RACGP criticises DoH telehealth compliance approach

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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