All vax-related services should be free: DoH

The government 'encourages' practitioners to bulk-bill consults for possible side effects, even though that category is not well defined.

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Doctors treating patients with suspected vaccine-related side effects should use the standard Medicare Benefits Schedule Level A to D general attendance items, and are encouraged to bulk-bill these consultations, says the Department of Health.

The RACGP says it has been assured that mandatory bulk-billing only applies “when the main reason for the patient to consult their GP is related to the vaccine”, but says this is nebulous and may leave some practices under pressure to bulk-bill more.

Last week, we reported that Dr Lucas de Toca, the covid-19 Primary Care Response First Assistant Secretary, told GPs in the weekly webinar update that generally patients shouldn’t be out-of-pocket for any healthcare interaction related to the vaccine process.

TMR put a series of questions about those comments to the DoH, with concerns that GPs could be rightfully confused about all the presentations that may or may not be due to a vaccine side effect.

We also had concerns that this advice could trap practices for later compliance or audit action from the government.

But the DoH doubled down on its position that bulk-billing patients was preferable.

“Medical practitioners treating patients with suspected vaccine-related side effects should use the standard Medicare Benefits Schedule (MBS) Level A to D general attendance items, depending on the level of care required to treat the patient’s condition,” a representative said.

“While billing policies are generally a decision for individual practitioners, the Government encourages practitioners to bulk-bill these consultations in line with the principle that patients not be charged for services related to receiving a covid-19 vaccinations.”

Of course, the existing rules around practitioners only bulk-billing the specific covid vaccination MBS items still stand too.

“In the webinar Dr De Toca was reiterating that practices participating in the covid-19 vaccine rollout cannot charge patients any out-of-pocket costs associated with receiving a vaccine and that the MBS items implemented to support covid-19 vaccination must be bulk-billed,” the DoH said.

RACGP president Dr Karen Price said that the collegehad sought clarification from the DoH since the comments about GPs bulk-billing presentations of suspected vaccine side effects.

“They have assured us that mandatory bulk-billing only applies when the main reason for the patient to consult their GP is related to the vaccine,” she told TMR.

“Patients talk to their GPs about a range of issues every day so it can be difficult to make a call on the primary reason for the consultation when part of it may cover some possible side effects of the vaccine.”

Dr Price also raised the issue of financial viability for practices who now might feel pressured to bulk-bill a larger proportion of consults.

“The number one priority of any practice is providing quality, affordable care to all patients. However, no one in the community wins if practices are unable to operate sustainably,” she said.

Dr Price said she would encourage the DoH to consider the fact that participating in the vaccine rollout is not straightforward or easy for many GPs.

“GPs have already been caught out by the officious enforcement of telehealth compliance requirements, so it is important that the guidelines are clear for GPs and patients,” she said.

“The current fact sheet is 25 pages long and GPs don’t have the time to read this when they are busy delivering vaccines on top of routine care.”

On top of those existing pressures, determining which presentations may or may not constitute a vaccine side effect for the purpose of Medicare compliance would be taxing on any professional.

“What may prove most difficult is determining whether a symptom is actually related to the vaccine because it may not be black and white,” Dr Price said.

“If someone presents with a headache 24 hours after receiving a vaccine, is that definitely a result of the vaccine or could it be something unrelated?”