Meanwhile, GPs are subsidising the cost of longer telephone consults for disadvantaged patients.
THE removal of Medicare funding of long phone consultations is a “cost-cutting exercise and just another way of screwing GPs”, says one, as researchers call for a review of rebates for telehealth.
Seven months after the expiration of Medicare rebates for telephone consultations over 20 minutes, Victorian researchers say the move is potentially disadvantaging lower socioeconomic groups as well as the elderly, and vulnerable, complex patients.
Medicare rebates for long phone consultations ceased on 1 July 2022, forcing patients who need more time to either switch to video consults, travel to see their GPs face-to-face, or self-fund longer phone appointments.
With only 3% of the 99 million standard GP telehealth consultations (as of October 2022) being delivered by video, the time has come for a government rethink, according to Dr Feby Savira, a Postdoctoral Research Fellow at Deakin University, and her colleagues.
Writing in the Medical Journal of Australia, Dr Savira et al. said the evidence for shifting to video consultations rather than telephone was “unclear” and “indirectly suggests that patients who require long telehealth consultations can only achieve better outcomes through video consultations”.
In fact, patients have found phone and video consultations similarly satisfying, while cardiologists at St Vincent’s in Melbourne found no difference in outcomes between video and phone consults.
Lack of strong Australian evidence in the context of primary care is a big problem, say Dr Savira and co-authors. Their own research, which analysed data from 140 regional primary care practices in Western Victoria, found that “long telephone consultations are still being used in the region, and there is as yet insufficient evidence that long video consultations are an appropriate alternative”.
Dr Brad McKay, a Sydney-based GP and science communicator, and TMR editorial board member, told TMR that there was no reason for the removal of rebates for long phone consults “other than as a cost-cutting exercise and another way of screwing GPs”.
“We end up trying to fix 1000 problems in 15 minutes on the phone or we end up going overtime and not being paid for it,” he said.
“We should be billing the patients for longer consults and they’ll get back whatever the rebate is, but that disadvantages those patients who cannot afford it. So we end up giving the same quality care and paying for it out of our own pockets.”
The MJA authors highlighted that compelling video consultations for longer appointments was disadvantaging several groups.
“While long telephone consultations remain available for remote and very remote towns (Modified Monash Model classification, MM6-7), many medium and small rural towns (MM4-5 classified areas) are limited in internet and mobile telephone service infrastructure that would enable video calling capability,” they wrote.
“Many rural and remote areas also have higher proportions of older people who may have reduced digital literacy and increased barriers to accessing face-to-face care.
“During the pandemic, many older people chose to cancel face-to-face appointments because of complex medical vulnerabilities for which they still required care.
“The increased cost of travel for face-to-face appointments creates a situation of reduced health care equity for those who are both socio-economically and geographically disadvantaged.”
Reinforcing Dr McKay’s statement that removal of the rebates was “a cost-cutting exercise”, the authors continued: “We need to recognise that there was evidence of substantial use of this MBS item and there is little evidence to support a change. Long telephone consultations have been critical in supporting Australians to receive health care they need.”
