The MRAC review of telehealth settings stopped short of recommending that existing relationship rules apply across the board but took a swing at pop-up online clinics.
The independent Medicare advisory committee has recommended telehealth rules be strengthened for nurse practitioners but loosened for GPs using MyMedicare.
While GP patients are only eligible for a telehealth Medicare rebate if they’ve seen their doctor face-to-face in the previous 12 months, nurse practitioner patients are able to be bulk billed without an existing clinical relationship.
This has enabled nurse practitioners to run bulk-billing telehealth-only clinics.
Some of these have not made it immediately obvious to consumers as they’re booking that they will not be seeing a doctor in the first instance.
Enter what may sound like the dullest paper in the history of bureaucracy, the MBS Review Advisory Committee’s Telehealth Post-Implementation Review Final Report, which was quietly dropped last week.
Despite the unassuming name, it will likely have big implications for the future primary care.
The recommendation with the biggest immediate impact for the industry is number eight, which looks to introduce existing relationship rules for nurse practitioner MBS items.
There was pushback to this recommendation on the nursing end.
“Workforce concerns were raised for both maintaining current settings (with the expansion of online only business models seen as detrimental to quality care) and introducing eligibility and exemptions to nurse practitioner telehealth items (with the changes seen as having detrimental impacts on nurse practitioner business and scope of practice),” the MRAC report said.
That’s not to say GP-led online clinics were completely let off the hook.
Indeed, it used strong terms (well, strong in a government-speak sense) to take aim at single-issue online-only clinics.
“These services are marketed as a convenient way to access healthcare for services such as getting prescriptions and referrals where the outcomes are pre-determined and patient-led,” it said.
“However, these consultations are generally quick and once-off … as a result, these services do not support integrated, safe and high-quality care.”
While there was no recommendation that specifically addressed GP-led models – which tend to be private-billing only, avoiding the MBS altogether – recommendation three did look at MyMedicare.
More specifically, the recommendation was to consider how MyMedicare and other non-MBS funding options could better remunerate doctors for the asynchronous work associated with managing patients.
One option that it floated was using a patient’s MyMedicare registration as a proxy for the existing relationship rule, given that MyMedicare registration itself has face-to-face qualification requirements.
This could be useful for GPs because the MyMedicare existing relationship qualification is two face-to-face consults in the 24-month period prior to registration; there is no ongoing face-to-face consult requirement.
Theoretically a patient could see their GP face-to-face twice, get registered for MyMedicare, and then have ongoing treatment entirely via telehealth for as long as they remained registered, without having to come in every 12 months for a face-to-face.
While the MRAC considered applying the existing relationship rule to non-GP specialists and other allied health specialists, it ultimately declined to make this recommendation.
Stakeholders successfully argued that putting a face-to-face requirement on non-GP specialist rebates would likely disadvantage people in rural and regional areas, and MRAC determined that allied health services in relation to chronic disease management and mental health were already coordinated by GPs.