Dear Doctors,
Below is the next tranche of responses to the excellent questions that arrived before 4.30pm today.
Questions
1. If I have to cancel my consulting room sessions, due to patient concerns (i.e. am a geriatrician), can I offer telehealth consultations from home?
Yes. As long as all of your patients are over 70, which they probably are. Any patients under 70 would need to meet one of the other criteria for ‘vulnerable patients.’ See Bulletin No.1. Point 2.
Please also note the requirement to offer video over phone if possible. See point 4 in today’s bulletin.
2. To use COVID- 19 items, do I need to have seen these patients face to face in the last 12 months?
Yes, if you are a GP.
This is provided for in the Health Insurance (Section 3C General Medical Services-GP and Allied Health COVID-19 Services) Determination 2020, which you can read at this link, https://www.legislation.gov.au/Details/F2020L00259. There have been changes, but the latest iteration of Subclause 1.1.1(6) of Schedule 1 provides:
(6) For items in Subgroups 1 and 2, a person who meets the requirements of a “patient at risk for COVID-19 virus” in paragraph (c) of the definition must:
- have had at least one face to face attendance rendered in the preceding 12 months by the practitioner who renders the COVID-19 virus service; or
- have had at least one face to face attendance service rendered in the preceding 12 months at (or arranged by) the medical practice where the practitioner who renders the COVID-19 virus service is employed.
No, if you are a specialist.
There is no equivalent provision of subclause 6 in the Determination for specialists which you can read at this link https://www.legislation.gov.au/Details/F2020L00254
The relevant text in the Determination relating to both items 91824/34 (item 110 equivalents) states:
“Where the attendance was other than a second or subsequent attendance as part of a single course of treatment.”
This is legalese for – it is the first consultation – and remember it is the equivalent of item 110, which is an initial. Also makes sense from a policy perspective because the health system relies on keeping referral pathways open, to ensure new patients can access timely specialist care.
3. If the patient is elderly and has a phone consultation. Can we accept a text message initially with authorisation to bulk bill and then send out the form to be signed or will a text message suffice for the authorisation?
Please see Bulletin No. 2 point 8 and Bulletin No. 3 point 5.
Sending the form to the patient and asking them to sign and return it is also a great idea.
4. Do I have to use video or can I use phone. Like is there a rule or hierarchy about that?
Yes, there is a hierarchy and a legal requirement to use video rather than phone if possible. The relevant provision, which you can read here https://www.legislation.gov.au/Details/F2020L00254 provides:
1.4.1 Application of COVID-19 medical practitioner phone services
- For items in Subgroups 4, and 7 the rendering practitioner must not perform a service in subgroup 7 if the practitioner and the patient have the capacity to undertake an attendance by telehealth.
Specialist services fall within subgroups 4 and 7, so, if both you and the patient have ‘the capacity’ to use video, use it over a phone call.
5. How long can we use these services?
All of the relevant Determinations currently have an end date of 30 September 2020, unless earlier revoked. So, the government can remove them earlier if it so chooses.
Thanks everyone, and please keep the questions coming and share with your colleagues. We are happy to help.
Margaret & The Synapse Team.
COVID MBS items explainer and FAQs No. 5, 20 March 2020… Read more