patient records more readily available through My Health etc it could work to have this option when a patient can’t get an appointment with their own GP for a few weeks.. Certainly a much safer option than the proposed Nth Qld Pharmacy trial. The existing ‘relationship’ rule would need to be reviewed.