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RACGP calls for immediate exemption to 12-month telehealth rule for vulnerable GPs


Anastasia Tsirtsakis


10/02/2022 3:39:08 PM

The college is urging the Federal Government to change compliance rules to allow immunocompromised GPs and those in isolation to safely continue caring for patients.

A GP doing a telehealth consult from home.
There are concerns patients may be missing out on receiving care from their usual GP or practice.

RACGP President Dr Karen Price has called for changes to the telehealth compliance rule in an open letter to the Department of Health.
 
Addressed to Daniel McCabe, First Assistant Secretary of Benefits, Integrity and Digital Health, Dr Price notes that the high demand for general practice care in conjunction with the high likelihood of exposure to COVID-19 is impacting general practice’s workforce capacity.
 
‘An exemption from the existing relationship rule for immunocompromised GPs and GPs in isolation for patients known to the practice [eg patients who have been to the practice within the last 24 months] would increase workforce capacity at this critical time,’ the letter reads.
 
The Federal Government first introduced the 12-month compliance rule for GPs in July 2020, stipulating that a practice could only provide rebated telehealth services under the Medicare Benefits Schedule (MBS) to a patient that has been seen by a GP at the practice face-to-face in the preceding 12 months.
 
The rule was intially introduced to stop opportunistic telehealth-only pop up clinics from fragmenting care by ensuring patients had an existing realtionship with the GP or practice providing the service.

But with the risk of COVID-19 transmission so high since the emergence of Omicron, Dr Price said it is ‘not pragmatic’ for immunocompromised GPs and those in isolation, particularly given the demand for care.
 
‘Two years into the pandemic, it’s become apparent that this rule doesn’t always work as intended,’ Dr Price said.
 
‘GPs with serious health issues making every effort to keep themselves safe from harm during this pandemic are hamstrung by this officious requirement.’
 
GPs have been vocal about the impact of having staff furloughed and unable to work on the delivery of patient care since the Delta variant became widespread in 2021.
 
But with Omicron even more infectious, Dr Price said that there are concerns patients are missing out on receiving the care that they need from their usual GP or practice, at a time when general practice and the entire health system is ‘under enormous strain’.
 
‘We should be doing all we can to maximise our capacity to see patients via telehealth,’ she said.
 
‘If the individual seeking a telehealth consult is an existing patient of the practice, either via face-to-face or telehealth, let’s provide an exemption from the 12-month rule and let common sense prevail.’
 
Melbourne GP and practice owner, Dr Todd Cameron has been a vocal advocate around making the telehealth criteria more patient-friendly and understands the complexities GPs face when navigating patient care and risks to their own health.
 
‘One of my practices has a doctor that has not seen a patient physically since the outbreak of COVID and that is because he has a family member who is immunocompromised,’ he told newsGP.
 
‘He believes the risk is too high of taking it home … and so he’s not interested in seeing people face-to-face and we have just managed it as a team-based option.’
 
But if the 12-month telehealth rule were to change, potentially giving more GPs the chance to work from home when needed, Dr Cameron said practices would need to ensure that there are GPs on site to see patients face-to-face if needed, given the majority of telehealth services are delivered via phone.
 
‘There are a group of patients that are highly appropriate for telehealth … [but] there’s a lot of stuff that obviously must be done in person,’ he said.
 
‘The group that presents the biggest challenge is the middle group, those that it isn’t certain or it depends on the context. A lot of these will start with telehealth and then what will happen is they will have to be transferred to face-to-face.
 
‘[So] you need to have some kind of buddy system whereby you can hand them off for a physical examination.’
 
Dr Cameron said his clinic is not alone in operating this way, with many in Melbourne already having adopted a similar model.
 
Reflecting on general practices’ contribution to delivering care during the pandemic, Dr Price said the sector has played a ‘vital role’ and is continuing to step up with managing thousands of COVID-positive patients and delivering vaccinations, all while providing regular care.
 
Despite these efforts, however, the college president said that GPs are often having to look over their shoulder ‘in fear of receiving a compliance letter’ due to not strictly meeting the letter of the law.
 
‘The RACGP has previously warned the Health Department that the 12-month requirement came at a time when GPs were struggling to navigate complex and rapidly changing compliance requirements for telehealth and doing their best to care for their patients in a pandemic,’ Dr Price said.
 
‘So, my message to the Government is simple – please aim for a common-sense interpretation and enforcement of Medicare rules for telehealth.
 
‘Let’s amend the 12-month requirement for immunocompromised GPs and those in isolation right away and ensure all GPs can safely provide the care their patients need.’
 
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Dr Jeanine Suzanne McMullan   11/02/2022 8:53:18 AM

GPs should have the same provisions as Australian public servants.
https://www.apsc.gov.au/circulars-guidance-and-advice/circular-20206-temporary-mobility-arrangements-part-continued-response-covid-19


Dr Shyamala Hiriyanna   11/02/2022 12:32:09 PM

I am also scared of seeing people F2F specially Unvaccinated. I don't see why the benefit of Telehealth is not recognised. It is so hard to get people to R/T for follow up. You should see my recall list. So many people are working from home. It is easy fit the consultation some time, rather than taking time off. Any system can be misused. Why punish every one? Why no one is thinking of Doctor's mental and physical health?


Dr Harsh Aggarwal   11/02/2022 10:36:54 PM

I am a little confused. Isn’t the 12 month rule more about keeping the spirit of ‘doing the right thing’ in place? In which case that as GPs we don’t comply is more the exception rather than the common? And if it is more the exception how come the RACGP is lobbying for it…I mean I am glad they lobbying for something…
I just feel that this lobbying from RACGP is not for the everyday GP it is more for “friends with deep pockets”


Dr Peter James Strickland   13/02/2022 8:32:39 PM

This has always been my whole argument ---- Medicare is run by public servants, and they are the ones causing the bureaucracy. The problem relates around GPs doing so much work for the public free since Medicare(Medibank) began. Advising patients (and others) for free over the phone, writing scripts for free (esp. for nursing homes), not being able to bulk bill ALL patients to Medicare plus add an additional charge for the patient to pay according to their means and/or the Item number involved. To pay less than $40 for a standard diagnostic consultation is an absolute outrage when compared to what these bureaucrats get paid daily (plus benefits such as holidays, super etc) giving advice behind a desk, AND the amounts paid to others such as lawyers in private practice with respect to consultation fees. STOP bulk billing everyone should be the advice from the RACGP until the system is fixed, as the cost blow-outs in health are in the hospital system, and NOT via GP services.