The Royal Australian College of General Practitioners has urged the federal government to address some of the issues which have surfaced since the rollout and expansion of telehealth services in Australia.
RACGP President Adjunct Professor Karen Price says telehealth is beneficial to many patients but that several issues need to be urgently addressed.
‘The swift introduction of patient rebates for Medicare Benefits Schedule telehealth services in general practice was welcome and long overdue,’ she said.
‘GPs and patients across Australia embraced telehealth when the new patient rebates were first introduced in March 2020 and for good reason – it’s a popular form of service delivery that helps many patients access the care they need from their usual GP, when they need it.
‘While we acknowledge the Department of Health’s willingness to engage the RACGP around telehealth over the past two years, there are several challenges the new government must face head on. Abrupt and constant changes to Medicare item numbers, descriptors and interpretation have resulted in widespread confusion and an unprecedented amount of administrative work for practice teams across Australia.
‘The government can help relieve this burden by removing separate Medicare Benefits Schedule items that differentiate between telephone and video consults and merge these items into general telehealth item numbers,’ she said.
‘The government should also ensure that patients with complex needs can access the care they require by making longer telephone consultations a permanent fixture of telehealth.
‘This is a no-brainer considering that in 2020-21, phone consultations comprised 98% of all telehealth services provided by GPs. The former government did temporarily reinstate patient rebates for phone consultations lasting longer than 20 minutes.
‘The RACGP wants to see the new government better support patient care by introducing these rebates for patients on an ongoing basis. It is our understanding that the government’s extension of COVID-19 Response funding arrangements announced following the National Cabinet meeting of 17 June does include an extension of Medicare rebates for longer phone consultations until 31 December this year.
‘So that is a positive development for us to build on because phone consults make a huge difference for many patients.’
Vulnerable people require more support
Adjunct Professor Karen Price said, ‘Removing Medicare rebates for longer phone consultations is particularly detrimental for Aboriginal and Torres Strait Islander people, older patients, people with disability, and those living in rural and remote areas. These groups already have poorer health outcomes than the general population so making these Medicare items for longer phone consultations permanent needs to be a high priority for the new government.
‘We also want to see Medicare phone items for chronic disease management and mental health services reinstated as part of the permanent telehealth model.’
The RACGP President said the government should learn from the implementation of telehealth services and how this has affected practices across Australia.
‘Mandatory bulk billing of COVID-19 Medicare Benefits Schedule telehealth items was a mistake,’ she said.
‘This rule was relaxed in April 2020; however, it was unfair and unreasonable for the bulk billing requirement to apply to general practice and not other health professionals.
‘GPs and general practice teams are fully aware that many patients have been affected financially by the pandemic, and we support access to primary care for all patients. However, this requirement was imposed at a time when many practices were struggling to keep their doors open.
‘GPs and practice teams were still feeling the effects of the longstanding Medicare rebate freeze as well as natural disasters such as the 2019-20 summer bushfires and 2022 floods. The bulk billing requirement contributed to low morale and led to a significant loss of income, with most practices reporting between 10–60% loss in revenue compared to the same time in 2019. No one wins when practices are pushed to the brink and forced to close up shop and we should have been trusted to apply our usual billing practices to telehealth services and exercise discretion.
‘I also note that mandatory bulk billing inflated bulk billing figures for GP attendances, which were frequently touted by the previous government. In communities across Australia, GPs have continued bulk billing telehealth consultations because patients became accustomed to being bulk billed in the early stages of the pandemic. For many practices, this will be difficult to sustain in the years ahead.’
Lessons need to be learned
‘The introduction of Medicare telehealth item numbers was an unnecessarily overcomplicated and confusing process that took up too much time and energy for GPs and general practice teams,’ said Adjunct Professor Price.
‘Whole of population telehealth services should have been introduced when funding for telehealth was first announced. Instead, rules and requirements changed repeatedly over many months.
‘When the Medicare items were first introduced, they were available only for health professionals and some patients particularly susceptible to COVID-19, then telehealth rebates were available for all patients, then bulk billing requirements were removed except for some patients, and then it became a requirement for telehealth services provided by GPs to be linked to a patient’s regular GP or practice.
‘The list goes on and on and it has been difficult for practices to stay on top of the constantly shifting rules and requirements.
‘The staged rollout increased the possibility of errors being made when billing the items and forced GPs to review and adapt their business models repeatedly during a time of crisis. Busy reception staff, already bearing the brunt of frustrated and anxious patients, had to answer complicated questions about billing.
‘The Health Department’s telehealth compliance campaign has also been very concerning. It was rolled out at a time when GPs and practice teams were caring for patients in a rapidly changing pandemic environment, was based on inconsistent and confusing rules and requirements and was punitive in nature. Where there are increased compliance measures, these must be balanced with preventive educational activities.
‘The quality and timeliness of information about the Medicare telehealth items also left a lot to be desired. For example, clear information around the need for patients to have received a face-to-face services to access telehealth rebates has been extremely difficult to attain, and the Department’s COVID-19 Telehealth Items Guide appears not to have been regularly updated. An informative and up-to-date question and answer document would have been a useful resource for GPs and general practice teams.
‘The lack of information about whether telehealth items would be extended has often led to a great deal of uncertainty,’ she said.
‘Telehealth was eventually made permanent on 1 January this year, but until then telehealth items were only available on a temporary basis and extended incrementally.
‘The college was often advised that items would continue just days before they were due to expire, meaning GPs could not confidently book telehealth appointments with patients for the weeks ahead.
‘The next time that changes are made to the Medicare Benefits Schedule items, the implications for general practice teams on the ground must be front of mind for policy makers and department officials.
‘GPs and general practice teams are doing our best to adapt to new ways of delivering care, we are under a lot of pressure and don’t have an endless amount of time and resources.
‘I look forward to working with the newly elected government and the Department of Health on the continued rollout of telehealth,’ said Adj. Professor Price.
‘I hope we can work together closely and that any future changes to telehealth items will ensure better access for patients while making it easier for GPs and practice teams to understand and implement the necessary changes.’