7 April 2020

How one clinic is pivoting to telehealth

Communicable Disease COVID-19 Telehealth

As COVID-19 case numbers climb, rheumatologist Dr Irwin Lim’s waiting rooms are emptier than they’ve ever been, but the practice is being inundated with patient enquiries by phone and email.

Over the past few weeks, Dr Lim’s Western Sydney-based practice, called BJC Health, has been “pivoting at speed” towards telehealth.

“On Tuesday [31 March], I saw 37 patients and 36 by telehealth,” Dr Lim, who is also editor of TMR sister publication Rheumatology Republic, said.

“The whole aim is to keep patients away to keep them and my staff safe, so whoever we can convert to telehealth, we are converting.

“It’s what we’ve always wanted to offer. But the problem has always been a lack of Medicare rebate, and so the incentives now move to telehealth, and I think it’s good for everyone.

“We run a lot of exercise classes and we’ve had to transition all of those online.”

The rapid move towards e-health wasn’t occurring without hiccups, however. One major issue was the sheer volume of phone calls coming into the clinic from patients with rheumatic disease who were understandably worried about being immunosuppressed during a pandemic.

“We got 350 calls on Monday [30 March],” said Dr Lim. “If it takes five minutes a call, how many people do you need to even just answer phone calls?

“Our volume of phone calls has doubled since COVID-19 and we are able to take one quarter of them.”

While call numbers were sky high, the clinic was also down on staff.

“We’ve halved our onsite reception workforce,” Dr Lim said. “We’ve reduced everyone’s hours as well.”

With staff dropping out to care for children or to self-isolate, the clinic just didn’t have the workforce to stay open as long as it used to, he said.

Some receptionists were working from home now, with clinic calls being diverted to their mobile phone and remote accessing the practice software, Genie, he said.

The other major reason for decreasing hours for some staff (administrative and allied health professionals) was to save on costs.

While telehealth was working well for most patients, it was crushing the business financially,  Dr Lim said.

As of 3 April, all telehealth consultations had to be bulk billed, and rheumatologists and GPs were unable to charge a gap fee.

“I don’t want to cry poor, but rheumatologists typically charge $100 to $150 for a follow-up consultation and the rebate – which must be bulk billed – is only around $60,” Dr Lim said.

“Essentially, think of it as something like a 40-60% pay cut… Private practices are not run on a 50% profit basis. So, if you take a 50% cut in your billings, there’s no way it would work out. It’s not feasible to run practice at that rate.”

And the federal government’s pledge to allow telehealth gap payments won’t necessarily solve specialists’ financial troubles. At the moment, the nine rheumatologists at BJC Health had just accepted a pay cut to help everyone through the crisis, Dr Lim said.

“With the community suffering, BJC Health’s approach has been – we’ve all decided – we’re just going to drop fees to try to help the community over the next two years, whatever it takes.”

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