Here’s my number, call me maybe. Telehealth rules change again but where’s the consultation?
Lobbying has temporarily reinstated 33 MBS item numbers, raising questions about the lack of consultation and what the future of telehealth and rural health will look like.
Two weeks before Christmas, amid a burgeoning Omicron crisis, the Department of Health announced it would be removing many items from MBS in an effort to nudge consumers to video calls instead.
In a turnaround this month, the department stated that it has temporarily reinstated items 91834 and 91835 – consultant physician initial and subsequent attendance – as well as 31 other phone items, but only till 30 June 2022.
A separate document, published on 17 January 2022, states that item numbers 92746 and 92747 have also been temporarily reinstated until 30 June 2022 for telephone consultations lasting 20 minutes or more.
The existing relationship rule still applies to all these item numbers, with a few exceptions including patients who are subjected to covid public health orders requiring isolation.
The reinstatement is very welcome, especially for immunocompromised and mobility-impaired patients. However, these item numbers are only for use till mid-year. This challenges longer term planning by clinic owners and also feeds growing telephone queues which have left small clinics grappling with how to service a peak of covid patients in the community.
Rural health patients and practitioners will potentially suffer with item number 112 removed permanently.
“One of the big issues is the removal of the longstanding item number 112 for regional video,” said rheumatologist Dr Claire Barrett, who has an outreach clinic in Longreach, Queensland.
“It makes bulk-billing, which I do for all patients at my Longreach clinic, really challenging from a business perspective.”
Rural Aboriginal and Torres Strait Islander health services have also felt the blow of MBS items being removed last year and not reinstated. In many remote Indigenous communities, internet access to engage in telehealth is limited. But still, about 50% of services have been done by video telehealth, said Dr Jason Agostino, epidemiologist and political adviser to National Aboriginal Community Controlled Health Organisation.
“The patients are actually coming into their local clinic and having a health worker or a nurse support them to access a remote specialist. And that’s largely unpaid work,” he said.
“It’s really important work, it’s actually really good evidence of team-based care, but for reasons that are difficult to understand funding changes are actually pulling back from the patient end support,” said Dr Agostino.
GP Dr Nathan Pinskier is owner of Onsite Doctor and former chair of the RACGP expert committee for eHealth & practice systems.
“Our whole system at the moment lacks health advocacy and support. Covid is highlighting that in big ways,” he said.
Dr Pinskier has lobbied hard against the recent MBS changes. He said that the Medicare Review processes do not appear to be as transparent or consultative with peak bodies as the Pharmaceutical Benefits Scheme processes are. He is also uncertain about the origins of the novel 30/20 rule.
The new 30/20 rule has also temporarily folded under lobbying pressure. It has been deferred and will be reinstated mid-year, at which time any doctor who has more than 30 telephone consultations in a day, for more than 20 days in a year, will be referred to the Professional Services Review.
“There was no consultation around the 30/20 rule, that I’m aware of. There was certainly no peer conversation. And whether it’s a good, bad or indifferent idea, I don’t know, because the evidence underpinning it is unclear.
One sugar cube to sweeten the ongoing changes by Department of Health is a new, but temporary, item number 93715 which compensates doctors for the protective equipment and systems required when attending face-to-face with covid positive patients.
Image-based prescribing was also thrown a lifeline at the end of last year due to the severity of the covid pandemic in parts of Australia. The program, due to end on 31 December 2021, has been extended to 31 March 2022.
