Time For Telehealth

GPs across the country are desperate to help stop the spread of Covid-19, but lack of Medicare Rebates is crippling their ability to provide telephone care to their patients

Dr Suresh Khirwadkar

General Practice is currently in a quandary. Apart from the abhorrent lack of PPE (personal protective equipment) that Primary Care faces right now, another glaring problem is the lack of Telehealth rebate for our patients.

Many doctors are up in arms at the moment about the Government’s response, or lack thereof, to Covid-19, but one figure, in particular, has been very vocal on Twiter and in the news about both the lack of PPE and telehealth rebates.

As @runningdoc14 & I said to @dhflorance from @abcnews GPs on the frontline need the right resources to fight #Covid_19 and keep our patients safe. That includes masks and gowns. We can’t have GPs scouring Bunnings for the supplies they need #CoronaAlert https://t.co/LbB3Dnxnk7

— RACGP President (@RACGPPresident) March 4, 2020

What is Telehealth?

Telehealth is a slightly thorny issue amongst doctors. Some tolerate it, some embrace it with open arms, and others hate it with a passion.

If you don’t know what Telehealth is, in its most basic form it’s doing a consultation through a non-face-to-face method. There are various platforms for doing them, but they all involve one of two things. A telephone call or an online consultation.

I’ve previously spoken about telehealth consults with regards to the consumeristic nature of healthcare in modern society, and I still remain of the opinion that telehealth has its downsides, but in this time of Covid-19 we need to be able to adapt.

As all Australians know, Medicare is our effectively our universal health insurance scheme, but it’s very far from being universal. There are many problems with it, and the latest big issue was the ‘nudge’ letters fiasco, but one thing that’s long been a problem is the lack of rebates for non-face-to-face consultations with GPs. Other specialists are also affected, but not quite as much as us GPs.

Why does telehealth matter?

We are usually the first port of call for our patients, especially the elderly or frail. Many of those will struggle to leave the house to come in at the best of times, which of course is mandated by the Government to allow access to Medicare rebates, but in these times of uncertainty surrounding Coronavirus, the restrictions seem not just antiquated but downright dangerous.

Forcing patients to see the GP in person to obtain access to their rebates is creating a situation where sick patients need to congregate in one place. A place where there are other sick patients. A place where there are other frail, elderly, immunocompromised patients. There are also newborn babies, patients with metastatic cancer on chemotherapy, and of course our practice staff, nurses and doctors. We are all being put in jeopardy by the Government continuing to restrict access to Medicare rebates.

AMA’s Tony Bartone has also been very active on Twitter and the news talking about both the lack of PPE and the lack of telehealth rebates.

Telehealth must be part of Australia’s #coronavirus strategy. It’s crucial for minimising community spread. We must ensure the supply of protective equipment to protect Australia’s Doctors, patients, and community #PPE #covid_19 @abcnews https://t.co/WVL0mRYgRk

— AMA President (@amapresident) March 4, 2020

Both the AMA and RACGP are calling for telehealth rebates for General Practice to be able to provide care for our sickest and frailest patients, to avoid them having to come into the clinics and risk both transmission of this virus and contracting it. A virus that has approximately a 15-30% chance of killing them if they are elderly and frail. A virus that they otherwise may not contract.

The risks are very real. We now sadly have 2 deaths in Australia from Covid-19.

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The lack of Medicare rebates for telehealth is forcing GPs to charge our patients to provide this much-needed service. Many may ask why GPs are not simply absorbing the cost of this, and why we are charging our patients. Well like any business, General Practice clinics operate on income and expenses. The expenses don’t stop just because patients stop coming in.

One of the articles ⤵️🦠😷🤧🛑📞#COVID19#StayAtHome & #UseThePhone https://t.co/mlXFEdg8ba pic.twitter.com/G7hPQHcjQ7

— Kat McLean (@drkatmclean) March 5, 2020

If patients don’t come in and we either don’t charge or can’t bill Medicare directly (bulk bill) then we get no income. GPs can only operate so long without income before they have to shut up shop. The result would be that General Practice goes under, practices will close, doctors will be forced to leave communities, or worse still General Practice would disappear completely, which would be disastrous for the country’s health.

It’s so bad that some doctors are anonymously saying they are worried about testing patients just in case they have to close the clinics. Those in rural clinics are really feeling the problems too, with most not even having any external testing facilities and it all falling squarely on the shoulders of my rural colleagues. They are broad shoulders indeed, but they can only carry so much.

What can we do?

Get active. Mobilize. Tweet. Share. Pin. Post.

Speak to your Member of Parliament and your Ministers.

Speak to the media.

We need to get the message out there. Demand access to your rebates for telehealth consultations to help reduce the spread of this condition and allow GPs to effectively provide care during this crisis.