The government has backed down on a move to strip all but basic telephone consults from the MBS telehealth arrangements, granting telehealth phone services a six-month reprieve after an outcry about the impact on patients at the height of the pandemic.

Telephone items for standard and extended consultations by specialists were struck out on January 1, in a telehealth package announced on December 13 which was billed as a $106 million investment to give “temporary” Covid telehealth items permanence under the MBS.

Under the plan, the only phone item left intact for physicians was the “minor attendance” item 91836 – equivalent to the face-to-face item 119 which has been rarely used by specialists and attracts a fee of just $45.40.

Specialists and other medical groups, surprised by the decision to erase the Covid phone items with the Omicron variant still raging, have lobbied strongly for a deferral.

In a statement released on Sunday, the government promised to restore temporary specialist inpatient telehealth MBS items (video and phone) and initial and complex specialist telephone consultation items, and longer telephone consultations for GP’s (level C) until 30 June 2022.

“These services will be made available nationally rather than targeted to Commonwealth-declared hotspots as they were previously, recognising the high infection rate and need to provide healthcare support across the community,” it said.

The move was welcomed by the RACP which said that telephone items were key to ensuring access to specialist care for many Australians during and beyond the pandemic.

“The College has consistently argued that phone consultations are preferred by many patients or necessitated by patient-specific circumstances such as old age, fragility, intellectual disabilities, deficit in technology skills, low bandwidth, geographical barriers, and inability to access in-person care,” it said.

“We are especially pleased that telephone items will be available for initial as well as complex consultations, and that telehealth rebates are now available for inpatients to receive a consultation with their specialist. Complex consultations via telephone are vital for specialist physicians who often see patients when they have multiple conditions that requires more complex care.”

Going nuts

Prior to the backflip, Professor Fran Boyle, president of the Clinical Oncology Society of Australia, said specialist physicians had been blindsided by the government’s decision to erase all but very brief phone consults at a stroke.

The short notice ahead of the Christmas break meant departments were “going nuts” trying to rearrange consultations, while immune-compromised patients living in virtual isolation were too afraid to attend clinics, she said.

“We have had almost no Covid in the cancer patient community for two years; it’s everywhere now.  At home, they are isolating because they have got Covid or they are close contacts, and they don’t want to come into the clinic.”

Professor Boyle said specialists wanted phone/video telehealth arrangements to become permanent rather than a temporary fix to cover the Covid crisis.

Even in a post-pandemic world, video calls would not be the telehealth solution for every patient because of issues with technology, age, intellectual capacity or the need for extra support, said Professor Boyle.

“Some people are accustomed to using Zoom. Then there are people who say, I just can’t do it. Then the doctor will have to go ahead with the phone consultation and must choose to charge it as a 119 or charge the full fee for the half-hour you spend with them,” Professor Boyle said.

“That is a tough call, making cancer patients more out of pocket.”

This would become an issue for doctors across the physician specialties, she said.

“The reality is that for a lot of people the phone is the only option, and it’s a fantasy to think that’s going to go away. It is a fantasy to think everyone is going to be on Zoom.

“We are on board with telehealth, but we would prefer a mix of telephone and video.”

The RACP said it would also “continue to advocate for the retainment of these items beyond mid-2022 in the interest of our patients and members.”

Remote consulting

Dr Rob Zielinski, an oncologist in Orange, NSW, says choices about telehealth media must be reflect capacity and Australia’s infrastructure falls a long way short.

As a regional specialist, he has used video telehealth for years, beaming into patients visiting small outlying clinics.  Pre-Covid that was his only means of remote consulting, and frankly he would prefer video to the phone.

“An 80-year-old patient can walk in and have the technology set up for them. You can converse with them and show relevant videos.  It works really well unless a patient is very hard of hearing.”

But attempts to make video calls to patients at home have failed, plagued by drop-outs and lack of bandwidth.

“Frankly it was a headache from the get-go,” Dr Zielinski said. “It just adds an extra level of technical difficulty, on top of the problems of age and broadband connectivity available to rural  patients.”

He said he had been “appalled” by the potential loss of telephone MBS items under the government’s plan.  If funding for those services is withdrawn, he said he would require patients needing attention to attend the clinic.

Following the “temporary” Covid telehealth items introducyion in March 2020, physicians’ use of telehealth services by phone has far exceeded video.

In the 2020-21 financial year, physicians’ phone consults of at least 45 minutes (telehealth item 92431) surpassed 64,000 services and $15 million in Medicare costs, compared with a spend of close to $11 million on 45,700 services for the equivalent video consult (92422).

The “minor attendance” telehealth phone item 91836 totalled more than 27,000 services costing Medicare $1.04 million, possibly reflecting short calls which specialists have always made to update patients but not had the means to charge for.

The comparable video item (91826) was used in just 1500 services costing $60,000.