RACGP criticises DoH telehealth compliance approach

Matt Woodley

28/07/2021 4:24:10 PM

President Dr Karen Price has written an open letter to Federal Health Secretary Professor Brendan Murphy, saying GPs feel ‘let down’.

RACGP President Dr Karen Price.
RACGP President Dr Karen Price says the Department of Health has caused unnecessary stress for many GPs.

The letter states that the college is ‘disappointed’ that the Federal Department of Health (DoH) did not heed advice regarding compliance letters sent to hundreds of GPs who were caught out by rules concerning MBS claiming for telehealth consultations.
The DoH had initially identified thousands of GPs potentially in breach of the rules, but reduced the scope of its compliance activity following RACGP advocacy that highlighted the difficulty of navigating complex compliance requirements while caring for patients during a pandemic.
However, according to the letter, increasingly frustrated GPs have not only still received compliance letters but demands for payment from the DoH.
‘After a challenging year of COVID outbreaks, GPs feel let down that their best efforts to provide care to all Australians, in a complex and changing pandemic, have not been taken into consideration by the department,’ RACGP President Dr Karen Price wrote.
‘In addition to confusing and changing rules, we are particularly concerned about GPs that were made to repay Medicare funding for providing telehealth services to ongoing patients of their practice but did not technically meet the rule of existing relationship.
‘While assurances were given by your department to the RACGP that GPs in this situation would be considered on a case-by-case basis, the feedback from GPs is that this has not been the reality of their experience.’
RACGP Victoria Chair Dr Anita Muñoz told Nine Newspapers she has spoken to more than 15 ‘enormously distressed’ GPs who have been targeted by the compliance campaign, including one who was reprimanded and asked to repay rebates received for conducting weekly telephone sessions with a teenager with suicidal thoughts who was unable to access any mental health services.
Although she had not previously seen the teen, the pair spoke the same first language.
‘The GP really didn’t want to say to that person, “Your only option is go to the emergency department”,’ she said. ‘She kept him out of hospital ... I believe that she saved that person’s life.’
Dr Muñoz says the most concerning aspect of the compliance program is that many GPs are now ‘just too frightened’ to use telephone-based MBS items.
‘Patients are missing out on vital care because of this, and that is a disaster,’ she said.
Many GPs have described falling foul of requirements brought in to counter pop-up telehealth services offering patients low-value, fragmented care, because long-term patients – who had had face-to-face appointments for many years – resorted to telehealth consultations in early 2020 due to pandemic lockdowns.
Dr Price says the department’s ‘officious’ interpretation has caused unnecessary stress and anxiety for many GPs.
‘Over the last 16 months, GPs have been doing their best in very challenging circumstances helping patients during the pandemic and then the troubled vaccine rollout,’ she said.
‘We are managing not only an infectious disease pandemic but a mental health epidemic. I have patients who have become seriously agoraphobic and reclusive since the pandemic began.  
‘These compliance letters are the last thing they need; the entire situation risks GP goodwill and ultimately patient care, and the department should know that.’
Dr Price also said that the confusion on the part of GPs was completely understandable and could have been avoided.
‘Our concern relates to the breaches that relate to the requirement for a patient to have seen a GP – or a GP at the same practice – for a face-to-face consultation in the 12 months prior to a phone or video telehealth consultation,’ she said.
‘During a time of considerable stress managing patients during the COVID-19 pandemic, there was much uncertainty among some GPs about how the 12-month rule applied. Many GPs believed the intention of the MBS requirement was that they simply had to prove that the person had been a patient of the practice in the 12 months prior to the telehealth items being created.
‘In addition to the confusion caused by the changing rules, we are particularly concerned about GPs who did not technically meet the existing relationship rule and were made to re-pay Medicare funding for providing telehealth services to ongoing patients of their practice.
‘These GPs provided services in good faith to long-term patients of the practice, with whom they have an ongoing and continuous relationship – some for many years. In practical terms, the fact that the patient has not been physically seen face-to-face in a 12-month period is irrelevant in a relationship that is based on many years of care.’
The RACGP President stressed that the focus should be on the intention of the telehealth Medicare items, which was to ensure that an existing relationship with the GP or practice existed rather than unfairly targeting GPs trying to do the right thing.
‘We are certainly not opposed to ensuring proper compliance with the intention of the telehealth Medicare items,’ Dr Price said.
‘In fact, the RACGP lobbied strongly for measures to be put in place to reduce low-value use of Medicare-subsidised telehealth services. We were worried that “pop-ups” were taking advantage of the new Medicare items, providing low-value care to people unknown to the clinician.
‘That was the intention of these rules – to ensure people using telehealth were ongoing patients of the practice. The problem is the Department over-reached and targeted GPs who are only working in good faith trying to help their patients via telehealth during a very stressful and challenging time, especially in Victoria.
‘Enough is enough, common sense must prevail because GPs and patients deserve better. The focus of general practice should be on the vaccine rollout, not dealing with an unnecessary bureaucratic headache that was completely avoidable.’
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Dr Sanjoy Kanti Banik   29/07/2021 8:31:12 AM

One more issue that I have experienced and as few of my GP colleagues .
People with COVID symptoms/urtvi
Should have teleconsult for the sake of preventing spreading infection which was one of the criteria for Telehealth by the definition of DOH.But still got the Medicare letter.
It is very frustrating and humiliating behaviour from Medicare.Probably this is one more problem in the pandemic along with others existing…Now it seems to me say no to all teleconsult which is very confusing every day …changes daily basis ….

Dr Parvathy Murali   29/07/2021 9:18:17 AM

Too late redponse from RACGP i am a devoted member of the college and still continues
Affected by the recent medicare tlehealth issues
Some of my collaeguesxalready paid back to medicare
We are stressed with pandemicCovid vaccines roll out issues and trying to protect your community practice staffs from the infectin Working hard
Also i was grieving the loss of my younger brother and cousin died in India and not able to say good bye to them in person i received letter from medicare to pay back tele consults rebates i received
I am very honest and do billings with strct compliance with medicare rules
In a pandemic and repeated snap lock downs we did telehealth to help thevulnerable community
We got this reward !!
Now we are afraid to do telehealth and restricting it This is a loss gor everybody in primary care

Dr Fiona Jane Henneuse-Blunt   29/07/2021 11:55:34 AM

Maybe the hidden agenda is to discourage telehealth. What an archaic move that would be.

A.Prof Christopher David Hogan   29/07/2021 12:31:05 PM

The government has complained that they acted on GP advice to limit low value consultations. Well then, when unforeseen circumstances occur they should follow our advice to modify them!

Dr Maureen Anne Fitzsimon   29/07/2021 3:42:25 PM

I was in the same practice for 38 years, meeting some patients as long ago as 1981. I saw hundreds of people countless times for decades. Family and health circumstances forced me to take 10 months off in 2020, and I then joined another practice closer to my new home. Many of my previous patients have tracked me down, but I don’t meet the Medicare criteria for Telehealth that I must have had a face to face consultation within 12 months.Of course, I have tried to find them new, local GPS, but have spent hours on the phone, unpaid, giving counselling and advice. Some have made the 4 hour return journey to my new workplace just to satisfy this Telehealth requirement
! My current practice is that I bill for my time, but make it clear that there is NO Medicare rebate, if no face to face consultation has occurred during the last year.

Dr Shyamala Hiriyanna   30/07/2021 8:50:28 PM

Yes this was the most humiliating experience. I work in a women's health center. Most patients come to see me for women's health issues. I see women with trauma , Homelessness, DV situation , Homeless women, Sexual abuse and other complex mental health issues. Patients are referred by networking people. They don't always have a GP connection. I do not see 30-40 patients / day. So how can be making money out of these consultations? Lot of women Do not wish to see usual GP for STI check etc. I was also subject to scrutiny and humiliation. I felt i was treated. My patients, don't have a car, cant afford to pay for Taxi. scared to catch public transport ,because of Covid. Single women with kids, find it hard to attend appointments. women with mental health issue find it very to wake up on time, get ready, and travel to attend an appointment. So where is the kindness and empathy? No one supported me, except saying that you are not the only one getting this letter. Distressed and dissapoint