Complex telehealth rebates ‘worsen inequity’

4 minute read

There are systemic barriers that keep telehealth unavailable to those most in need, an RACGP position statement says.

The RACGP says that availability of suitable telehealth services can reduce costs to patients, the health sector and the environment, but GP remuneration is falling short.

Last week, the MBS Review Advisory Committee released a draft report detailing its recommendations for telehealth services going forward.

The RACGP has since released a statement outlining its position on the use of telehealth in general practice, which supports many of the MRAC’s suggestions, including its new position that the medium used for telehealth consultations – video or telephone – should be at the discretion of GPs, depending on the patient’s needs.

But, the college added in the statement, “Medicare should support phone and video telehealth equally”.

“This is particularly important to avoid worsening health inequalities for vulnerable population groups and patients in rural and remote communities.”

Also in concurrence with the MRAC’s review, the RACGP warned against “asynchronous” care provision, a position the college has expressed repeatedly.

The college agreed that requests made for medications or referrals via text, email, survey or online chat not preceded by real-time consultations “are not best practice and may result in adverse patient outcomes”.

“These services have the potential to undermine the therapeutic relationship between a patient and their regular GP, often increase costs for patients as Medicare rebates may not be available, as well as providing a service that may put the patient at risk,” the statement read.

The college instead supports “telehealth services that provide continuity of care between a patient and their usual GP or general practice, including other members of general practice multidisciplinary teams”.

“For example, follow-up appointments for those who live in rural areas may be appropriately conducted via telehealth, and ideally as part of an established GP relationship,” the statement read.

But the college did support some exemptions to the requirement for an established clinical relationship for Medicare-subsidised telehealth services, including for populations such as infants and homeless people.

“The RACGP supports patients being able to access select telehealth services from any GP (if required), including sexual and reproductive health services, mental health care and eating disorder management.

“These services tend to be highly specialised and patients may not be able to access this type of care from their usual GP.”

The statement suggested that telehealth should act in tandem with face-to-face care, rather than as a substitute, but its appropriate use could save patient transport costs, loss of income and the environmental toll of travel.

Telehealth services may also reduce the demand on health sector resources.

“Providing on-demand telehealth services to patients may result in less time needed and fewer resources spent on routine care, including fewer home visits,” the statement said.

“Additionally, chronic conditions such as diabetes, hypertension and mental health services including eating disorder management, could be partially managed through telehealth by GPs known to the patient.”

But without addressing the challenges and barriers, such as complexity of Medicare billing, access and affordability may be negatively affected, the college said.

“The overall complexity of the MBS and the growing frequency of MBS changes, which became more pronounced during the covid-19 pandemic, is contributing to inadvertent billing errors and technical non-compliance.

“Many GPs are not being adequately remunerated for the services they provide or are avoiding claiming certain patient rebates for fear of Medicare compliance ramifications.”

The college called for simplification of MBS telehealth numbers, limiting changes to MBS billing if possible, and removing unnecessary barriers to access.

“The cost of complying with burdensome regulatory arrangements, for example additional forms to verify verbal consent, may result in increased costs for patients, reducing equity and access to healthcare,” the statement read.

The college said they would continue to support telehealth training for GPs, to ensure that the services were being provided by suitably trained professionals and advised that more research be done into understanding the true benefit of telehealth services and developing best practice.

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