Kudos to the government for opening up telehealth to all items so quickly, despite fears of abuse and cost blowouts, but by restricting it to bulk billing only the government may be locking in more damage than good for many primary care and specialist practices
As a crucial piece of infrastructure to our survival during the GFC, we guaranteed the banks. Public hospitals and their doctors are guaranteed already. Now we are guaranteeing the private hospital sector.
Why then is our most important frontline infrastructure for fighting the COVID-19 crisis, general practice, not given some guarantee so it can concentrate on the task at hand and stop worrying about applying for new ePIP, buying and installing new telehealth infrastructure, applying for telehealth rebates, and, ultimately, its financial survival?
The complexity of decision-making in the COVID-19 crisis may never be more apparent than in the government’s move to open up telehealth to all doctors, but restrict each session to bulk billing.
The announcement was welcomed by the RACGP and AMA, as you’d expect, but when you do the maths, you realise an unexpected consequence might be to lock in ongoing revenue loss for many primary care and specialist practices.
As some patients start settling into a life mostly lived in their homes, and they get used to calling their GPs and not coming in, any practice that has a strong mixed-billing revenue profile will start shifting to a more bulk-billing profile.
We might even end up with the bizarre situation where the government, which is trying to do the right thing, actually starts saving money. How does that work? If almost no patients turn up to the practice in person, there is some replacement revenue via telehealth but not enough to make up the difference for a mixed-billing practice.
Many practices are already awake to the issue and starting to report declines in income, over and above what they have already seen. Many are saying they are going into the red pretty quickly.
In the meantime, last night, the government came out to guarantee the private hospitals sector with an upfront commitment of $1 billion. It was a great idea and clever move from a government that is starting to get its groove on now with the problem. 30,000 more beds available when and if we get to that point of the crisis.
But it begs a very big question for the government.
Given Canberra’s willingness to be” no holds barred” in making sure the economy can be rescued, and all frontline health sectors bar primary care, shouldn’t it now act to shore-up what is surely going to continue to be the frontline of the community-based defence for controlling the crisis?
There is talk now of taking the bulk billing limit off telehealth, and that of course, will help (an announcement might be made as early as Friday).
But GPs and some specialists are still going to be a long way down on their normal revenue.
Yes, they, like other small businesses can apply for their slice of the $130b working employee program – $1500 per GP per fortnight if your practice is over 30% down on revenue.
And there are indications PIP will be increased as well.
But that’s time and effort spent on not doing medicine, and there are other new admin problems with COVID-19 which are also stealing precious consultatation time.
A rapidly emerging issue is that telehealth payments are not able to be automated yet, as they don’t run through their PMS systems like their face to face appointments. The system is going to clog up quickly and most GPs are needing to ring Medicare to get the payments flowing with each batch.
Do we really want our frontline troops spending their time at this point worrying about managing all this?
Shouldn’t the federal health minister move to make sure this emerging revenue issue for practices is plugged immediately for GPs and certain specialists, so they don’t have to worry about their financial survival on top of all the major issues they are dealing with at the frontline of the COVID-19 crisis?
Shouldn’t we, at least for a short period, bankroll the gap for all GPs and certain specialists immediately, so they don’t have to deal with this issue in their working lives?
It is not an issue if you’re employed by a public hospital as your on the government payroll mostly. Why should it be an issue for GPs?
We’ve already heard from many GPs who are saying, ‘hey, it’s OK…we can manage’, who are at the frontline of their patients who have lost their jobs and are in a much more hopeless position. ‘Survivor guilt’ is not what we want our troops to be feeling at the moment when we need them wholly focussed on their jobs.
The damage to sectors such as retail and travel is a tragedy for those involved and is not to be minimised in the scheme of this crisis.
But GPs and certain specialists are our frontline troops in managing this crisis. Getting the health crisis managed first is our strategy, even for saving our economy.
If the government is thinking, shouldn’t the next announcement be: “Don’t worry GPs about your financials for the next three months and the stability of your business. Like the banks in the GFC, we are announcing that we have your backs entirely. Just get on with the good work, please. We know you have enough to worry about without having to be thinking about your financial survival on top of everything else.”
Note: The federal government has flagged already that they are considering removing the bulk billing limitation on telehealth. An announcement on this is expected by Friday. That hint is in this information release from Minister Hunt’s office. There are also indications that PIP will be increased.
“Further changes will be introduced during the week that will allow GPs and other providers to apply their usual billing practices to telehealth consultations, while concessional and vulnerable patients will continue to receive services at no cost.
In addition, the Government will establish an incentive payment to ensure practices stay open to provide face-to-face services where they are essential for patients with conditions that can’t be treated through telehealth.”
