Practices must adapt to stay afloat as telehealth takes off

GPs have to adapt to stay viable – even by shifting into ‘survival mode’ during the pandemic.
 
That is the message from Dr Emil Djakic, GP and Deputy Chair of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR).
 
He told newsGP that the major telehealth expansion – which came after strong advocacy from the RACGP – will ‘fully empower’ general practice to serve the community.
 
But Dr Djakic stressed that adaptation is essential, given coronavirus is placing financial pressure on an already strained primary care sector.
 
‘I think we can all recognise that the business model that we were all working with last month is now not the same business model. So the goalposts have clearly changed,’ Dr Djakic said.
 
‘We need to recognise that our practices are moving into running on what I would call “safe mode”, and ideally you just need to look at the suite of item numbers that are available at the moment and look at how you can best put them to work so that you’re not finding yourself getting too disadvantaged.’
 
Some practices face the real possibility of having to shut their doors amid the coronavirus downturn.
 
GPs and practice staff have been working overtime with more clinical and administrative time dedicated to responding to the virus, while also facing the risk of infection and lack of personal protective equipment (PPE) an ongoing concern.
 
Prior to the Federal Government’s recent announcement of the expansion of telehealth, Medicare revenue for many practices was down and risk-minimisation measures have meant sub-letting services in clinics have been unable to pay rent, calling into question financial sustainability of the GP workforce.
 
Dr Colin Metz, GP and REC–FHSR member, told newsGP adaptation would depend on whether the practice runs on a bulk-billing or private model.
 
As it stands, the new telehealth Medicare Benefits Schedule (MBS) item numbers need to be bulk billed.
 
With the vast majority of GPs working in smaller non-corporate practices, those who work within a private model are concerned they are unable to privately bill patients.
 
‘If you’re a private-billing clinic, or if you have 30% of your patients privately billed, your biggest issue is [survival],’ Dr Metz.
 
The RACGP estimates that general practice lost $1 billion as a result of the six-year Medicare rebate freeze, which lifted only last year.
 
The freeze meant a number of practices had to increase fees for private patients to meet the cost of inflation.
 
But that is currently not an option without passing on the entire out-of-pocket fee on to the patient.
 
‘We charge patients $80, so the patient would [normally] pay $80 and it would cost them $40,’ Dr Metz said. ‘We’ve now decided to just bill them the $38.20 that we get from Medicare because there’s no rebate for those patients.
 
‘If they were a bulk-billing medical centre before, you can see they’ve got no change to their business model. The bulk-billing medical centres are probably doing better than most businesses, really, because they’ve got all their model back.’
 
The Government has indicated future measures will allow usual billing practices to continue for telehealth consultations; however, no detail is yet publicly available.
 
Dr Metz believes there are still opportunities to boost viability.
 
‘You can also do care plans. So if you don’t have a strategy to do a care plan for the patient, to put a time aside to call in, then you’re going to miss that opportunity,’ he said. ‘I think it just means each practice is different and needs to think about how it affects things.
 
‘With the [telehealth] changes, I think GPs should be quite happy. In essence our revenue is going to go down, there’s no question about it. But we’ve got to be careful not to be bleating when everyone else is really bleeding and we’ve got a little superficial wound.’  
 
Additional support for general practice is being made available through a doubling of the current bulk-billing incentives and Practice Incentive Payments. Other federal, state, territory and private industry initiatives aiming to support small businesses, such as the newly announced JobKeeper scheme and loan repayment deferrals, may also be relevant to practices.
 
Both Dr Djakic and Dr Metz agree that keeping GPs and other practice staff safe and healthy must remain a key focus in keeping practices running. Telehealth will be a significant help, but the need for more PPE is still growing.
 
Dr Mukesh Haikerwal’s clinic, the first to be set up as a drive-thru testing centre for coronavirus in Victoria, is among those facing possible closure due to staff absences, and limited testing supplies and PPE.
 
‘We’ve had no equipment; that’s all being saved for the hospitals. Yet we are expected to keep people out of hospitals, to do as much as we can in our clinics,’ Dr Haikerwal told the ABC.
 
But if general practices are forced to close their doors, where will the patients go?
 
Like most other clinics, Dr Djakic and his staff are taking strict screening measures via phone, while patients wait in the practice car park.
 
‘My practice waiting room today is empty. We’ve probably brought two people into the building,’ he said. ‘We’ve locked the doors so we can control the risks because the key to our business sustainability is making sure our staff stay well and our nurses stay well.
 
‘People that can arrive randomly without adequate screening are simply going to damage parts of the business, because if you lose staff you won't be able to trade anywhere efficiently as you should.’
 
With flu season around the corner and GPs encouraged to start vaccinations soon, practices will need to manage more people.
 
Dr Metz advises allotting a fixed time per appointment dedicated to administering the flu vaccine. These appointments should be done in a separate area of the building so they do not interfere with the ‘safe’ staff area, and patients must arrive and leave on time.
 
‘I think a practice that doesn’t want to shift to looking at how they use these tools is really not looking at how they deal with the current situation,’ Dr Djakic said.
 
‘If you want to sit at your desk and expect to see people turning up and wondering why you’re not doing very well on paper, it’s because you haven’t chosen to adapt.’
 
The Federal Government has said it will continue to work on further expansion of the telehealth model with the RACGP and other peak bodies, with additional changes expected to be announced during the week.
 
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