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Telehealth and phone attendance consultation for specialist obstetricians and gynaecologists (Australia)

16 March 2020

Updated 7 April 2020

The Federal Government has issued temporary MBS numbers to enable general practitioners and specialist practitioners to conduct telehealth and telephone consultations during the COVID-19 virus crisis.

This is relevant for all practitioners, and obstetricians in particular. RANZCOG has already issued advice regarding reducing or spacing antenatal and postnatal visits. These new item numbers will support this process and provide (reduced) remuneration.  
 
Medicare differentiates between phone consultation and telehealth in that the latter requires the use of videoconferencing.
 
The full list of new item numbers can be found at MBS Online

The College is grateful to Avant for providing access to their advice and allowing us to incorporate that advice into this communiqué. Further, detailed advice can be found on the Avant website.

All services provided using the MBS telehealth items must be bulk billed for Commonwealth concession card holders, children under 16 years of age, and patients who are more vulnerable to COVID-19. For all other patients, bulk billing is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.
 
Vulnerable means a patient at risk of COVID-19, so a person who:
is required to self-isolate or self-quarantine in accordance with guidance issued by the Australian Health Protection Principal Committee in relation to COVID-19; or
is at least 70 years old; or
if the person identifies as being of Aboriginal or Torres Strait Islander descent—is at least 50 years old; or
is pregnant; or
is the parent of a child aged under 12 months; or   
is being treated for a chronic health condition; or
is immune compromised; or
meets the current national triage protocol criteria for suspected COVID-19 infection.

The services will be available until 30 September 2020. The continuing availability of these items will be reviewed prior to 30 September 2020.
 
In the absence of more specific advice from the MBS, RANZCOG interprets chronic disease as a condition currently being managed under The Chronic Disease Management (CDM), formerly Enhanced Primary Care or EPC and, in the context of the new COVID-19 Telehealth MBS items, is the condition for which the patient has been referred.
 
A CDM enables GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.  

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.
 
Some relevant item numbers (not exhaustive) for specialist gynaecologists and obstetricians are:
 
If you (the practitioner) are unable to attend your practice, due to self-isolation (either because you have been diagnosed with COVID-19 or advised to self-isolate in accordance with AHPPC), but are not a patient of a hospital, you can continue providing services to your patients by telehealth or telephone as long as you have the capacity to provide “… the full service through this means safely and in accordance with professional standards”.
 
The use of teleheath or telephone consultations does not reduce the expectation of maintaining professional standards. Issues such as patient privacy, protection of data, thorough assessment and documentation are as important as in a face to face consultation. Important physical examination findings e.g. blood pressure or fundal measurement may require targeted face to face consultation or other arrangements e.g. home visit or pharmacy BP.
 
Advice regarding outpatient triaging and management can be found here.
 
The College encourages our members to familiarise themselves with the newly available item numbers for telehealth or telephone consultations and to implement a system of reduced face to face consultations as soon as possible. For further information, please review the links above.



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