Barriers to telehealth in danger of being rebuilt
Just as a long-awaited breakthrough occurred when the Australian Department of Health opened up the Medical Benefits Schedule to telehealth item numbers to help GPs deal with the coronavirus pandemic in March, that breakthrough may very well be in danger of being severely curtailed with new restrictions being placed on telehealth provision.
Under pressure from the doctors' lobby groups, Health Minister Greg Hunt announced on July 10 that restrictions would be placed on who can receive MBS-funded telehealth consults from July 20, limiting them to patients who have an existing relationship with a GP or practice and have been seen face to face in the last 12 months. Children and people at risk of homelessness remain covered.
The AMA and RACGP hailed this as a victory against corporate and pop-up telehealth providers, but it could just as easily be argued that it's a setback for a long list of patients who are unable for one reason or another to see a regular GP. As detailed in the comments on our story on Monday, this list could include people living in rural and regional areas, especially Indigenous people who live in remote communities; high school students; people looking for sexual and reproductive care; people with mental health problems who have been receiving care by telehealth already; and even people who have recently moved.
While the AMA and the RACGP say they support telehealth and want it to continue after September 30, it appears that is only if it's on their terms. We wonder how often anyone will check it a patient qualifies, whether there will be penalties for doing the wrong thing, and whether by introducing these new regulations, the government is tying up the whole system in such red tape that everyone just gives up and resorts to pre-pandemic business as usual.
New Zealand is providing an interesting lesson. A research team led by the University of Auckland has been surveying general practices since May, when New Zealand was under strict lockdown. Practices not surprisingly reported a vast decrease in patient volume, whether face to face or by telehealth, and plummeting revenue. In late June, after the restrictions had been lifted, there was an expected decrease in the number of telehealth consults, and now 90 per cent of respondents are reporting they are seeing most patients face to face.
Interestingly, NZ mirrors Australia's experience in the bulk of telehealth being provided over the phone. Almost all practices are still doing telephone consults, but this is for less than 20 per cent of consults overall. When it comes to video, just 43 per cent are offering it. It will be interesting to see what level this volume settles at in the next few months. There's some great data here.
Overseas, patients and practices in the UK and the US are also saying they are very keen on telehealth and hope it will continue in the future. The US has even experience bipartisan support in Congress to ease Medicare reimbursement rules for telehealth, which was previously strictly limited to people living in rural areas.
Like Australia, doctors' groups in the UK have been scathing about corporate-style telehealth providers qualifying for NHS funding, particularly Babylon Health, which provides a virtual service to people in parts of London called GP at Hand. Babylon has been accused of picking off the easy jobs – or “low value care”, as the AMA calls it in Australia – and leaving the burden of caring for the chronically ill and the aged to struggling bricks and mortar practices. They are correct in that – 94 per cent of GP at Hand's patients are under 45 – and Babylon has cleverly got around the NHS requirement that patients must be enrolled in a practice by offering that very capability. Babylon is also able to offer face-to-face consults through a few clinics in its target areas.
For the corporate or pop-up telehealth services in Australia that have attracted the ire of the doctors' groups here, they could consider doing the very same thing. In fact, a couple of them do, partnering with medical centre groups for after hours care. New Zealand also appears to be going down this path, with Auckland's Tāmaki Health launching its own bespoke telehealth consultation service, albeit to its own enrolled patients.
The question in Australia is whether the telehealth services can find a market of full fee-paying patients. It will be a struggle but some have in the past. It also remains to be seen if the Department of Health continues in the future with the new restrictions it will impose from next week or imposes further ones. That might come down to how much money this is all costing. If there is an increase in the number of MBS claims, whether for face-to-face care or virtual, then the future for MBS-funded telehealth may be a bit grim.
Two weeks ago, our poll question asked whether you thought MBS rebates for telehealth should only be available from the patient's usual GP. It was incredibly close, with 49.25 per cent saying yes and 50.75 per cent saying no. This week, we thought we'd look at the telephone versus video debate.
Should telephone consults attract an MBS rebate?
Click here to vote or leave your thoughts below.
In light of this week's COVID-19 surge in Victoria, our poll question from last week might need reconsideration. We asked: Should Melbourne Health postpone its Epic big bang until later in the year? A slight majority agreed: 56 per cent said yes, 43 per cent said no, 1 per cent were unsure.