Phone rebate cuts hurt the most vulnerable

With Level C phone consults on the chopping block, GPs are sounding the alarm bell for disadvantaged patients.

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Over the past two years, the Department of Health has played chicken with temporary telehealth rebates, renewing them days or hours before they were set to expire or – as in January this year – phasing them out for two weeks before reviving them.

Unlike most telehealth items, a general Level C phone consult (item number 92746) was not made a permanent part of the MBS.

The current extension, which was put in place in response to the Omicron variant, is set to expire at the end of June.

A new extended phone consult item will be available for rural and remote communities (Modified Monash Model 6 and 7 areas only), and a 20-minutes-plus telehealth item will also remain.

There’s still a chance that the government will renew the phone item – as of last week, a spokesman for the DoH said it was still assessing whether there was a need for long phone consults after June 30.

But GPs working with a disadvantaged patient population are in no doubt of the need.

Melbourne GP Dr Mariam Tokhi, who works at a clinic for refugees and asylum seekers, said her patient base tended to require longer consults in general.

“[My patients are often dealing with] two traumas – the trauma of what they’ve experienced that they’ve fled from, and then the trauma of finding your feet in a new [country],” she told The Medical Republic.

“That might come with mental health issues, or it might come with physical health issues, but on top of that, there’s a layer of communication, where English might not be their first language, or they need an interpreter.”

Other patients still, according to Dr Tokhi, will be unfamiliar with the structure of Australia’s health system as a whole and need additional time for education or context building.

For many of Dr Tokhi’s patients, simply switching to video telehealth is not a viable option.

“Policymakers are very often from the most privileged backgrounds in that [they] take for granted that [people] can pay for phone credit each month, take for granted that [they] can afford to pay for data on top of that, take for granted that [they] know how to negotiate those telehealth systems, and that [they] can read the language that all of those things are in,” she said.

“This doesn’t just apply to people who are from non-English speaking backgrounds, but to people with low literacy too.”

At the end of the day, it’s easier to answer a phone than log onto a computer system.

Enforcing in-person only consults also presents challenges.

With covid still causing chaos across the country, Dr Tokhi said many of her patients are still hesitant to come into the clinic.

“It’s not really fair that people who are wealthy and privileged get the flexibility of access to a doctor, whether that’s by phone or video or face to face, whereas people who are poor are forced into going face to face,” she said.

Sydney-based GP Dr Brad McKay told TMR that he tended to be grateful when patients even had a mobile phone, with some of his elderly patients still using a landline or an old-style Nokia phone.

“There are other people that are on very low plans and so they’ve got no access to data,” he said.

“Then you’ve got homeless people, they’re often trying to plug in their phones somewhere on the street and trying to get in contact with them [takes some effort].

“A lot of people in the more disadvantaged groups just aren’t organised enough to actually be able to do a video call.”

The very same patients often have more complex care needs and require longer consults as a result, Dr McKay said.

“I’ve got some patients who are immunocompromised, and they don’t want to leave their house – [but now] I have to tell them to come into a clinic where they can easily be coughed on?” he said.

“It’s counterintuitive in so many regards.”

Other changes rolling in on July 1 include the 30/20 rule, which will flag doctors who render more than 30 phone appointments per day on 20 days in a 12-month period.

The 80/20 rule will also apply to telehealth services moving forward, which it has not done previously.

“It’s a very vindictive system that’s also making GPs more concerned about their ability to provide service for patients,” Dr McKay said.

“[The choice is that] either we don’t provide the care and limit our numbers [to avoid the PSR], or we still service people, but we don’t charge it.”

Rural Doctors Association of Australia president Dr Megan Belot said she did not think that patients in non-MM6 and 7 areas would necessarily be disadvantaged by the change.  

“There will definitely be a small cohort of patients where phone consult will be preferred over telehealth, especially if internet connections are really crap – for some of our rural locations, unfortunately, that is the case,” she told TMR.  

“But still, to my mind, the gold standard would be seeing [patients] face to face or via telehealth consult.”