Telehealth tussle still a toss up but is all hell about to break loose in NSW?

The ongoing saga that is federally funded telehealth policy dominated the start of the week in Australian health IT, but at the end of it, we were hearing some pretty startling news about the direction that eHealth NSW is thinking of taking with its single digital patient record (SDPR) project.

The doctors’ lobby groups managed to get the Department of Health and Aged Care to change its mind on dropping the level C telephone consult item for COVID-19 antivirals, but that is as far as the department seems will to budge at this stage. The combined wrath of the college of GPs, the AMA and even the Royal Australian College of Physicians has been let loose on the department through submissions to the Australian National Audit Office’s (ANAO) recently announced audit of the expansion of telehealth services.

We here at Pulse+IT have whinged time and time and time again – and also time again – about the constantly fluctuating fortunes for telehealth policy and funding over the last two years but to little avail. It was a comment on our story on Monday about the drama – which also included some very wise words from Coviu founder Silvia Pfeiffer – that brought a lot of it home. It is the lack of access to GPs in regional and rural areas as well as the “prior requirement” that is causing the greatest hardship, not access to IT or money or how long a GP needs to prescribe antivirals.

The whole policy disaster is in no uncertain terms a shit show. It needs to be sorted. Surely one of the five ministerial appointments in the new government, whether it be Mark Butler, Anika Wells, Emma McBride, Ged Kearney or Malandirri McCarthy, could take the bull by the proverbial and once and for all sort it out?

We are well aware that there telephone consults over 20 minutes are rare enough and that DoHAC is on high alert for rorting, along with the doctors’ groups concerns over pop-up telehealth, but changes to policy and items over the last two years has been bewildering, illogical and bloody annoying. In the new government’s honeymoon period, there is time to sort it out once and for all, even if the doctors get upset.

Meanwhile, the acute care sector gets on with it. Money has been provided to Northern Health to extend its VVED initiative into aged care and for antiviral prescribing for people who don’t have a regular GP. South Australia is doing interesting things in paediatric telehealth (although SA Health media has blocked Pulse+IT from covering it) and Monash Health is piloting a virtual pharmacy service for hospital patients on blood pressure meds.

And while telehealth policy and funding were the big topics at the start of the week, we began to hear some quite remarkable rumours at the end. Could it be possible that NSW Health is planning to use its Single Digital Patient Record (SDPR) project, which is touted as providing a unified record that combines data from all matter of different clinical systems, as a means to reassess its whole hospital EMR strategy? Is Hunter New England, the outlier in NSW in using a different system from the other local health districts, being leaned on to try out an upstart that is increasingly gaining popularity and million-dollar contracts in Australia? And is the success or failure of that trial going to be used as a use case to ditch a billion dollars’ worth of investment in health IT systems since about 2009?

Could be. No one was available for comment today. If you know anything, give us a buzz here.

On Monday, Pulse+IT is launching our new aged, community and digital care newsletter, which we are fondly calling ACDC. It will be sent to everyone on our 19,000+ mailing list on Monday morning, but if it’s not your thing, you can adjust your preferences at the bottom of the email. We have also had a redesign of our vendor directory – take a look vendor directory – and are in the final throes of setting up a new website. More about that soon.

In the meantime and back to telehealth, here’s our poll question for this week.

Does MBS-funded telehealth policy need a complete reset under the new government?

Vote here or leave your comments below.

Last week, we asked: Does NSW’s patient app sound suspiciously like a good idea? Absolutely, according to 95 per cent of respondents to our poll. We also asked why you chose yes or no. Here’s what you said.

Comments  

0 # Kate McDonald 2022-07-29 17:07
Does MBS-funded telehealth policy need a complete reset under the new government? Big time, our readers said: 93 per cent were in the affirmative.

We also asked what you think should or should not be done about it. Here’s what you said:

- Funding reform to include Telehealth in a funding system that looks at outcomes and is agnostic of how the care is delivered. Patients need choice.

- Consultation on understanding requirements, patient use cases and clinician use cases for Telehealth.

- Reinstate subsidies for the regional areas as they are the losers in the Telehealth revamp - often with no access go high quality internet they are unable to access AVL at home and need the support of their GP practices. This also applies to the elderly.

- I think patients and doctors should have choice to choose F2F consults or TeleHealth (phone or video). Working in a rural regional area, many people have poor internet & mobile phone service. I find many patients like a hybrid model

- Implementation of the primary health reforms and ensure telehealth is linked to patient registration; review the incentives for phone and video telehealth and rewrite the schedule + adequate funding for a well structured re best practice (education) use of telehealth services for GPs and consumers; properly designed program to promote and incentivise higher video telehealth for appropriate services

- Rebate should be higher for time involved

- Telehealth is not to be seen simply as a ‘cost’ issue. There is a lot of established research on the positives and negatives of Telehealth. Our system needs to realign its focus and not make it predominantly a reimbursement issue.

- Available to all

- Too many item numbers just use 23 or 23T or 36 or 36T would have much easier. Why make thing so complicated

- Driven by lobbyist not evidence

- GP-Specialist VC to reduct on referrals and upskill GPs

- Let patients choose, open it up. Why different to usual consults? Those who do it well can do it at same or less cost base then an in person consult. When we survey patients they want it, when we offer it they select it.

- Work with Australian consumers to determine how they use and want to use TH in the future then implement changes to funding models to reflect current and future TH needs.

- Move into the current world please and make telehealth permanent

- Look at more than just phone calls and how in video, home and vital sign equipment can be shared between all health service providers such as primary care, hospital and aged care providers

- Scrap the 12 month face to face rule and bulk bill all telehealth, phone and video for any patient to see any doctor they like. Push notes to MHR.
Rural and Regional communities are being decimated by GP shortages, while the current Telehealth policy forces them to pay full price for access to readily available GP services online. This policy is a direct attack in those most disadvantaged by both distance, access and cost of healthcare. We are seeing a significant increase in population requiring support for basic food items from our Food Bank, not just unemployed but now low income families just can afford food after paying all the bills. Add to all this no access to local GP services and paying $130 out of pocket for a standard Telehealth consultation. Please help rural communities who pay more for petrol, travel further, have higher utilities and council rates costs and lower wages, its a recipe for disaster.

- Adequate funding for rural, remote, disadvantaged and disabled patients to access any health services by any means, including email, telephone, or video

- Remove restrictions so that people have access to remote care as and when they need it.

- 1 - better access to equitable healthcare in rural areas
2 - sometimes someone might be quite ill e.g with flu and it’s an unnecessary burden to come to a GP for medical certificate

- Too many acute changes. Introduce change slowly in health or care suffers.

- Virtual component (means video) to access the payment. Also we need to shift to the convenience factor for the patient. Surely some easy rules could be agreed on who could access telehealth on the initial and ongoing consult.

- A Minister (any) needs to take responsibility for pushing it forward in conjunction with key industry representatives . This govt claims to be different from the last, but so far its all talk.

- Provision for more long consultation items.

- 1. Policy needs to follow the inevitable momentum that will increasingly drive consumer demand for as full a digital experience in ambulatory health care as is experienced in other digitising service industries.

In so doing, and by allowing general (and specialist) practice to receive appropriate remuneration, DOHAC policy will 'pull' professional standards policy to ensure telehealth is subject to appropriate profession-led clinical governance and standards assurance.

2. The Digital Health division of the Department of Health and Aged Care should be both moved and elevated from its present position as third-tier division under Health Resourcing to a second-tier division under the Chief Medical Officer.

- For Digital Health to report to the Deputy Secretary, Health Resourcing via the First Assistant Secretary, Benefits, Integrity and Digital Health creates a fundamental conflict of interest between digital health and fiscal management issues.
Both are legitimate bases upon which health policy must be developed. However, without any consciously designed executive (i.e. Deputy Secretary) tension within DOHAC's corporate governance structures, the risk of a Resourcing-focu sed bias is inevitably introduced to Digital Health policy decisions.
MBS-funded telehealth has become a extant issue arising from this risk: Concerns over cost exposure - the likely increase in telephone consultations risks an increase in consultations (MBS claims) per GP unit time, plus the potential 'abuse' of telephone consultations from a Compliance Enforcement and Compliance Audit perspective (both currently peer divisions with Digital Health) - appear to be favouring fiscally driven policy over health outcomes driven concerns.
The recent RFT for Digital Prescribing is a further extant issue, potentially risking the benefits of what has been widely lauded as Australia's most successful digital health initiative, in return for a fractional saving of DOHAC's overall expenditure, but significantly increased Integrity and Compliance control.
Bringing Digital Health directly under the Chief Medical Officer places digital health initiatives, that fundamentally are designed to increase the accessibility to and impact of health services, under the direct control of the executive team member professionally responsible for health outcomes. After all, the data they create are as critical to the CMO's Health Protection and Response portfolios as they are to the Integrity and Compliance portfolios that fall under Health Resourcing.
Elevating it to a second-tier division of DOHAC will increase exposure to, and understanding of, the digital health agenda across the entire Department. Digital Health derived data will increasingly inform and impact portfolios under every Department Deputy Secretary with the exception of Corporate Operations.
Finally, it will create the necessary executive tension between Digital Health and Resourcing based decisions to ensure that the full executive leadership team, and ultimately the Department Secretary, are stakeholders in the challenging, but necessary trade offs between two inevitably conflicting agendas, the outcome of which will flow into the information available to them to make insight driven policy decisions.

- 1. Remove the ridiculous requirement for a previous face-to-face consult with the same provider in any timeframe, and thereby open up access to those of us in regional areas.
2. Offer higher rebates for video consults to encourage doctors to use them, instead of just the phone.

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