Should video kill the audio star?

Telehealth was again a hot topic this week, with Andrew Baird's article on how GPs were using both phone and video our most popular. The AMA and RACGP have both been hard at it lobbying the federal government to extend the temporary MBS items for telehealth beyond September 30 and everyone seems to agree it would be a good idea.

Federal Health Minister Greg Hunt does too, repeatedly saying he's keen on telehealth and touting the benefits of the temporary measures. That he is in the unique position of actually being able to make them permanent but as yet has not done so seems to have escaped his notice.

When the temporary measures were introduced, it was made clear by the Department of Health that video conferencing was the preferred option, with telephone as back-up if video was not available. However, as Dr Baird reports, just three per cent of GP consultations completed in May and June this year in Australia were conducted by video, and while there are obvious barriers to telehealth, it is still hard to get a good idea of exactly why the numbers for video are so very low.

Reports from the UK and New Zealand appear to show similar low percentages of video for telehealth in general practice, although this data is difficult to interpret. The NHS data is from GP appointments and the NZ data from surveys. However, the US seems to be bucking that trend somewhat. Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma says that of the nine million telehealth consults funded by CMS between mid-March and mid-June, three million have been done by telephone. CMS figures include telehealth by “eVisit” or patient portal as well as by video and there do not appear to be separate figures for this available as yet, but it seems that phone consults as a proportion of telehealth are much lower there.

While we wait for definitive research on exactly why video is so vastly underused in Australia, perhaps we could debate whether something should be done about it. Should phone consults, for example, attract a lesser rebate than video? Or should MBS-funded phone consults be restricted to regular patients who the GP knows well, while video is opened up to new patients? With video conferencing platforms offering benefits over telephone for healthcare purposes, should they not be encouraged by regulation? Let us know what you think.

In other news, we were on the money with our story earlier this week that the new chief of the Australian Digital Health Agency would be announced. We were told by several sources that former Department of Health deputy secretary Caroline Edwards was the favourite, but some late money came in for Medicare CEO Amanda Cattermole. As of Friday at 5pm, Ms Cattermole was confirmed.

Also this week, it was National Stroke Week in Australia and the WA government came to the party by announcing that it would put some funds forward towards making its telestroke service operate 24/7. Victoria has a well-established telestroke service that is now helping Tasmania with remote stroke care, and South Australia has also been running a telestroke service for a couple of years. NSW has committed to implementing its service over the next three years following a successful pilot, and New Zealand is also moving ahead with a hub and spoke model that hopefully will cover the entire country in the longer term. Australia still needs Queensland and the NT to get on board for a truly national system that the Stroke Foundation is in favour of.

We also had an interesting story on a remote monitoring platform for confirmed and suspected COVID-19 patients that is being offered to general practices in Gippsland by the local PHN. It's on offer to the Gippsland Contact Tracing Unit as well. While the platform can be hooked up to common Bluetooth-enabled devices, at the moment it is just using manual vital signs data entry and patient-reported outcomes surveys, which can be monitored by care teams and quick interventions made if the patient deteriorates.

The Gippsland project is similar in intent to other remote monitoring of COVID patient programs being run by various health services such as Sydney LHD, Western Sydney LHD and Melbourne Health. We think this sort of technology should be on offer to all COVID positive patients with mild symptoms who are recovering at home. It can then be repurposed once the pandemic is over for chronic disease management.

That brings us to our poll question for the week:

Should telehealth rebates be adjusted to promote video conferencing over telephone calls?

Vote here and feel free to leave your comments below.

Last week we asked: Will the pandemic spur the further use of remote monitoring technologies in aged care? Overwhelmingly yes, readers say. 93 per cent said yes, just seven per cent said no.


+1 # Terry Hannan 2020-09-04 22:15
We need all communication formats as much of the care and communication requires ‘asynchronous’ contact. A review of the number of encounters that require physical contact/visuali sation would be interesting.
-1 # Telehealth advocate 2020-09-05 11:10
RE: Should telehealth rebates be adjusted to promote video conferencing over telephone calls?
On first glance, yes, as it would incentivise patients to use video over phonecall to interact with GPs and aid in GPs providing a better service. We don't need to talk about the benefits of a video call over a voice call. The bigger question is how much more does a video call have to be subsidised to create an economic mechanic that actually works. ie. If phonecall is $30 and video call $35 from MBS, I would hypothesise that it wouldn't be enough. You also need to manage the element of patients without a smartphone and therefore no access to video. This would be an edge case and a very small minority, but this is healthcare and you must cater to all.
In short, yes we should try and promote video over voice call by increasing MBS rebates, however, that's not the hard part of the question. The hard part is by how much in a way that is in line with current rebates and patient access, and then lobbying government to provide this increase by using the large number of positives created by telehealth. If telehealth is done correctly, far more Australians will enter the healthcare system earlier and reduce the burden on the system later in life.
+1 # Alison Johnson 2020-09-07 08:48
I would like, as a consumer, to be able to select which I would prefer - phone or video. There are some discussions that do not need video... and others that I would prefer to speak face to face with my GP. Moving the decision to the consumer addresses the issues with internet/ no device - as the consumer would select phone. There could be some conditions that either require face to face or video, from the GP perspective.... .. Now - just how you change GP practise to do this - that I do not know....
+1 # Janine Hoult 2020-09-07 09:28
I'm an Occupational Therapist with most of my patients being vulnerable elderly with no ability or access to use video devices. When asked if they would like to use a device with a family member present to assist they also decline and say its too difficult and too much fuss and state a phone preference.Cogn itive decline is also a huge barrier so with only one patient agreeing to using video with her daughter, phone is the only option when health restrictions prevent face to face treatment sessions.
0 # J. Davey 2020-09-08 09:08
If a Video option were to be incorporated into the BP software, it might make it a more likely option.
0 # Helen Robertson 2020-09-08 09:44
I'm in a rural area. Few patients have a smart phone recent enough to do video teleconsults, so although the practice is set up for video consulting, it mostly ends up being phone.
+1 # Simon James 2020-09-10 17:24
Hi Helen, can I ask if you work in a practice? If so it would be interesting to collect some data on the types of devices people in your area do have access to. Apple introduced their first "selfie" camera on the iPhone 4, which came out a full ten years ago and I'm sure other phone companies were doing similar things at the time. While I appreciate some people consciously purchase phones that might not be considered smart (limited features and big physical buttons etc), the number of people that don't own a portable video conferencing device has to be a tiny proportion. Beyond the device itself I appreciate there are serveral factors that could limit access to telehealth over video, but I'm not convinced technology is one of them.
0 # Retha 2020-09-10 14:19
From a personal perspective I found some telehealth consults e.g. getting back results from pathology tests or even other consults much more convenient than driving to a surgery, waiting 20 - 30 minutes longer than the appointment was actually scheduled for, just seeing the medical/health practitioner for 10-15 minutes and then having to pay for the consult, the parking and fuel. In some cases where physical examinations are needed telehealth won't work, but in other cases, in can be very convenient. So I'd say - give patients the choice!
0 # Simon James 2020-09-10 17:26
Hi Retha, how much would you be prepared to pay out of pocket for this "choice" and the convenience of telehealth?
0 # Ez 2020-09-18 01:03
Obviously broadband in the bush for a lot of Aussies is still bad and unreliable at best. So geographic location will still be a huge thing for a while for Australians spread out populous. Often phone service is only option in this case. Hence the irony of truly isolated having less options to choose video over phone, even if they could.

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