30 March 2020

Nurses included in some new telehealth item numbers

Communicable Disease COVID-19

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The latest

4.20pm, 30 March

2.45pm, 30 March

  • There’s some confusion about how the new telehealth item numbers work for general practice nurses.
    The short answer from the RACGP is that nurses can assist over telehealth and bulk-bill for that. The longer answer is that the new MBS item number for telehealth will reflect existing items, and practice nurses can assist a GP with those items.
    For example, the existing item for a GP management plan is 721, and this will be replaced by 91790 (for telehealth) and 91795 (for phone).
    According to MBS, “a practice nurse, Aboriginal and Torres Strait Islander health practitioner, Aboriginal health worker or other health professional may assist a GP with items 721, 723, and 732 (e.g. in patient assessment, identification of patient needs and making arrangements for services). However, the GP must meet all regulatory requirements, review and confirm all assessments and see the patient.”
    MBS Online now has a detailed list of the telehealth item numbers, including for nurses and for nurse practitioners, and a short information sheet.

2.20pm, 30 March

  • NPS MedicineWise is ditching face-to-face educational sessions with health professionals in favour of video calls. These virtual visits are approved under the RACGP and ACRRM CPD programs, and the visiting material is sent in advance either electronically or in hard-copy. To schedule a visit, go to www.nps.org.au/cpd/request-a-visit, call 02 8217 8700 or talk to your local Educational Visitor.

1.40pm, 30 March

  • While some pets are getting more attention than in their wildest dreams as their owners work from home, those of over-worked healthcare personnel are missing out. So one pet hotel chain is offering discount daytime and overnight accommodation for dogs and cats of medical professionals in Sydney, Melbourne, Brisbane and Canberra. They’ve also extended the offer to people infected with COVID-19.

12.15pm, 30 March

  • That old chestnut of intravenous high-dose vitamin C has reared its head again; this time there are claims circulating that it can treat COVID-19 infection. The TGA has wearily (or maybe I’m projecting) put out a statement saying there’s no data to support this, and the only condition for which vitamin C has proven benefit is scurvy.
    Although with supermarket shortages, that last bit could be prescient.

11.45am, 30 March

  • Could transfusions of plasma from people recovering from COVID-19 help treat those who are still critically ill with the virus? An uncontrolled case series in five patients (aged 36-65) from a single hospital in Shenzen, China, suggests it’s a possibility.
    Published in JAMA, the study involved five patients with laboratory-confirmed COVID-19, acute respiratory distress syndrome, on a ventilator, and with continuously high viral load, who were treated with convalescent plasma infusions.
    Four of the five showed normalised body temperature within three days, negative viral loads and increased Pao2/Fio2 within 12 days. Four had resolution of their respiratory distress within 12 days, three were weaned off mechanical ventilation within 2 weeks, three were discharged from hospital and two were in a stable condition at 37 days after the transfusion.
    An accompanying editorial noted that while the cases were “compelling and well-studied”, the research was subject to the usual limitations of anecdotal case series.

10.15am, 30 March

  • One Sydney hospital has allegedly asked staff to reuse single use face-masks, according to an ABC report. Two anaesthetists told the ABC they were being told to reuse N95 or P2 masks throughout the day by putting their name and date on the mask and putting it into a communal bin for later reuse. One said their hospital only had around 60 masks left.
    The ABC reported that they contacted the hospital and were told the practice had ceased.

10am, 30 March

  • Remove bulk-billing-only restriction on telehealth, says the Australian General Practice Alliance, in response to the government’s announcement on the expansion of Medicare-subsidised telehealth.
    While applauding the increased focus on GP telehealth, AGPA also pointed out that “many General Practices in Australia are structured in a way that private billing of patients is essential for their financial viability.” They called for government to allow practices to decide how to organise their own billing structures.

9.40am, 30 March

  • In case you missed it… NSW Health has a regularly updated page listing all domestic and international flights to or from Sydney that have had a confirmed case of COVID-19 infection on board, including seating rows that might be affected.

9.25am, 30 March

  • Don’t drink your fish’s medicine. Geez …do we even need to say it? Clearly yes, because a man has died in the US from drinking the chloroquine phosphate intended to treat his tropical fish, thinking it might protect him from COVID-19. The news prompted the FDA to issue a safety alert (and you can almost hear the face-palming going on behind the scenes), saying “Chloroquine products sold for aquarium use have not been evaluated by the FDA to determine whether they are safe, effective, properly manufactured, and adequately labeled for use in fish–let alone humans.”

9am, 30 March

  • From today, Medicare will subsidise a wider range of telehealth consultations with GPs, including non-COVID-19-related services such chronic disease management, pregnancy support, mental health and others, the federal government has announced.
    The federal government has injected $669 million into telehealth, as well as doubling the GP bulk-billing incentive – both for face-to-face and telehealth consults – and introducing a new incentive payment to keep GP practices open for essential face-to-face consultations. In the announcement, the PM said “this will take pressure off hospitals and emergency departments and allow people to access essential health services in their home, while supporting self-isolation and quarantine policies”.
    The AMA, RACGP, RACP and RDAA all cheered the announcement, with respiratory physician Professor John Wilson, President-elect of the RACP saying, “We have long campaigned for the removal of telehealth distance requirements to make it easier for patients – many who find it difficult to attend face to face appointments.”
    The details of who, when, where and how are yet to be released, and we’ll bring you details on item numbers and eligibility as we learn them (but you might like to revisit this story from TMR’s Penny Durham on the last telehealth item numbers announced two weeks ago).
    The PM’s statement says the new incentive will cover “GP services” (without specifying what that means), mental health, Aboriginal and Torres Strait Islander health assessments, chronic disease management, services to people with eating disorders, services to patients in aged care facilities, children with autism, pregnancy support, after-hours consultations, and nurse practitioners.
    AMA president Dr Tony Bartone said the new arrangements “will support patient consultations, which do not require a physical examination, to be conducted with general practitioners and some other medical specialists by telehealth”.
    The federal health department said the arrangements will start today – Monday 30 March – and continue at least until 30 September 2020.
    Stay tuned for updates.
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