RACGP denies misleading members, accuses TMR instead

The RACGP has denied it misled its members around an article about an impending DoH compliance campaign on telehealth rules, but its denial raises more questions than it answers.

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The RACGP has denied it misled its members around an article about an impending DoH compliance campaign on telehealth rules, but its denial raises more questions than it answers.

Today the college published a rebuttal to an editorial written by The Medical Republic on Saturday.

The editorial had suggested that the college may have misled its members by publishing articles on March 9 and 12 which stated that nearly 30,000 GPs had been identified by the Department of Health as potentially breaching telehealth rules, and who might therefore be in line to get a DoH letter.

However, the rebuttal raises more questions about how the college may be trying to mould the narrative of its advocacy efforts to its members, and around the transparency of its communication to members and the media.

The full RACGP rebuttal is as follows:

RACGP role in influencing the DoH telehealth campaign

Late last week, the RACGP was accused of lying to its members by the publisher of a medical media outlet in Australia that focuses on general practice.

The article in question suggested the RACGP has deliberately misled members by saying up to 30,000 GPs had inappropriately billed Medicare Benefits Schedule (MBS) telehealth item numbers.

Here are some of the facts:

• The Department of Health (DoH) wrote to the RACGP on 12 February 2021 regarding telehealth compliance, advising it will commence a compliance campaign in March/April 2021.
• In its letter, the DoH states that 26,429 providers ‘may not have met the legislative requirements for an existing relationship’.
• The DoH confirmed it would apply a tiered approach to compliance treatment, including targeted awareness letters to 9470 providers, targeted compliance letters to approximately 730 providers, and an audit of approximately 33 providers.
• RACGP President Dr Karen Price responded to the DoH on 18 February 2021 regarding the proposed compliance campaign. In this letter, the Dr Price raised a number of serious concerns about this campaign for GPs
  • ‘The timing of the campaign puts undue pressure on GPs at a time when they will be implementing the most important public health initiative [vaccine rollout] seen in Australia for decades.’
  • ‘A high-profile compliance campaign will do little to encourage GP commitment and dedication that government need for a successful vaccination program.’
• Dr Price also addressed the confusion regarding the existing relationship requirement introduced in July 2020 for access to MBS telehealth services
  • The RACGP’s specific concern was that we were unable to gain clarity for our members between July and December 2020 about the ambiguity around exceptions to the existing relationship requirement. Dr Price advised the DoH, ‘Given the ambiguity of this period and the lack of clarity provided until December 2020, the integrity of the data for this time period is called into question.’
  • The letter also sought DoH clarification on what criteria were used in their data extraction, seeking answers to a range of questions.
• While the questions asked weren’t specifically answered by DoH, a follow-up meeting was held on 3 March 2021
  • At this meeting, also attended by RDAA, AMA and ACRRM, the RACGP once again led the charge against such a compliance campaign, citing professional fatigue, stress, anxiety and the COVID vaccine rollout.
  • Fortunately, the DoH then agreed to write only to 730 GPs (since revised further down to around 500 GPs) where there were clearer questions regarding potential non-compliance.

Ensuring an additional 9470 GPs don’t receive an anxiety-producing awareness letter during a public health emergency when we need their skills and expertise more than ever is a win, no matter how others choose to (mis)characterise it.

The RACGP maintains the existing-relationship requirement can help facilitate the delivery of high-quality primary healthcare by GPs and practices with knowledge of a patient’s medical history. As we saw in the first months after the March 2020 introduction of telehealth rebates for patients, there were rogue telehealth-only operators setting up shop to exploit the system. Supporting the introduction of an existing-relationship requirement was a reasonable measure taken to limit the erosion of quality healthcare, while supporting patient access to these vital services.

As the RACGP expressed in its 18 February 2021 letter to the DoH, the challenge for members in seeking to ensure compliance with the requirements was five months of ambiguity over what specifically constitutes a person in a COVID-19-affected area.

According to this, the RACGP knew on February 18 that:

• 26,429 providers had been identified as potentially breaching rules
• The DoH intended to write 9370 targeted awareness letters, 730 compliance letters and audit 33 providers

And as of March 3 it knew:

• That the DoH would only write to 730 providers. It remains unclear whether it was writing compliance or targeted awareness letters.

The RACGP first published its article on the topic on its newsGP website on March 9.  Yet, according to the RACGP rebuttal above the college knew on March 3 that only 730 providers would get a letter, not potentially 30,000. Why did the RACGP then publish the 30,000 figure without any clarification and risk creating significant anxiety among its membership? It knew at that point the campaign would be less than 1000 GPs getting some notification from the DoH, not 30,000.

Australian Doctor published an article on the afternoon of March 9 using the same 30,000 figure based on the RACGP story, but the RACGP did not attempt to correct the story in any way. Australian Doctor did attempt to clarify the figures with the DoH but went to press before it got an answer.

On March 12 the RACGP updated its March 9 article to add that it had now negotiated the number of doctors who would receive a letter down significantly, but still maintained the DoH was originally looking at up to 30,000 GPs. This is a claim the DoH denies. The article is here.

The actual figure that the DoH had originally provided to the college as possibly representing GPs in breach of the telehealth rule was 26,429 not 30,000. But the DoH maintains that much earlier than March 9 it had indicated to the RACGP that it wouldn’t be targeting the initially identified 26,429 GPs.

On March 10, and subsequently on one other occasion, TMR asked the RACGP if it could check the 30,000 number for us as the figure represented nearly 90% of all GPs in the country and we felt it might be a mistake (i.e., that the 30,000 might be claims, not GPs).  The RACGP refused to do that despite having the latest figures to hand.

TMR also asked the DoH for confirmation on the number on March 10. TMR checked the figure with several senior GP leaders and the president of ACRRM, and all said the figure seemed implausible.

On March 11, a senior leadership figure in the RACGP sent a Twitter-based communication to a TMR journalist which said that the 30,000 figure was in fact incorrect. When that journalist then asked what was the actual figure, that RACGP figure tweeted back the cryptic message the figure needed a “Fact Check”.  The cryptic reply was almost certainly a reference to the article written by the journalist on the afternoon of March 11 which was titled FACT CHECK: Have 30,000 GPs misused their telehealth?

What was a senior leader in the college doing sending a tweet back to a medical journalist of a media group whose primary readership is GPs, that said the 30,000 figure that the college published was wrong, and not saying what the actual figure was, when according to the college’s rebuttal above, it knew the figure was below 1,000 by then?

On March 12, the DoH got back to TMR and stated clearly that it never had any intent to send letters to 30,000 GPs. This was in contrast to the initial article published by the RACGP on March 9 which said that nearly 30,000 breaches had been identified and the college was negotiating with the DoH to reduce the number of GPs who might be in trouble, given that phase 1b of the vaccine rollout involving 4600 GP practices was about to commence.

In the updated article of March 12, the RACGP still does not admit to knowing that the DoH never intended to send letters to up to 30,000 GPs. It states that “following RACGP recommendations, the campaign has been changed, and the vast majority of GPs will no longer receive a letter”.

There is no mention of 9370 targeted awareness letters, 730 compliance letters, and audit 33 providers, that the DoH had informed the college about initially on Feb 18, and none of the 730 that the college says it knew after a meeting with the DoH on March 3.

The question is, why?

Why keep scaring your members with the 30,000 figure, and not publishing what the DoH had told you already about their intention to only target less than 1000 GPs?

On March 13, I wrote this piece on the RACGP advocacy effort with respect to the telehealth rule and the manner in which it appears to manipulate the narrative by publishing a 30,000 figure when it already knew the figure was significantly under that number.

The basis of that article was that the DoH told us it never had any intention of sending 30,000 letters and that the figure would be more like “under 1000 letters”.

In the article, I did not definitively say the RACGP was lying or misleading, as I’ve been accused of in the RACGP rebuttal. I said that the DoH version of events which stated that less than 1,000 letters will be sent, not up to 30,000, varied so dramatically from the RACGP that one party had to be lying. I then said I thought it would more likely be the RACGP, because the 30,000 figure seemed implausible and the group had not bothered to clarify it.

A timeline of the events is reproduced below. It is apparent that when the RACGP published an article saying the DoH was targeting 30,000 GPs, it already knew that the government body wasn’t intending to do this. The actual initial figure the DoH floated as possibly non-compliant was in fact 26,429 not “nearly 30,000”, which is another less significant misrepresentation of the college in its media to members. But by March 3 that figure was 730, not 30,000.

What was the RACGP doing writing an article on March 9 that would clearly create significant anxiety among its membership by not clarifying what it already knew to be the number of GPs who would actually be targeted?

You decide if RACGP narrative published last week, and now today – that it managed talk the DoH off a cliff on punishing GPs through a mass letter campaign which might have involved up to 30,000 GPs – adds up to transparent communication to its members of how successful it had actually been in its advocacy efforts.

I still am confused as to why it would publish an article that would scare nearly every GP in its membership when it didn’t need to.

One possibility is that the DoH had asked the RACGP to withhold the information that the RACGP says it got on March 3. Or it might be that the RACGP did not get that information on March 3, although it has indicated it did in its article above (we aren’t giving the RACGP full marks for clear communication at this point).

Why does the RACGP think it is OK to withhold information from the media when it knows that without that information the media might write incorrect stories about the DoH and its membership?

One reason might be that if you blow all the smoke away from this episode, and remove the odd mirror in your way, there stands the plain fact that the RACGP’s advocacy on behalf of its members around telehealth, early in the pandemic, which resulted in the creation of the ‘relationship rule’, though well intended, ended up backfiring in the face of its members.

Did the college not want us to figure that out by publishing an article that makes them look like negotiation geniuses : ‘from 30,000 down to less than 1,000, you’re welcome everyone?’

The DoH has told us the number was never significant from the outset.

As I asked on Saturday, who is telling the truth here?

By the looks of the RACGP’s own communication above, the real story was that the DoH had identified 26,429 (not up to 30,000 as the RACGP published) potential breaches, had an original intention to send 9470 targeted awareness letters (“nudge letters”), and 740 compliance letters and then this figure was negotiated down to around 500 letters in all (we don’t know if those are awareness or compliance letters yet).

But this negotiation, which was by rights a good negotiation on behalf of GPs, wasn’t the RACGP acting alone. The negotiation included ACCRM, the AMA and the RDAA. There’s an irony here perhaps because the RACGP has just decided to reconstitute the Unite General Practice Australia group, with the RACGP president, Dr Karen Price, as its chair.

If you’re the DoH, ACRRM, the RDAA, or an RACGP member, how do you view the colleges’ transparency and integrity when negotiating and communicating the results of those negotiations?

Why did the college not mention the other colleges in its communication? Weren’t they involved in any way?

At the end of all this hoo haa, it is mostly RACGP members who will be getting a letter for breaching a condition that the college advocated to the DoH to introduce to protect their members.

Thankfully, probably only about 450 RACGP members at this stage will get a letter. So although well intended, it was always a fail in advocacy terms of some sort. Members likely got stung on the basis of the mismanagement of the communication of the relationship rule.

As I said in the Saturday First Draft column, the RACGP is seriously restrained from being able to advocate for its members to the government by its conflict with being the recruiter, trainer and educator of most GPs in the country, essentially getting its mandate to make money from the Medical Board of Australia, which it loosely reports to.

This whole affair is an example of how that conflict ends up operating.

Badly.

The college has attempted to mould the narrative to make it appear to have done a much better job than in it did. An attempt to deflect from the fact that its advocacy last year has backfired on members (at least 450 of them now).

In its processes it has been happy to mislead the media by either not responding to them on an important question they had the answer to, or sending them cryptic information, hoping we guess, so that we will trip up and they can later point to our mistake and say “TMR misled everyone”.

Does anyone think this is a good use of RACGP executive time?

I wrote to the CEO of the college last week before writing the Saturday editorial pleading with him to have a chat over what was going on. I felt that his organisation’s management of the media has been very poor, and that we needed to talk about the implications as it was likely affecting members.

I had written to the president of the college one week before this episode with a series of questions we wanted answered in a Q&A interview format. They were important and relevant questions for members which weren’t being answered.

Both attempts have been met with silence. That is bad media management, no matter how bad the media is actually behaving.

If you leave a vacuum, the media will always try to fill it.

The RACGP article this morning would have people believe that we’ve tried to do that by filling the vacuum with misleading and inaccurate information, when what we’ve tried to do in reality is join the dots on something that smells wrong, and which the RACGP refuses to engage in to help us unravel on behalf of members.

Real news is information someone somewhere doesn’t want you to publish.

For some insight, we put the following questions to the college at 2.15pm today asking them to get back to us by 4pm. They did not get back to us.

1. According to the rebuttal published by the RACGP today about our Saturday Editorial, the RACGP knew on Feb 18 that only around 10,000 GPs would be getting a letter for awareness or non compliance, and then after the meeting of March 3, that only 730 would be getting a letter. Why did the college publish an article on March 9, with no reference to either figure, and suggest that up to 30,000 GPs had been identified as being in breach by the DoH relationship rule, when you had already information from the DoH which made the 30,000 figure redundant?
2. Having all these numbers to hand, why did the RACGP fail to supply them to the Medical Republic when requested on March 10 for a story it was doing? 
3. Having all these numbers to hand, did the college make any attempt to correct the article in Australian Doctor which was using the incorrect 30,000 figure, which of course would have misled their members?
4. Why did a senior figure in the leadership of the college, subsequently send a communication to one of our journalists which stated that the 30,000 figure was incorrect, but when asked what the figure was, failed to supply it, and instead added a message that said it needed a “Fact Check”. If you knew the figure, why would the college not provide it and avoid any potential confusion in the press?
5. When you knew the exact figure of GPs that the DoH originally felt may have breached the telehealth rule, which was 26,429, why did you write in your article that the DoH figure was “nearly 30,000”?
6. If TMR was told by the DoH that the figure was “never” 30,000, as your article stated ,and likely “under 1000”, and the RACGP refused to supply the correct and current figures despite having them to hand, by what logic do you make the claim that the publisher of the Medical Republic “deliberately misled” college members and “misrepresented” the college in its Saturday editorial?
7. Why do you think the Medical Republic would deliberately attempt to mislead your members?