‘They’ve got the maths wrong’: GPs say telehealth should be part of PIP

When GP and practice owner Dr John Henderson noticed that his practice’s Practice Incentive Program Quality Improvement (PIP QI) payments had significantly declined, he was surprised given his clinic’s busy workload.
 
But that surprise soon turned to disbelief.
 
‘Our practice manager was told that our SWPE [Standardised Whole Patient Equivalents] had gone down because they’re not counting telehealth – I actually did not believe it,’ Dr Henderson told newsGP.
 
‘As it turns out, that’s been happening since the start of the pandemic.
 
‘We didn’t know if we’d missed an announcement. But all the searching I did, I couldn’t find any sign of any announcement.’
 
As it stands, telehealth consultations are not included in the mix of MBS items used to inform the PIP, e-health and after-hours incentives.
 
The telehealth items, introduced in March 2020 following RACGP advocacy, are presented on the Department of Health’s (DoH) website as a means to ‘help protect healthcare professionals, their staff and patients from unnecessary risk of infection’.
 
However, when asked why telehealth items have not been included to inform PIP incentives, a DoH spokesperson told newsGP ‘this was in the interests of encouraging general practices to maintain face-to-face services during the pandemic period’.
 
Dr Henderson, who is located in Victoria where COVID cases are continuing to climb despite stringent lockdown measures, says the department’s approach is ‘illogical and unfair’ and creates a ‘disincentive to use telehealth’.
 
After sharing his concerns with other practice owners in his network, Dr Henderson found his experience and concern was widespread, leading him to launch a petition calling on the Federal Government to change its policy and make retrospective payments to practices.
 
Since its launch on Sunday, it has received more than 1100 signatures, having resonated with GPs across the country, including RACGP President Dr Karen Price.
 
‘I’ve signed the petition because it is aligned with our policy,’ Dr Price told newsGP.
 
‘If the pandemic has taught all of us anything, it is that health is an investment and not a cost. So we need to resource the people who are providing frontline healthcare and that is including GPs.’
 
The RACGP’s position, to include telehealth consultations in SWPE calculations, was raised both in meetings with the DoH and in a college submission in response to recommendations on the Federal Government’s Primary Health Care 10-Year Plan.
 
‘Any consulting through communications technology should be included in the item numbers that generate the Standardised Whole Patient Equivalent value for incentive payments,’ the submission states.

GP Dr John Henderson believes the DoH’s approach creates a disincentive to use telehealth. (Image: Supplied)
 
Since March 2020 up to July 2021, 26% of GP attendances have been conducted via telehealth compared to 74% face-to-face. Chronic disease management overwhelmingly took place in person (81%), while 19% was conducted via telehealth.
 
Dr Price says there appears to be an assumption that telehealth is not a quality consultation, or that it will be overused – a premise she says needs to be challenged, particularly in a pandemic environment.
 
‘We can’t run the thought experiment, really, but what would medical care look like without telehealth? That should be the answer to this question of whether or not it is quality medical care,’ she said.
 
‘The evidence that I’ve seen of telehealth is that it goes up during a hotspot pandemic outbreak and it goes down appropriately when we’re returning to face-to-face life.
 
‘The very fact that we had the innovation of telehealth – as it was hailed by the [Federal Health] Minister – has meant we can provide healthcare during a pandemic in an extraordinarily safe way.’
 
Dr Bernard Shiu, RACGP Victoria Deputy Co-Chair and a Director of Australian GP Alliance, thinks not counting telehealth in line with other healthcare consultations sends practices a mixed message.
 
‘On the one hand the Federal Government is encouraging patients to maintain contact with their GPs via telehealth during the pandemic, but on the other hand they are cutting funding to telehealth left, right and centre,’ he told newsGP.
 
‘It will particularly impact clinics in areas like Melbourne and Sydney when most consults are carried out via telehealth during lockdown.
 
‘General practice, especially independent clinics, suffer ongoing devaluation by the Federal Government and this funding cut will almost certainly be affecting care for our patients.’
 
Dr Henderson says he is also concerned about the impact on workforce incentive payments (WIP) and the reduced capacity to employ nurses, at a time that workloads have increased with more complex care requirements.
 
‘The PIP and workforce incentive payments, they’re to promote quality in general practice,’ he said.
 
‘That should also be a relatively stable income for employment of staff rather than something that will turn on and off depending on what lockdown you’re in.’
 
Having been overwhelmed by the support for his petition, Dr Henderson says deciding to conduct a telehealth or face-to-face consultation is ultimately a clinical decision, and should not be influenced by the potential financial impact on a practice. 
 
‘It’s a bit sort of sneaky; it’s a backdoor way of trying to save money,’ he said.
 
‘But at the same time [it’s] seriously threatening the viability of general practices around Australia and punishing quality.’
 
A DoH spokesperson told newsGP that ‘overall PIP payments increased from over $400 million in 2019–20 to over $421 million in 2020-21’.
 
‘As the Government considers longer-term arrangements for MBS telehealth beyond 31 December 2021, it will consider flow-on impacts for PIP incentives and whether telehealth consultations should be included in PIP calculations,’ the spokesperson said.
 
Dr Price said the RACGP has been in talks with the DoH, and will continue its advocacy.
 
‘The assumption here is that medical care is a single discrete episode, and that’s the problem with the way that the people who manage finances are seeing healthcare,’ she said.
 
‘It is not a single discrete activity-based episode, particularly in general practice; it is a longitudinal continuous care model that telehealth is a part of the whole.

‘They’ve got the maths wrong on what general practice is.’
 
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