Rheumatologists switch to telehealth but face uncertain financial future

Dr Marabani

Rheumatology clinics have switched to telehealth consultations but many in the private sector face financial ruin if the COVID-19 pandemic is prolonged, a leading rheumatologist says.

Sydney-based Dr Mona Marabani told the limbic she was now seeing most of her patients by telehealth consultations unless it was absolutely necessary for them to attend the clinic in person.

“With the recommendations on social distancing it would be hard to reconcile that with seeing patients face to face. I am in private practice and the vast majority of consultations I know of among my colleagues are being done with telehealth,” she said.

Dr Marabani said she understood a similar switch to telehealth had taken place in rheumatology outpatient clinics in hospitals

“In the public system as far as I am seeing they have encouraged all patients to consult by telehealth as far as possible rather than face to face. Many outpatients have closed or have been downgraded as hospitals have repurposed clinic spaces to set up COVID-19 clinics.”

Medicare telehealth rebates:

Covid-19 telehealth 91824/telephone 91834/face to face 110 Fee (initial attendance– Medicare fee $155.60, 85% rebate $132.30)

Covid-19 telehealth 91825/telephone 91835/face to face 116 Fee (subsequent attendance Medicare fee $77.90, 85% rebate $66.25)

Covid-19 telehealth 91826/ telephone 91836/face to face 119 Fee (minor attendance Medicare fee $44 .35 85% rebate $33.30)

There is no COVID-19 item equivalent to 132 or 133. 

Dr Marabani said the lack of clinician access to PPE was another reason for using telehealth.

“We are discouraging patients from attending in person and are screening every single patient by phone and allocating to telehealth if possible. Some people do need to come in for injections or need to be examined. They are screened for risk factors for COVID19 and asked not to come if they pose a risk.

“We don’t qualify for supplies from the National Medical Stockpile and our usual surgical supply company has run out of masks and hand sanitiser and isn’t taking orders.

“I have a few masks purchased from Bunnings and a limited supply of hand sanitiser. It’s a very challenging time to be practising medicine!”

Dr Marabani said her transition to telehealth had been helped with useful tips and information from the ARA on issues such as getting PBS authorisation for DMARD treatment if you cannot examine the patient or they don’t have current bloods.

In terms of treatment during the risk of COVID-19 infection, she said she was following ARA guidance that there was no need to stop or change treatment such as biologic immunotherapy for patients.

But while the Medicare telehealth items were welcome, she feared they would lead to some practices going out of business due to the low level of rebates.

“The Medicare items are working but many private practices have taken a big financial hit because the items are set at the equivalent of the bulk billing rate that has not been adjusted for inflation for many years,” she said.

“I think for most of us the aim is just to try meet our practice running costs  so we can stay open and keep helping patients as best we can. We just hope we can keep going on until we’re past this crisis,” she added.

In its tips for rheumatologists the ARA noted that the 112 item is not applicable to the COVID-19 telehealth item numbers.

“Some might feel this in inequitable, but so many members of society have lost so much it is not an issue the ARA are going to explore,” it said.

Meanwhile the AMA says that struggling specialty practices may be helped to stay open by the government’s new JobKeeper package and other measures announced over recent weeks to support small business.

AMA President, Dr Tony Bartone, said medical practices were not immune to the economic impact of COVID-19, just like every other small business in Australia.

“Some medical practices …  have already had to consider laying off staff due to the significant changes to their operating environment. Without this kind of support, the viability of many others would suffer.”

Dr Bartone said medical practices were being affected as operations are being cancelled and patients are increasingly reluctant to visit their doctor for fear of catching COVID-19.

“While telehealth will be a tremendous help for doctors and patients alike, there are some medical conditions that can’t be dealt with over the phone or by a video call. Face to face traditional consultations are a key cornerstone of good medical practice.”

“COVID-19 will not last forever, so we need to ensure that medical practices, like any other business, are ready to emerge on the other side of this crisis to continue delivering high quality patient care.”

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