Why we can no longer bulk bill

Abandoning Telehealth Item 112 cost rural patients money and maybe their lives

Hi. My name is Dr Hilda High. I am a Genetic Oncologist. I see patients throughout Australia and, using the Telehealth 112 item number, have bulk bill all my consults to rural and regional patients.

The Federal Government announced changes to Telehealth that will come into effect on the 1st of January 2022

The COVID Telehealth items for video consults will become permanent and available to everyone, with the same Medicare rebate available regardless of whether the patient is seen in their specialist’s rooms or via video and regardless of where they live.

While it sounds fair and equitable, the Federal Government has also announced it will abandon Telehealth item 112 and many phone Telehealth item numbers.

Telehealth Item 112 was introduced in 2011 to allow rural and regional patients to obtain a Medicare rebate for consults that were conducted via video.

It also provided an extra 50% of the calculated fee. This could be assigned to the specialist if the patient was bulk billed or was paid to the patient if there was an out-of-pocket cost.

This encouraged specialists to bulk bill and benefited rural and regional patients immensely.

Who will be affected by the loss of item 112?

To find out, search for “doctor connect map”; click on "Health Workforce Locator" and then click on the blue box “Start the locator now”.

Select the Modified Monash Model for 2019

Abandoning Telehealth item 112 hurts rural patients part 1

Abandoning Telehealth item 112 hurts rural patients part 2

Abandoning the Telehealth 112 item number hurts rural and regional patients.

Reducing the fee specialists receive will mean fewer specialists will be able to bulk bill patients. And, for patients who are not bulk billed, their rebates will fall dramatically. (Note: they must pay the full cost first – it is illegal to bulk bill someone and then add a fee on top).

For example the rebate for a consult of 30mins (item 110) via video (new item number item 91824) is $135.45.
If the specialist charges $210.00, the patient is $74.55 out-of-pocket.
Under item 112, if the patient is in a Telehealth eligible area, the rebate will be $135.45 + $67.70 and the out of pocket cost $6.85

For more complex appointments, the losses will be even greater, leading to cancer patients being $1000s of dollars out-of-pocket over a course of treatment

Why is this happening? The Federal Government seems to have confused Telehealth item 112 with the financial incentives were introduced and paid to the specialist as a lump sum at regular intervals.

These included a one-off incentive to cover hardware and staff training etc, incentives to support bulk billing and a per-patient-consult incentive.

These were all phased out completely in 2014-2015.

Cancer deaths are already higher in rural areas. Abandoning Telehealth item 112 will significantly disadvantage already marginalised patients.

Patients who can’t afford the gap or the up-front fees will have to return to the pre-item 112 era of travelling long distances to join queues to access “free” services in large public hospitals.

These changes still need to be made into law. Please stop the Federal Government from abandoning the Telehealth 112 item number. Don’t allow “postcode medicine” to again discriminate against non-metropolitan patients.

What can you do?

You can write to your local MP, raise the issue with patient advocacy groups or on social media and speak to your local radio or newspaper.

You can find a list of your MPs and their emails and postal addresses here

The email / letter doesn’t need to be long. It just needs to say who you are, where you live and why losing the 112 rebates will affect you, either because of not being bulk billed, of having a larger out-of-pocket cost or of again having to travel long distances to access specialist healthcare. Tell your story of how item 112 or phone Telehealth helped you