Private payers may step up for telehealth: experts

The cuts to the MBS telehealth scheme announced in Monday's mid-year economic and fiscal outlook are disappointing and will probably slow the momentum of the rollout of telehealth provision, advocates say, but some remain positive about its future.

The federal government has clarified which metropolitan areas will lose eligibility for the MBS telehealth item numbers, following Monday's announcement that it was tightening the geographical restrictions for the scheme.

The government had already announced in the May budget that a 15km distance between specialist and patient would apply, and has now announced it will align eligibility for the scheme with the Australian Standard Geographical Classification Remoteness Area (ASGC-RA).

The changes are due to come into place on January 1, 2013.

The cuts will mean doctors undertaking telehealth consults within the major cities will not be able to claim the MBS items, except if they are providing services to residents of aged care facilities or patients of an Aboriginal Medical Service.

The Department of Health and Ageing's MBS Online website states that the government “has introduced this change to better target funding to areas where access to specialist services is limited.

“This will encourage people living in major cities to maintain relationships with local specialists, and provide patients living outside major cities, access to specialist video consultations where availability and distance is a barrier to accessing these services.

“Some areas will become ineligible because of these changes (for example Canberra), however, some patients will become eligible because of these changes (for example all patients in Tasmania).”

Prominent eHealth expert George Margelis, general manager Australia for GE-Intel joint venture Care Innovations, sharply criticised the move, saying it could spell the end of telehealth consultations in Australia.

“By marginalising them to only a delivery method suitable for remote populations, essentially a technology enabled version of the Royal Flying Doctor Service, they are significantly blunting the value proposition for telehealth consultations,” Dr Margelis wrote on his blog.

“Actually they are restricting it more than the RFDS, as it can deliver services to places not limited to those classified as remote, but to those areas that need its help. Essentially these changes have taken away from clinicians the right to make that type of decision.

“Rather than expand on what seems to have been a successful program, it has chosen to “strangle it on the vine” to prevent its growth.”

Dr Margelis told Pulse+IT that besides needy patients missing out, the main concern he had was about effect on “stimulating innovation in the sector that the initial announcements fostered and how the constant changing of the goal posts leads to that innovation being stifled”.

David Allen, an occupational and environmental physician who runs Telehealth Solutions Australia Australia and Quality Occupational Health and has been providing telehealth services since 2007, was not so pessimistic, saying that while the cuts were unfortunate, he believes telehealth will still continue to grow in Australia, albeit a bit more slowly.

“My opinion on this is that the ones who most need it are the rural and remote [patients] anyway,” Dr Allen said. “The volume may go down but the people who most need it can still access it. I would have liked to think the funding could continue but far be it for me to comment at a political level, but the people who most need it can still access it, so at least it is something.”

Dr Allen said while he was positive that telehealth provision would continue to grow, it was unfortunate that GPs in outer metropolitan areas of the major cities would now miss out.

“It really is unfortunate for the GPs who do need it and I think that a shame, but regardless of what happens we will be pushing ahead and I think it will succeed in the long term. It will probably slow down the momentum a little bit.”

Mike Civil, eHealth spokesman for the Royal Australian College of General Practitioners, also described the cuts as disappointing but he too believes the technology will continue to grow.

“It is unfortunate to be reducing the impetus, rather than increasing it,” Dr Civil said. “I remain firmly convinced of the long-term benefits to be seen in the capabilities of telehealth, with improved access and flexibility to medical services our patients can experience, with the addition of telehealth consultations to augment our normal face to face consultations.

“There should not be any geographical limitations for telehealth, rather the decision to conduct a telehealth consultation should be about clinical appropriateness, not location.”

However, both Dr Allen and Dr Civil believe both patients and doctors themselves will drive telehealth provision on a private basis.

Dr Civil's practice in outer metropolitan Perth, Stirk Medical Group, is likely to consider offering video consults as a non-MBS rebatable service in the new year, he said.

“Hopefully as things improve for health finances generally, we can expand and increase our use of telehealth generally,” he said. “I remain committed to the long-term use of telehealth and eHealth, as I strongly believe that at the end of the day it will actually reduce health costs, by greater efficiencies.”

Dr Allen said he believed patients will be willing to pay privately for the convenience of the service. “Talking to a lot of GPs about this, I say don't be afraid to charge privately. If someone wants to connect to you then you charge them. You won't get a reimbursement, that's all.”

Dr Allen said that many doctors were nervous about charging outside the Medicare system, but uses his own practice as an example. “None of the work that I do by telehealth is reimbursed by Medicare – 100 per cent of it is privately paid,” he said. “And people will value that whether in an occupational health setting or a private setting. It shouldn't make a difference and a lot of it is consumer-driven – I'm a believer in that.

“I would strongly encourage GPs to get involved in it and be confident they can charge and there will be people who will pay, particularly if they have to travel long differences.”

Dr Margelis said that while private pay may be suitable for some people, “those most in need of healthcare services are not those who can afford private pay".

“As a result they are more likely to end up in a government hospital ED and still cost the government the amount if not more than what was saved by removing their right to telehealth services,” he said.

The government also announced on Monday that it will introduce new MBS telehealth items for video consults that last 10 minutes or less. These consults will now only receive 50 per cent of the normal fee.

The government says this change is due to allow the fee to reflect the time and complexity of the service. “Currently, a video consultation with a specialist or consultant physician of less than 10 minutes can attract rebates and financial incentives of over $250,” it says.

The government expects to save an estimated $134.4 million over four years by changing the geographical eligibility and $4.5 million over four years with the shorter item numbers.

GPs in outer metropolitan areas can check if they are still eligible at www.doctorconnect.gov.au.

Posted in Australian eHealth

Comments   

# Dr George Margelis 2012-10-27 00:57
The idea that telehealth becomes only part of a concierge healthcare model for those who can afford to pay for it out of pocket goes against the ideal of equitable access to care in Australia. Generally, those who can afford private pay care can afford access to our current healthcare provider market. The burden of growing healthcare costs is largely because much of the population does not have access to good quality primary care, and thus end up in expensive and inappropriate hospital care. That is the problem telehealth can help solve. Yes it is an issue in remote areas, but is also an issue in regional and urban areas, and the sheer numbers of people in those areas are a large part of the cost.
My concern is that if this is something only a few boutique practices do for an ever dwindling segment of the market we will not see any innovation in the area, and it will become a small niche product that is subject to further pruning. Let patients and providers experiment with this new delivery modality to find out what works. Evaluate these projects so you can determine which uses of telehealth are advantageous, and help develop a new vibrant industry that Australia can export. Don't shut it down in its infancy with overly burdensome administrative complexity and market limiting regulations.
# Dr David Allen 2012-10-27 11:45
Unfortunately it may just be that we have to demonstrate that it works in the private setting to encourage more funding. This can be done, but it will take time.
# A/Prof Geoffrey Boyce 2012-11-08 13:22
I have only provided services to remote areas

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