Petition Summary:

It is illogical and unfair for the mathematical tool used to calculate the size of Australian General Practices to have a built-in disincentive to use telehealth.

Petition Request:

That all telehealth consultations attracting Medicare Benefits Schedule rebates be counted by the Department of Health in the calculation of general practice sizes and that retrospective catch-up payments are made to practices.

Background: Please refer to appendix below.

Issue: While it doesn’t appear to have been publicised or that there was opportunity for consultation or warning to practice owners[1], telehealth consultations have not been counted as health consultations by the Department of Health (DOH). This has reduced practice income significantly; and over time will progressively limit the quality of care practices around Australia can provide. This is despite DOH determining “health professionals can provide health care remotely through telehealth”[2] and that “health care workers should take steps to keep themselves and their patients safe”[2]. As a result, practice size calculations by DOH have plummeted around Australia and General Practice incomes have been decimated, "falling 26% in the past three months, compared with a year earlier, despite seeing almost an identical number of patients" [3]

Practice Incentive Payment[4] (PIP) income losses relate to quality practice activities that should continue regardless of whether healthcare is delivered via telehealth.

This mistake also affects nurse Workforce Incentive Payments[5] (WIP). As a result of GPs using telehealth, practices' capacity to employ nurses to improve patient care is reduced. Workloads of nurses have increased with more complex care requirements due to increased nursing support and care. Examples are the GP support and patient care required during the numerous daily consults with patients with COVID symptoms, also infection control measures, triage complexities, and social distancing needs; duties which all increase concurrently during times of increased use of telehealth. Furthermore, if a practice employs nurses, they are doing it to vastly enhance patient care, particularly in the role of chronic disease management. It is very hard to understand why the subsidy for employing nurses (WIP), who also provide chronic disease management, and who are usually full-time employees, is suddenly reduced because the GPs at the practice have provided some telehealth consultations. Nurses' jobs in Australian General Practice are likely to decline as a result of this mistake.

The same applies to incentives for e-health, quality improvement, and after-hours work by the practices and their GPs; there is no justifiable reason that they should be suddenly reduced just because practitioners have provided telehealth consultations to patients.

The result is that General Practice around the country is at risk of not remaining viable, undermining the utility of Medicare and bulk billing. The very systems established “to support quality care, and to improve access and health outcomes”[6] of complex care of patients with chronic disease and multiple comorbidities, has ‘had the rug pulled from under it’. This pushes practices towards providing the old-style high- turnover, acute-illness-centred care, which is increasingly the opposite type of care required in Australia[7]. General practice is being pinched from all directions.

The reason given by DOH to the Royal Australian College of GPs (RACGP) for the non-inclusion of telehealth healthcare consultations in the calculation of the payments due to practices for quality practice was that “it is not a full substitute for face-to-face care”[3] There is no validity to this argument. While telehealth could never be a “full substitute” for medical care for obvious reasons, in the nine months to June 2021, nearly 25% of all GP consults were provided via telehealth, health department statistics show[1]. Furthermore, GPs and their patients should be making the decisions about how appropriate care is received, not the General Practice facility itself.

Sign this petition to encourage the Federal Government to correct this mistake and help allow general practice in Australia, the backbone of our health system, to remain viable.

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Appendix:

Background: General Practitioners and their practices are paid by both patients for the provision of consultations (supported by Medicare rebates) as well as practice incentives payments.

These payments are available to GP practices that meet high standards via an incentive scheme which was started in 1998, called the Practice Incentives Program (PIP) which is administered by Services Australia on behalf of DOH. “The Practice Incentives Program (PIP) aims to provide a flexible, cost-effective mechanism for the Government to encourage both short and long-term changes to general practice, to support quality care, and to improve access and health outcomes with a minimum of red tape.”[6]

In order to qualify, practices must first attain certified accreditation every three years by meeting the quality standards set by professional standards body RACGP[8]. This is a costly process in terms of both time and money[6].

Subsequently, practices must also meet other (changing) criteria to earn the PIPs, which currently include quality improvement goals, e-health goals, after-hours provisions, and the employment of quality practice nurses; the criteria of which are determined by DOH. The amount received by the practice for all these listed is solely determined by the practice’s size. Since 1998 the size of practices is calculated by the method called Standard Whole Patient Equivalent (SWPE), which is based on the number of patients provided care by the practice per year, and adjusted for age of the patient, and the amount of care provided by the practice for that patient in comparison to other practices[4].

Telehealth consultation item numbers were introduced to the Medicare Benefits Schedue (MBS) from 30th March 2020 in response to the COVID-19 pandemic[9], allowing patients to avoid exposure of themselves and health practitioners and other patients to infections[10]. There were extremely rapid transformations in practices to conduct telehealth consults and this was a significant part of Australia’s successful control and near- elimination of COVID-19 during 2020 and 2021[10]. In 2020 during lockdowns many GPs and their supporting practices were attempting to provide the majority of consults by telehealth; arranging face to face consults when clinically required.  Many patients would not attend to healthcare needs unless they could do so by telehealth consultations. It was compulsory for GPs to Bulk-Bill telehealth consultations from 30th March to 30th September 2020[11].

During lockdowns and the pandemic in general, the elderly, who need protection from COVID-19 the most, are the least likely to attend General Practices, and prefer to use telehealth instead. The elderly are the patients who contribute to a practice’s size calculation (SWPE) the most[4]; patients >75 years old actually contribute three times more than a patient aged less than one year old. Hence it is particularly punishing financially for practices that take the time and care and deal with the associated greater complexities.

[1] https://www.ausdoc.com.au/news/racgp-warns-practices-are-being-shortchanged-govts-arbitrary-pip-rule             
[2] https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-advice-for-the-health-and-disability-sector/providing-health-care-face-to-face-during-covid-19
[3] https://www.ausdoc.com.au/news/pip-payments-fall-15-million-after-govt-imposes-unfair-telehealth-rule              
[4] https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/practice-incentives-program/what-are-payments/calculating-payment 
[5] https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/workforce-incentive-program-wip-practice-stream   
[6] https://www.anao.gov.au/work/performance-audit/practice-incentives-program            
[7] https://grattan.edu.au/wp-content/uploads/2016/03/936-chronic-failure-in-primary-care.pdf
[8]https://www.practiceassist.com.au/PracticeAssist/media/ResourceLibrary/Practice%20Incentives%20Program/What-is-the-Practice-Incentives-Program-Factsheet.pdf  
[9] http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB   
[10] https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/australians-embrace-telehealth-to-save-lives-during-covid-19    
[11] https://www.racgp.org.au/running-a-practice/practice-resources/medicare/medicare-benefits-schedule/new-items-for-covid-19-telehealth-services