Pandemic practicalities webinar
Remaining participants’ questions answered
Live webinar held on 8 April 2020
You can watch the webinar’s recording here.
Telehealth
I'm doing consultations via telephone not video, is that ok?
Yes, there are specific MBS items for telephone consults and the MBS states: “A service may only be provided by telehealth where it is safe and clinically appropriate to do so”. If vision of the patient is clinically indicated, revert to a video consultation or face to face consultation. See telehealth FAQs.
I use my mobile phone since I am working from home on some days. What do I need to consider?
Personal mobile devices should not be used to record video consultations. We also recommend you block your number if using your personal phone. Any images relating to patient care need to be added to the patient record and then deleted from your device.
See this Clinical images and the use of personal mobile devices guide (MIIAA & AMA) for further information.
Can I use telehealth with a carer/relative if the patient is incapable of using audio-visual capabilities?
Yes. Document the presence of other parties and the patient’s consent for their involvement.
See telehealth toolkit.
I am only using telephone and remotely logging in to my practice software. Do I need to enter the start time and end time in consultation notes?
The usual MBS requirements apply for billing and documentation. It is useful to note the time taken for the consult (start and finish times not necessary).
Can we see new patients via telehealth?
Yes. Patients do not need to be a practice patient or have been seen in the last twelve months. See telehealth FAQs.
Are we required to bulk bill all telehealth consults, especially if there is no item number for telehealth that suits our cohort of patients?
Relevant changes were made on 20 April 2020. See telehealth FAQs.
GPs need to bulk bill telehealth consults if a patient is more at risk of COVID-19. Is there an official list of what these risks are?
See telehealth FAQs.
Will telehealth consults be covered by MDA National indemnity insurance for existing Members?
Yes. See telehealth FAQs.
I have a baby, 6 months of age, so I am in a vulnerable group. Our clinic has 3–4 more GPs working in practice. Can I provide just telehealth or video, and no face to face appointment in clinic with myself?
Yes. See telehealth FAQ.
Privacy requirements for telehealth platforms. What do we need to confirm from a telehealth platform to ensure we do not get in trouble here?
e.g. what level of encryption is needed, what do we need to check about where the data from the teleconsults is stored/sent etc?See telehealth FAQ and toolkit.
And see the MBS Privacy checklist for telehealth services.
What may be the implications of not being able to do a physical exam especially for neonates ranging from 4 weeks to 12 months of age?
Not all consultations can be done via telehealth. The MBS states, “A service may only be provided by telehealth where it is safe and clinically appropriate to do so”. It will be a clinical decision as to whether a face to face consultation to conduct an examination should be arranged.
The Department of Health (DoH) have advised that referral to available face to face services should occur as appropriate.
Billings
Can I do a care plan – GPMP/TCA – via telehealth for a patient?
Yes. See MBS Online COVID-19 Temporary MBS Telehealth Services GPs and OMPs items fact sheet.
Note: the requirements of the Chronic Disease Management items are as per usual e.g. 721, 723, 732.
Can we charge a gap for paediatric patients for telehealth consultations?
If you are a non-GP specialist, you can charge a gap. General practitioners must continue to bulk bill patients under 16 years of age. See telehealth FAQs.
For clarity, can a specialist use 104 Initial consults while doing telehealth?
Yes. See the MBS Online COVID-19 Temporary MBS Telehealth Services Specialists fact sheet for the video and phone equivalent item numbers.
Are there any limitations to bulk bill patients in a mixed billing general practice?
I have been bulk billing everyone either through telehealth or face to face. Is it okay to do that?Yes. See telehealth FAQs.
I could not find the FAQ about adding private charge on top of bulk bill. Could I please get a link to that document?
See telehealth FAQs and Mixed billing changes for COVID-19 telehealth blog.
What about two visits, same day?
If there is a need of face to face consult, (1) should it be billed as a separate consultation, (2) what is the billing if another GP from the same practice sees the same patient?1. See Provider Frequently Asked Questions, MBS Online: “Where the subsequent attendance on the same day does constitute a continuation of an earlier attendance, the sessions are regarded as being part of a single attendance for benefit purposes” (p5).
And see MBS Note AN.0.7.
2. This depends on whether each consultation is considered a “full service”. See MBS Provider Frequently Asked Questions.
Employment
I am employed by a public hospital as a staff specialist in speciality X. Can I reasonably be asked to work in a COVID clinic or ICU?
For example, where does an anaesthetist who’s asked to provide ICU care stand if not credentialled?You may be asked to work in area that is not your specialty, please see the Medical Board of Australia’s “Guidance scope of practice – doctors with general and specialist registration” (scroll down to the text box in this link).
Also see Membership and insurance FAQ, “What if I am asked to work outside my usual specialty or area of practice?”
Our practice has advised us to buy personal protective equipment (PPE) as doctors are independent contractors. Is this appropriate?
What if we’re unable to find PPE?This is a practice issue but doctors should not be working without the appropriate PPE.
Can you comment on the recent Medical Board of Australia statement that in the event of complaints during this period doctors will be judged considering the circumstances of the time?
See Membership and insurance FAQ, “What if I am asked to work outside my usual specialty or area of practice to help with the effort to manage COVID-19?” See part b. Standard of care.
If colleagues chose to work from home, are doctors in the practice obliged to cover their patients like you would if they were on leave?
This would need to be discussed and agreed between the practice management and doctors.
Practice/staff
Our staff has encountered aggressive behaviour from some patients during stressful times. Does the clinic have the right to terminate the care of a patient based on this ground?
Yes. See our Ending the doctor–patient relationship article.
What about not being able to decline to see a patient in an emergency?
What’s the emergency definition, e.g. rocking up to the practice, collapsing in front of you, short of breath at home?It will be a clinical decision as to whether an illness or injury requires immediate action. Treatment of patients in emergencies is covered in the Code of Conduct in that in addition to the patient’s best care, doctors should take “… account of their own safety, skills, the availability of other options and the impact on any other patients under their care …”(p7).
How far do we need to go in a practice to protect our staff from the risk of infection especially if we decide to remain open for selective face to face consultations?
At what point do we need to close our clinics because of unacceptable risk to our staff?This is a clinical and workplace issue, and see practice related FAQs.
What happens if a staff member contracts SARS-CoV-2 from the workplace?
What happens if a staff member infects others?This is a clinical and workplace issue, and see practice related FAQs.
Are practices legally allowed to temporarily reduce the pay and/or rostered hours for permanent staff over this period to ensure practice viability?
Need to seek independent legal, accounting or workplace advice, and see practice related FAQs.
How would JobKeeper apply to GP contractors?
Need to seek independent legal, accounting or workplace advice, and see practice related FAQs.
Regarding JobKeeper, do you have to show a drop in revenue in any month to be granted the whole subsidy?
Are there any guidelines about disinfecting/cleaning of equipment in clinics?
For example, blood pressure cuffs?Seek advice from local public health unit (PHU).
Who decides what PPE is “appropriate”?
This is a complex clinical issue, seek advice from local PHU. Many guidelines are available, for example:
- Australian Government DoH, Revised advice on non-inpatient care of people with suspected or confirmed COVID-19, including use of PPE
- Clinical Excellence Commission, Application of PPE in Response to COVID-19 Pandemic
- AMA guidelines, COVID-19 Transmission and PPE
- ANZCA, Statement on personal protection equipment during the COVID-19 pandemic (30 March 2020)
- Queensland Health, Interim infection prevention and control guidelines for the management of COVID-19 in healthcare settings.
Other
If a patient has flu-like symptoms and COVID-19 test is negative, there is concern they may still have it, and they demand a certificate to return to work, my understanding is they should be off work for 2 weeks?
See federal Department of Health website for up to date information for health professionals. Also see patient FAQ, “My patient has asked me for a certificate …”
Employers are requesting employees to get a medical certificate from a GP to cover them as high risk for COVID-19 to stay home. What should the GP do?
Can we provide letter of support to a person whose spouse is immunosuppressed (so they want to stay away from work due to fear of passing SARS-CoV-2 to spouse)?
Could I please confirm if specialists still need a GP referral if over 12 months from last review?
Generally yes, if the previous referral was for the usual 12 months – see MBS Note GN.6.16.
If my old patient’s referral has expired, I find it hard to get a new referral as their GP or optometrist is closed. What are my options? Can I get an SMS referral?
See above and: if the referrer is providing telehealth then it is possible to receive an electronic version; however, the original referral does need to be signed by the referrer and sent to the receiving specialist.
For patients with case by case consideration for procedures there is a judgement call whether to proceed or not with investigations / procedures – what are the medico-legal implications of delayed diagnosis due to government recommendations?
Any complaint or claim which may arise from an alleged delay in diagnosis or treatment will be judged in the context of the environment and government recommendations that were in place at the time.
The Medical Board has indicated it will take account of extraordinary circumstances in which you are working and heavy demands being made of you.
Is a new patient consult enough reason to bring them into the practice for review?
Not on its own. If both the doctor/practice and patient agree that physical attendance is necessary and/or acceptable, a face to face consultation can be arranged. If the patient meets the “vulnerable” criteria then a telehealth attendance in the first instance may be preferable.
What if a patient has chest pain on telehealth, is advised to call 000, then refuses to go with an ambulance?
Attempt to speak with someone else in the patient’s home to encourage an ambulance call, explain urgency, and what may happen if the person does not attend hospital and get medical care – do the best you can. A competent person cannot be forced to go to hospital. Document very clearly your advice and their response.
This Q&A is generic information only and does not take into account the physical state, medical status and/or health requirements of any particular individual which are relevant to proper diagnosis and treatment of any problem, condition or disorder, nor does the information take into account the particular facts relevant to any legal, financial or workplace issue. MDA National Members need to contact us for specific advice. We may also refer you to other professional services. The opinions expressed by any health professional on this website are those of the relevant health professional and not the MDA National Group.