RACGP to Federal Health Department: Heed our advice on telehealth compliance letters

The Royal Australian College of General Practitioners (RACGP) has written an open letter to the Federal Department of Health expressing disappointment that health officials have not heeded the college’s advice regarding telehealth compliance letters.

As reported in April this year the Department of Health (DoH) sent compliance letters to hundreds of GPs who were “caught out” by rules concerning Medicare Benefits Schedule (MBS) claiming for telehealth consultations.

The Department initially identified thousands of GPs potentially in breach of the rules, but reduced the scope of its compliance activity following  RACGP advocacy. The RACGP pointed out that GPs were struggling to navigate complex and rapidly changing compliance requirements for telehealth and doing their best to care for their patients in a pandemic.

However, in recent months the RACGP has been contacted by many increasingly frustrated GPs who have received not only compliance letters but demands for payment from DoH.

These GPs had been using telehealth to provide essential care to ongoing patients of the practice, including for mental health concerns. One GP gave an example of an adolescent patient they were treating via telehealth who was suicidal.

Many GPs have described falling outside of the strict scope of the requirements because long-term patients, who had had face-to-face appointments for many years, resorted to telehealth consultations in early 2020 due to pandemic lockdowns.

RACGP President Dr Karen Price said that the Department’s officious interpretation had caused unnecessary stress and anxiety for many GPs.

“Over the last 16 months, GPs have been doing their best in very challenging circumstances helping patients during the pandemic and then the troubled vaccine rollout,” she said.

“We are managing not only an infectious disease pandemic but a mental health epidemic. I have patients who have become seriously agoraphobic and reclusive since the pandemic began.  

“GPs feel let down that their best efforts to provide care to all Australians, in a complex and changing pandemic, have not been taken into consideration by the Department. These compliance letters are the last thing they need; the entire situation risks GP goodwill and ultimately patient care, and the Department should know that.”

Dr Price said that the confusion on the part of GPs was completely understandable and could have been avoided.

“Our concern relates to the breaches that relate to the requirement for a patient to have seen a GP – or a GP at the same practice – for a face-to-face consultation in the 12 months prior to a phone or video telehealth consultation,” she said.

“During a time of considerable stress managing patients during the COVID-19 pandemic, there was much uncertainty among some GPs about how the 12-month rule applied. Many GPs believed the intention of the MBS requirement was that they simply had to prove that the person had been a patient of the practice in the 12 months prior to the telehealth items being created.

“In addition to the confusion caused by the changing rules, we are particularly concerned about GPs who did not technically meet the existing relationship rule and were made to re-pay Medicare funding for providing telehealth services to ongoing patients of their practice.

“Even though assurances were provided by the Department to the RACGP that GPs in this situation would be considered on a case-by-case basis, the feedback from GPs indicates that this has not occurred.  

“These GPs provided services in good faith to long-term patients of the practice, with whom they have an ongoing and continuous relationship – some for many years. In practical terms, the fact that the patient has not been physically seen face-to-face in a 12-month period is irrelevant in a relationship that is based on many years of care.”

The RACGP President stressed that the focus should be on the intention of the telehealth Medicare items, which was to ensure that an existing relationship with the GP or practice existed rather than unfairly targeting GPs trying to do the right thing.

“We are certainly not opposed to ensuring proper compliance with the intention of the telehealth Medicare items,” she said.

“In fact, the RACGP lobbied strongly for measures to be put in place to reduce low-value use of Medicare-subsidised telehealth services. We were worried that ‘pop-ups’ were taking advantage of the new Medicare items, providing low value care to people unknown to the clinician.

“That was the intention of these rules – to ensure people using telehealth were ongoing patients of the practice. The problem is the Department over-reached and targeted GPs who are only working in good faith trying to help their patients via telehealth during a very stressful and challenging time, especially in Victoria.

“Enough is enough, common sense must prevail because GPs and patients deserve better. The focus of general practice should be on the vaccine rollout, not dealing with an unnecessary bureaucratic headache that was completely avoidable.”

RACGP Victoria Chair and Melbourne-based GP Dr Anita Munoz said that the situation was particularly difficult for Victorian GPs.

“Melbourne’s GPs have managed patients through five hard lockdowns and that is proving to be a very stressful experience,” she said.

“Every time a lockdown occurs, we have anxious patients delaying or avoiding care, which means that their conditions can worsen. We are working very hard in trying circumstances and these compliance letters could not come at a worse time.

“To make matters even more complicated, there are exemptions relating to areas where COVID-19 restrictions are in place. So Victorian GPs managing a pandemic and repeated lockdowns significantly affecting many of their patients’ health status have had to figure out those requirements as well.

“We now have a cohort of Victorian GPs very reluctant to use telehealth at all for fear of government retribution. This is a terrible result as the use of telehealth is one of the ways GPs can deliver high-quality patient care during a pandemic. Give Victorian GPs, and GPs across Australia, a break – they certainly deserve one.”