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.
Comments
It does not affect other specialist only GPs.
You should be fine to continue Telehealth with your Cardiologist.
There is no one answer to healthcare in Australia.
As for "mandated two way communication" -- we have yet to find an infallible way of sustaining such a thing between the many Aboriginal Medical Services to which our patients travel. We had a perfect example of the issues with two way communication on the weekend -- a visitor to a remote community with a life-threatenin g situation about whom we could obtain no information except her name. We could not contact her home clinic as they have no phone number for after hours services; patients just go to the house of the on-call nurse.
I understand this is an extreme example but it's a good example of the difficulties remote and rural patients face, and anything that restricts the ability of patients to access a doctor is not helpful to patients. These requirements do just that.
I'd agree that telephone consults and video consults should not necessarily attract the same reimbursement, but I don't believe we should be limiting access in this way.
My point there was in regard to registering with one practice. Say a patient, who sees doctors in multiple communities, rocks up in one where there's currently a doctor and decides to get a check up. It's not the one where they're registered and they can't get in touch with the community where they are registered; if, in your scenario, their "home" clinic needs to authorise care, this will reduce their chances of seeing a doctor where they are right now. This doesn't seem like the best thing for the patient.
It is also important to ensure the phone consults are included in the MBS items as many regional patients do not have access to IT devices or internet at home, phone is the only option available to them.
We also have patients on low income. Don't have family support , women with DV issue complex trauma. Some times they don't have a regular doctor . They find it hard to leave home due to mental health and other issue .Now many don't want to travel by public transport due to covid. I also feel not a good idea for too many patients to present at the practice . Telehealth was an option to provide service for at least 30% of patients.