Dear Doctors and all Health Care Workers
The key message today is that, despite some excitement around the prospect of all Australians being able to talk to a medical practitioner online for free from next week, we do not know the details and it is not yet law.
Talking ‘for free’ is of course a contentious issue, due to the attempt by the Government to force bulk billing, see Bulletin 1, which is ongoing. Further, we do not know if the changes slated for later this week will bring inpatients within scope and thereby bring some relief to worried specialists treating admitted patients. So, there are a lot of questions, not yet answered. We will be keeping a close eye on developments to bring you up to date with clear, accurate information.
Remember, until it is law, you cannot do it. So, we wait.
Here are answers to today’s questions.
1. Is there a requirement to comply with data security and privacy issues when using video to conduct consultations, or can I just use Skype, WhatsApp or whatever works?
Yes, there is a legal requirement to maintain data security and privacy. The definition of ‘telehealth attendance’ includes the following (my underlining):
telehealth attendance means a professional attendance by video conference where the rendering health practitioner:
(a) has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
(b) is satisfied that it is clinically appropriate to provide the service to the patient; and
(c) maintains a visual and audio link with the patient; and
(d) is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.
You should all know the relevant security and privacy laws applicable to your day to day practice operations, but if you are unsure please visit the website of the Australian Information Commissioner for more information https://www.oaic.gov.au/
2. The Government press release on 23 March 2020 said:
“From today, the Government will enable all vulnerable general practitioners and other vulnerable health professionals who are currently authorised to use telehealth item numbers, to use telehealth for all consultations with all their patients.”
What does ‘with all their patients’ mean? Do the patients have to be existing patients, or can it be a new patient?
This is unclear and ill defined, though my reading of the relevant provisions suggests both existing patients and new patients who fit the vulnerability criteria come within scope.
Also, note point 1 above in subclause (b) also, where the ‘clinical relevance’ requirement is reiterated in the definition of a telehealth attendance. See Bulletin 6, Point 1 for further clarity around what constitutes a ‘clinically relevant’ service.
3. I am a specialist Nephrologist and see chronic patients. When I see them in person, a common billing is a 116. If it is a consult on an existing patient for the same disease/problem but via telehealth, is the 1st telehealth (telephone consultation) considered a 1st visit and item 91834 can be used or should I use a 91835 because it would have otherwise been a 116?
This is a follow up consult using item 91835 because the continuous course of treatment rules apply to COVID services. See Bulletin 1, clause 10.
4. Can I use telehealth and COVID item numbers to consult patients who are mainly follow ups but also to assess patients for degree of urgency of surgery?
No. Not unless you or your patients meet the vulnerability criteria. See Bulletins 1, 2, 6 & 7.
However, this may change later this week. See Bulletin 7.
5. Do the COVID telehealth/phone item numbers still apply if I am consulting from home rather than a hospital/usual practice place but am logging in through remote access etc? So essentially it is entirely the same except I’m at home. I do not fall into the vulnerable practitioner category.
No. Not unless you or your patients meet the vulnerability criteria. See Bulletins 1, 2, 6 & 7.
However, this may change later this week. See Bulletin 7.
6. I am a Geriatrician and my rooms are at hospital. As part of risk reduction, consulting in person has been asked to be replaced with telehealth, which is a reasonable request. My new patients (80min appointment) are usually associated with a 141 (sometimes 132). I am aware that I can telehealth these numbers, if greater than 15k away or in a res-care facility. My general follow up appointments take 40 minutes and I usually bill item 116 with a small out of pocket expense. The current COVID numbers do not allow for a 141 or 132 telehealth. They do not allow for more than a 116. Who do we lobby to kindly suggest how we telehealth these patients?
Look let’s hope that the Stage 4 changes due to be announced later this week provide some relief.
Lobbying via the RACP would be a good place to start.
Thanks everyone. Lots of anticipation around the Stage 4 plan so let’s hope it provides a good balance supporting the needs of patients, health workers, and the need to preserve Medicare.
Stay safe.
Margaret and the Synapse team.
COVID MBS items explainer and FAQs No. 9, 26 March 2020… Read more