For Helen and Korrie Kueper, a trip to the doctor is no small undertaking.
From their property near Bredbo in regional New South Wales, it's a 45-minute drive along a partially unsealed road to the nearest doctor in Cooma.
"It's about a 50-kilometre each way trip," Korrie says.
It's also an important one.
Triple-bypass surgery means Korrie needs regular prescriptions for blood-thinners and arrhythmia medication.
When the coronavirus pandemic hit, the pair followed official advice and bunkered down at home.
"We didn't leave the farm for at least eight weeks," Korrie says.
"The less time we spend in town, we say, the better, being over 70 years of age with heart problems."
Helen says they put off going to the GP.
"We thought there'd be people sitting in the surgery, maybe contagious."
Telehealth 'a great advantage'
In March, as part of a $1.1 billion coronavirus package, the Federal Government pumped nearly $670 million into rebates for telehealth consultations.
Helen booked an appointment as soon as she heard about the scheme.
"Being able to do these calls over the telephone has been a great advantage", she says.
"It's made it more accessible and less time-consuming."
"We can't speak highly enough of it," says Korrie.
GPs forced to adapt quickly to pandemic healthcare
The pivot to phone and video consultations was a challenge for the medical industry, requiring rapid upskilling and reliance on unfamiliar technology.
"It was a little bit overwhelming … we went from no telehealth to nearly all telehealth," says Michael Wright, a GP based in Sydney's eastern suburbs.
"We were trying to provide healthcare safely, but then we were trying to adapt to this whole new business model of telephone consults and video consults, when none of us was used to doing them."
The subsidies provided financial relief for practices contending with plummeting patient numbers.
Research from the Melbourne Institute showed that over April and May, telehealth accounted for more than a third of all consultations.
It also circumvented the need for personal protective equipment, which in many cases was not readily available.
"Our primary health network distributed masks to all of the practices, but for things like gowns we struggled," says Dr Wright.
"Lots of people didn't want to come into the practice and so [telehealth consults] protected them and also it protected me."
Mandatory bulk-billing rules 'restrictive'
When telehealth services were first rolled out in March, all practitioners were required to bulk bill for consults.
In April, the freedom to charge a gap was handed back to specialists and Allied Health professionals, but GPs are still required to bulk bill telehealth provided to concession card holders, the elderly, children under 16 and those considered at risk of contracting COVID-19.
Speaking on The Drum, Melbourne GP Vyom Sharma said those rules were restrictive.
"If you're a patient of mine [earning] half a million dollars a year but you're on asthma medication for an inhaler you take every day, I can't charge a gap. I must bulk bill you," he said.
"It's really just not sustainable as a business model for a lot of us."
Nearly one in five GPs surveyed by the Melbourne Institute said their practice had applied for JobKeeper and 65 per cent reported a fall in monthly income over April and May.
Earlier this month, Federal Health Minister Greg Hunt announced a $2 billion, six-month extension to telehealth subsidies.
The move has been roundly welcomed by doctors and patients alike, but Dr Sharma says if telehealth is here to stay, changes are needed to make it financially viable.
"There are some significant structural funding issues to sort out."
The extension came as welcome news for Helen and Korrie, who remain concerned about the possibility of a second wave in NSW.
"We have a lot of through-traffic in the Cooma district, where lots of people are going to the snow.
"We don't know where they're coming from and we're very aware of the possibility of COVID coming back," Korrie says.
Corporate practices at an advantage
Dr Sharma says telehealth gives large-scale corporate providers a clear advantage.
"If you're a corporate clinic who's paying half a million dollars every few months to be ranked high on Google searches, suddenly you get the flow of patients and reduce competition among service providers.
"Not to mention … that style of medicine is sometimes at odds with the small cottage industry-style GP, who can cater to what that community specifically needs."
Dr Wright said over-the-phone telehealth consults were not suitable in all circumstances and could compromise the quality of patient care.
"By seeing a GP on multiple visits, you tend to gain more information each time and use that information at the next consult," he said.
"Offering an instant telephone consult is OK for some limited conditions but it's not a good use of resources if you're providing extra care away from the usual GP, and not the highest quality of care if you're not following it up with face-to-face visits.
The Drum airs weeknights on ABC and News Channel.
