Tasmanian GPs are concerned patients could put off a check-up because of the cost, as bulk-billing incentives introduced at the height of the pandemic come to an end.
In March additional government-subsidised Medicare Benefits Schedule items expanding patient access to telehealth were introduced in response to COVID-19.
The changes provided incentives for doctors to bulk-bill, with government funds essentially doubling.
Before October 1, doctors were mandated to bulk-bill patients using a range of new COVID-19 services, including telehealth.
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Last month the government announced a $2 billion, six month extension to a range of the pandemic health measures, which will now be in place until March 2021.
Patients will continue to have access to Medicare-subsidised telehealth for general practitioner, nursing, midwifery, allied health and allied mental health services.
However, temporary bulk-billing incentive items for patients who were vulnerable to COVID-19 and the temporary doubling of all Medicare bulk-billing incentive fees ceased on September 30.
The changes have left many medical practices grappling with their ongoing payment options, with most reverting to systems in place before the pandemic - predominately private billing, with a mix of bulk-billing.
Newstead Medical Centre partner Dr Toby Gardner said GPs were trying to negotiate the changes moving forward, with the understanding that the finances of many patients had been hit hard by the pandemic.
"About 99 per cent of all telephone consultations in Australia and about 97.5 per cent of video calls have been bulk-billed over the past six months, because of extra incentives," he said.
"It still meant our fee per patient was less than what we would have seeing them in the surgery, but it really incentivised us to keep people out of the practice and look after COVID.
"Now the situation is getting back to normal, all those incentives have gone and practices around the country will go back to previous model of billing.
"The concern among a lot of my colleagues around the country is because everyone has been really used to bulk-billing over the last six months, returning back to a private fee model is going to be difficult and there is going to be a lot of resistance in the community."
According to Health Department data, between July 2019 and June 2020 Tasmania had the second lowest GP bulk-billing rate in the country at 78.3 per cent, after the ACT on 67.9 per cent.
Summerdale Medical Centre GP Dr Don Rose said after Medicare changes were introduced in March, his practice became an almost fully bulk-billing surgery.
However, at a time when more patients were returning to face to face care, Dr Rose said GPs have been put in a tough position.
"The incentives have been withdrawn and they've basically said - 'go back to business as usual'. Obviously from our point of view we think it's way too premature," he said.
"There are still a whole lot of people who have a lot of uncertainty about their jobs and their incomes.
"But they have forced us to go back to previous billing practices.
"It's going to change how we operate. I think every surgery has had to go through the whole thing.
"The only good thing about the change is that at least we can continue to use some telehealth for some patients."
Doctors are also warning of a potential backlog of patients, with many who put off regular check-ups at the height of the pandemic now now seeking care.
"I am definitely seeing cancers presenting later than they would have and now we are trying to catch up and get to those people who are presenting later," Dr Gardner said.
"It means people are presenting a lot later with complex disease, which is of course leading to worse outcomes.
"Realistically a video consult and a telephone consult, they never substitute for an in-practice consult.
"Because there are things we miss. We are all really worried about that as well ... about missing things. This is a concern nationwide."
Dr Rose said there was already a lot of catch up going on.
"We are starting to see people who haven't had a check-up all year, and they should have," he said.
"We just hope reintroducing the gap doesn't further delay already late presentations. That's one of the biggest worries."
Bass Liberal MHR Bridget Archer said she has been working alongside a number of Northern Tasmanian GPs around the challenges they were facing pre-COVID-19 and throughout it.
She said the recent extension of telhealth services would be integral to regional communities, and enable GPs to stay connected to their patients.
"That work is not finished and we will continue to advocate strongly ... for GP practices in the Bass area and for their needs," she said.
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