Doctors unhappy with lower web consultation rate

• Medical schemes pay less for telemedicine since fewer consumables are needed, but association says members are reeling from fewer face-to-face visits

Doctors in private practice, who have already seen a decline in patient visits due to fears of Covid-19 transmission, now face a fresh challenge as medical schemes offer lower reimbursement rates for virtual consultations. Two of SA’s leading medical scheme administrators, Discovery Health and Medscheme, confirmed on Tuesday that they are paying less for telemedicine consultations covered by their client schemes than they do for face-to-face interaction.

Doctors in private practice, who have already experienced a decline in patient visits due to fears of Covid-19 transmission, face a fresh challenge as medical schemes lower reimbursement rates for web consultations.

Two of SA’s leading medical scheme administrators, Discovery Health and Medscheme, confirmed on Tuesday that they are paying less for telemedicine consultations covered by their client schemes than they do for face-to-face interaction.

The move has upset SA’s biggest doctor organisation, the SA Medical Association (Sama), as its members’ income have already been knocked by fewer visits to their practices. SA is in the middle of a three-week lockdown, which requires all but essential workers to stay home and only go out if they need essential household items, or need vital medical care.

The disease has been recorded in all nine provinces, and the tally as of Tuesday evening, is 1,749 cases and 13 deaths.

Discovery Health, which has 19 client schemes including Discovery Health Medical Scheme (DHMS), said it had set virtual consultation rates at 65% of those usually provided for face-to-face consultations with doctors and specialists. DHMS is SA’s biggest open medical scheme.

Medscheme is also paying less for virtual consultations than it does for face-to-face interactions, according to its executive director for healthcare management, Lungi Nyathi. Medscheme’s biggest client is the Government Employees Medical Scheme (GEMS).

She said the lower tariff for telemedicine is consistent with international best practice, and is being applied to all the schemes

Medscheme administers.

Sama chair Angelique Coetzee said the organisation’s members are unhappy because medical schemes have not provided a rationale for the lower rate, or indicated a willingness to negotiate. “We are price takers,” Coetzee said.

Discovery Health CEO Ryan Noach said the lower rate applies to all disciplines, including general practitioners (GPs) and specialists, since virtual consultations are shorter, have lower input costs, and do not require consumables such as tongue depressors, swabs, and gloves. A virtual GP consultation is currently reimbursed at R310.

“These rates are benchmarked against global tariff comparisons, particularly in the US, where virtual consults are well established. In most situations, virtual rates are set at approximately two-thirds of face-to-face [consults],” he said.

“We recognise that [virtual consultations] are being used to substitute revenue for practitioners who are forced out of face-to-face practice during Covid-19 ... but must position the tariffs to ensure long-term sustainability way beyond our emergence from the Covid-19 lockdown and precautions,” Noach said.

Discovery Health is reviewing the rates for mental health practitioners and considering adjusting to the full rate, as virtual consultations are of a similar duration to those they do face to face. It said it has taken note of “numerous requests” to reconsider its rates.

Said Noach: “Understanding the pressures presented by the lockdown and the wider Covid19 situation, we have increased the rate for doctors consulting on Discovery’s DrConnect [online platform] to 75% of the in-room consultation rates.”

SCHEMES HAVE NOT GIVEN A RATIONALE FOR THE LOWER RATE, OR SHOWN A WILLINGNESS TO NEGOTIATE. WE ARE PRICE TAKERS

WE MUST POSITION TARIFFS TO ENSURE SUSTAINABILITY WAY BEYOND EMERGENCE FROM THE COVID-19 LOCKDOWN AND PRECAUTIONS