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COVID 19 is bringing about many changes to the way we live our lives. Some of these are obvious – social and geographical restrictions, working from home, fewer face-to face interactions with extended family and friends and more skyping and zooming, and less shopping in brick-and-motor stores and more online shopping.

Another big area of change is the way we interact with doctors. Whereas once we took it for granted that seeing our doctor meant a visit to the doctor’s surgery, now we’re just as likely to have a ‘virtual’ consultation over the phone or via the internet.

Telehealth – the delivery of GP and other health services via the internet or phone- has become the new normal for many patients and for doctors too.

Why telehealth is popular

Telehealth has been embraced by many patients, who like the fact that they can get a GP consultation in the comfort and convenience of their home or office, avoiding the need to go to the doctor’s surgery, where they fear they may be exposed to Covid-19 in the waiting room from other patients, or from the doctor or nurses or other health workers who may have been exposed to Covid-19 without knowing it.

Telehealth been especially valuable for those patients who are at risk from the worst effects of Covid-19, such as those who are elderly, overweight or have a chronic health condition.

Having access to doctors via telehealth is also convenient for many patients, because it also eliminates travel time, scheduling conflicts and the need for taking time off from work to go to a doctor’s office.

Telehealth services may be available after hours, when traditional doctors’ offices are closed.

These patients can simply book and undergo a consultation remotely via phone or the Internet, and be diagnosed and treated online. Of course under these circumstances physical examination is not possible with telehealth, but the majority of simple cases, those that doesn’t require the doctor to do a physical examination, can be adequately treated this way.

Telehealth has also been embraced by doctors who see many advantages. Easier access to the GP increases the likelihood that patients will go seek medical advice when they otherwise may not have seen their doctor because of these Covid-related fears. Instead, using telehealth services, patients will seek health care when needed and keep their follow up appointments.

Telehealth means that doctors are less likely to catch Covid-19 from patients who may have it, and they don’t have to invest as much on protective gear like masks, gloves and gowns required for at risk patients in face-to face consultations.

Changes to telehealth billing may impact patients

Furthermore, the federal government has encouraged the widespread adoption of telehealth by making telehealth services eligible for the Medicare rebate, so there are no out-of-pocket costs for the patient. In fact the Government has determined that GP telehealth services must be bulk-billed. All patients need is their Medicare number, and the rebate covers the cost of the consultation.

But recent Federal government changes that restrict billing for some patients, may reduce the advantage to some patients.

Medicare rebates for telehealth services were originally set up by the Federal government to be in place until the end of September 2020; but because of the success of telehealth Medicare rebates for telehealth will now continue beyond this date.

However, the Federal government has determined that the rebate, and the ability to bulk bill telehealth patients, now only applies to patients who have had a face-to-face consultation in the previous 12 months with the doctor from the practice providing the telehealth services. These changes have been in place since 20 th of July 2020.

So now, to have their telehealth consultation covered by the Medicare rebate, existing patients of a practice need to have had a face-to-face visit with a doctor from the practice providing the service (not necessarily
the same doctor they saw previously, as long as it is one from that same
practice) within the previous 12 months.

To have their telehealth consultation with a GP covered by the Medicare rebate new patients to a practice must have a face-to-face appointment as their first contact with the practice – otherwise, patients will not be eligible for the Medicare rebate for and will instead have to pay the full private fee charged by the practice for the GP consultation.

There are some exceptions however. The new rules don’t apply to:

Why the changes? The changes were brought in on the urging of the Royal Australian College of General Practitioners (the RACGP), who argued that patients should have some connection to a regular practice and see a doctor face-to-face at least once every 12 months to ensure continuity of care.

The RACGP, and the Federal government, also wished to limit the spread of fly by night shonky operators that are not run by doctors for the benefit of patients and do not provide quality care.

Changes will exclude some patients from telehealth services

The changes have met a mixed reaction from GPS. Many GPs applaud the facts the patients are being encouraged to maintain content continuity with their practice, and have the opportunity to have at least one face-to-face consultation every 12 months.

However many GPs also recognise that there are many patients who simply do not have the opportunity to, or choose not to, see a GP face-to-face. They include patients in remote, regional and rural areas who do not have access to a GP, or patients in towns and cities who don’t have a regular GP. Many young people, for example, are in this category, who don’t have a regular GP.

The danger is that some of these patients will be discouraged from, be unable to afford, telehealth consultations and will put their health at risk. Illnesses may go undiagnosed and untreated.

It also disadvantages those telehealth services that do not offer face-to-face services, such as those set up to provide services across Australia, for example to service needy patients in rural and remote areas. These services won’t be eligible for the rebate as they don’t have doctors that can provide face-to-face services.

Here at nationaltelemedicinedoctors.com, we believe that patients who have telehealth consultations should continue to get the Medicare rebate, regardless of whether they have seen a practitioner face-to-face in the previous 12 months. This is the best way for patients and doctors to get the most out of telehealth.

For more information:
Commonwealth Department of Health media release

Author: Dr Peter Lavelle
15 October 2020