10-year primary care plan puts a lie to universal telehealth claims

Yes, we know we have been banging on about this for ages but this week has revealed in living colour just how ridiculous outgoing health minister Greg Hunt’s commitment to telehealth is. Despite masses of spin to the contrary, the Australian government has no intention of instituting universal permanent telehealth, and nor has it gone to Herculean efforts to institute it, as the Medical Software Industry Association ridiculously likes to tout.

The surreptitious release of the grandly titled Primary Health Care 10-year Plan – allegedly published on March 25, four days before the budget but somehow evading everyone’s notice – suggests that there are quite a lot of elements to the plan that the Department of Health wants to hide.

One of them is surely the further restrictions it is putting on MBS-funded telehealth. While Mr Hunt spouts universal permanent telehealth as one of his great legacies – not only that, but apparently one of the biggest reforms to Medicare since it was enacted – repeated policy changes and restrictions show this is simply not so.

Everybody welcomed the MBS items for telehealth when COVID hit and it certainly was an achievement to get the DoH to institute new item numbers, but since then it has been a policy schmozzle. The technology has been out there for yonks but GPs had no idea how to use it – or more importantly, bill for it – and thus resorted to telephone. They were then spooked by what they thought were dodgy online telehealth services and were worried that their regular patients might go elsewhere and get substandard care.

Substandard care is certainly true of some services that diagnose by chatbot, prescribe unsafely and aren’t set up to let the patient’s regular GP have any idea of what was going on, but most telehealth services are staffed by fellows of the RACGP or ACEM and are perfectly capable of providing good care by video.

That didn’t stop the pressure being exerted on what the doctor lobby groups called “pop-up” telehealth companies – most of which had been in business for quite a few years on a paying basis and were nothing of the sort – and demanding restrictions.

The department gave in, bringing in new rules in favour of continuity of care by limiting MBS-funded telehealth to patients who have seen a GP, or a GP from the same practice, in the past 12 months. There were exceptions – homeless people, babies under 12 months, people in COVID hotspots – but it was pretty clear that the department was wilting under pressure from the RACGP and the AMA to ensure pop-up telehealth firms weren’t harvesting the low-hanging fruit.

We were then told that “universal permanent telehealth” had been ushered in, but just how much the DoH folded like a wet suit in the face of this pressure is writ large in the primary health care 10-year plan, which doesn’t just restrict MBS-funded telehealth to a practice the patient has attended in the previous 12 months, but to a practice in which the patient has “voluntarily enrolled”.

Patients will have to attend a specific practice several times over a certain period to qualify, and according to the plan, they will need to preserve their registration by visiting again in a certain timeframe.

This is just nonsense. Medicare is Australia’s public health insurance scheme and was set up to ensure that money was no barrier to accessing healthcare. It seems that despite all of the government’s claims to “Guaranteeing Medicare”, it has a policy that will guarantee nothing of the sort. The RACGP, which supports these moves, should be ashamed.

These restrictions only apply to telehealth at the moment, but there’s scope for them to be extended to a whole host of Medicare-funded services like chronic disease management plans and team care arrangements. Should you be eligible for publicly funded screening services like breast, cervical or bowel cancer screening unless you are registered with one practice? What about heart health checks or free vaccinations? There is no thought given to people moving house, state or country, to people unable to attend a practice, to people who need care right now. Hello emergency departments! Medicare was set up to ensure equitable access to care. The 10-year plan for primary care guarantees nothing of the sort.

There was a lot of attention paid in the lead up to last fortnight’s budget, but it swiftly lost attention, it seems. We asked in our poll question last week whether it was a useful budget for healthcare and health IT. We got a desultory response, we must say. Just a handful of respondents said yes: 88 per cent said no.

We also asked that if you thought yes, what measures did you support? If no, what would you have liked to have seen? Here’s what you said.

This week, we ask:

Is the Department of Health’s voluntary patient registration scheme the end of publicly funded telehealth?

Vote here or leave your comments below.

Comments  

0 # Margaret Faux 2022-04-11 08:18
Thank you for this excellent article Kate. Honest, accurate and forthright. I share your concerns and have been writing and podcasting about this issue on various platforms. Basically, the 10 year plan entrenches bricks and mortar medical practices on the corner of the street and ensures GPs retain their constitutional right to charge what they want, while consumers lose their reciprocal right to choose their GPs. I am very concerned that this is not only sending our health system down the wrong path, but will also drive up already intolerable consumer out-of-pocket costs. And it will definitely reduce access to health services, as you have rightly pointed out. Urgent attention to necessary structural reform, and digital enablement, is what Medicare needs without delay.
0 # Kate McDonald 2022-04-22 12:35
In our last poll, we asked if voluntary patient registration heralded the end of publicly funded telehealth in Australian primary care. We received a range of strong opinions – see below – with 60 per cent of votes saying yes, and 40 per cent saying no.

Here’s what you said:

- Your evidence free opinion piece on Teleheatlh shows why: you have no understanding of the evidence relating to Quality care: especially knowledge of the patient's personal history, complexities and needs - and therefore the critical nature of continuity and coordination and time, in achieving the 'outcomes that matter to the patient'. VPR properly implemented, works for patients and providers - look at the evidence.

- Some Patients will drive the Telehealth option for their own convenience.

- Thank you Pulse+IT for highlighting the rort that is voluntary patient registration. The scheme is about protecting GP business models, not about improving care. It will actually risk decreasing the quality of care as it restricts access to care for people who don’t register with a single clinic. It also adds burden to the patient by increasing the time spent in the act of registering, and reduces their choices of where and how they receive and participate in their care. It’s a disgrace!

- If you look at the language used to describe the scheme, one could ask their GP “so if I don’t register with you, am I to receive sub-standard care from you? Am I receiving sub-standard care now? Why am I only going to get high quality care after registering? Do you feel ok with having a two tiered system of caring for your patients? But I prefer to go to a different clinic to see a female GP for some things, another clinic that specialises in skin cancer, and another for anything routine - how can I choose just one clinic?” etc etc

- And where will it end? Restricting access to telehealth could just be the beginning. How does this align with patient-centred care?

- Restricting choices and quality of care only to those who register is also a dumb business move. Patients will go to where they feel respected and valued and restricting my choices is no way to make me feel that you care about me and my health.

- I applaud the state govts who are moving to seamless care provision between telehealth and in-person. More of this please!

- Patients and doctors don't want or need more red tape

- Plenty of public funded health care occurs in state funded (hospital) health services.

- GPs might think that enforcing painters to register with them is a good idea to bind patients more to them, to charge them more and incur more services. Patients will look through this and start comparing to online services that are cheaper. Instead of resulting in more continuity of care, it will result in less.

- Thin edge of the wedge for expansion to other areas.

- The government cannot afford it..and therefore we should question the nivana of free publicly funded healthcare services are gone..
Adding yet another barrier. Shame there isn’t also other promotion and patient choice strategies that insist of medical profession providing the choice for patients. At my service we offer patients a video call via an appt reminder system and currently 25% reply back to convert their in person appt to a video call!! If patients know about video call many of them are choosing it. It is the medical staff who aren’t offering it

- What a simplistic take! We need to see funding details first but if we can support multi D care with more sophisticated funding models, Telehealth will become a tool and not a mode of care

- Your comments are unnecessary scaremongering

- The solution will increase the value of GPs because then they will be truly be seen as a health partner rather than just an anonymous doctor
Continuity of care is very strongly associated with better health outcomes. Tying Telehealth to a practice is promoting continuity. The practice can have arrangements with other providers for after hours care.

- You have missed the value to patients of Voluntary Patient Registration, as it will allow more fundamental reform of primary care with greater use of needs based population based funding of GPs such as used in the UK. Telehealth means that a person can call the GP they are registered with even if they are on holiday or at work when say their GP is near home. I expect most people would prefer to use telehealth to talk to a GP practice that knows them and where they know the GPs, rather than see a new GP.

- Too much onus on the patient to do something, needs to be very simple

- Good policy implementation requires practice methodolgy education and development: the DoH has abandoned this proven 'requirement' in favour of Ministerial politicisation of Medicare which makes the 'voluntary patient registration scheme' and similar bad public policy create restrictions on access to approriate health care. If cost was the issue, sack a Minister for maladminstratio n of pulic funds i.e., make such policy a criminal offence of 'murder by administration of policy that acts as a crime against humanity'.
Because health care is largely a reactive/respon sive model. This scheme does not support this human operation/engag ement model over time.

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