RACGP calls for GP to patient telehealth on the MBS

The Royal Australian College of General Practitioners (RACGP) has called for GP to patient video conferences to be introduced to the Medicare Benefits Schedule as an alternative to face to face consultations.

As part of its pre-election statement, the college said telehealth services are beneficial for many groups of patients, particularly those with chronic diseases who have difficulty accessing their GP due to transport, mobility and distance issues.

At present, GPs can only claim a telehealth consult on the MBS if the patient is present and the consult is with a specialist.

The RACGP is now calling for GPs to be able to claim a video conference just like an ordinary face to face consultation, saying it would be a cost-neutral exercise as it would be an alternative to in-person consults, not in addition to.

It said the college can work with government to ensure that the system benefits patients who are most in need.

The college has also welcomed the extra $10 million in funding recently announced to upload advance care directives to the PCEHR, saying it would be a very valuable addition to the system.

While details of exactly how the money will be spent are not yet available, RACGP president Liz Marles said she understood some of it would be used to develop a standardised template to upload to the PCEHR.

Dr Marles said it was essential that advance care directives be an easy, standardised form. “For GPs to be able to do this, is has to fit well within our workflow,” Dr Marles said. “Form-filling and red tape are real bugbears.

“Having said that, working through with your patients their advance care directives is an important thing for the GPs to do. Having something that is clear, that is fairly standardised but is easily translatable for the patient is really important.”

She said the addition of advance care directives will be valuable to the PCEHR as they are only really useful if clinicians can actually see them.

“Admissions to hospital often happen on the weekend and you have relatives who have to make very important decisions but can't talk about it at the time,” she said.

“That's when you really do want to have access to the advance care directive. We know that as soon as someone goes to an acute hospital, they tend to get all of the acute interventions unless there is some clear statement that they don't want that, so it makes sense to both the patient and for the health system to not do treatments that are not wanted.”

She also called for continued and targeted funding for the PCEHR for patients with significant illnesses who would benefit most, and for the GPs who care for them.

“What would be nice is to target the resources on the people who need it. With this particular advance care planning funding, we would like to see some of it there to resource general practice.

“Having some guidance for GPs on how to conduct these conversations is an important part of it as well. There are a number of issues: one is that it is a difficult conversation to have, so being able to provide some guidance to GPs about how to raise it, when to raise it, how to have the conversation let alone what the questions are and completing the form, is important.

“Also, how you take your patients through it. I've found when I have done it with patients – some people will raise it with me because they're concerned about it, and then there are other people who I may raise it as something they may want to think about. It is quite a confronting thing."

The RACGP is currently running a series of seminars and webinars on the PCEHR for those members who are still unsure about it. Dr Marles said feedback from the seminars had shown that there are still some concerns from GPs who still do not trust the system in terms of security of information.

“[The development of the PCEHR] will be an ongoing process that is going to require ongoing input and refinement and feedback,” she said. “That needs to be recognised and needs to be funded if you want to ensure its success.”

Posted in Australian eHealth


0 # Dr George Margelis 2013-05-28 13:41
The RACGP call for direct telehealth consultations between patients and GPs is in full agreement with the Australasian Telehealth Society's discussion paper on a national telehealth strategy.

One of the key strategies is to apply 'fit for purpose' models which includes direct primary care. In the document we argue that clinicians should have the freedom to decide what modality is best suited for their patients.

You can download the strategy discussion paper at http://aths.org.au/telehealthstrategy/
0 # Chris Pickett 2013-05-28 13:44
Fully agree with this. It is essential for telehealth to take hold that the Govt provides access to the MBS for GPs particularly in remote areas. If the government is concerned about the cost blowouts it needs to look at the this as a workforce initiative providing GPs with greater reach into communities and the cost containment can occur by providing an area of need classification.
0 # Susan Jury 2013-05-28 13:45
From the tertiary end perspective I also strongly support the RACGP proposal.

The Medicare telehealth Item numbers have been an excellent start. It would now be a great next step to also extend these to other tertiary or secondary care providers to help ensure the most appropriate person is providing care, for example:

1) Nurse Practitioner at specialist end
2) Paediatrician at patient end in consultation with paediatric sub specialist
3) Specialist end allied health for example psychologists, physio, OT

I don't believe this would add to the costs of healthcare but in fact improve access to services while reducing the cost of consultations being run by medical specialists that could at times be equally or better run by another colleague.
0 # Edwin Kruys 2013-05-29 05:35
Love the idea indeed as I expect many people living with chronic diseases will benefit. The idea has been floating around for a while and I wonder if there's a 'business case' or trial data/experience s? In fact same is true for advance care directives and throwing more money at the PCEHR - or RACGP promoting PCEHR - at a time when Govt is cutting back on basic health care funding. Need to justify every tax dollar spent.
0 # tanyag 2013-06-03 16:00
Great idea to have advanced care directives in PCEHR. A couple of concerns though:
1. how will GP (or whomever) consultation for discussing ACD and completing form be funded? MBS? I could see these discussion potentially taking a good half hour (probably over a number of consults)
2. It's great to have this info available on PCEHR but how many hospitals/hosp clinicians have access to PCEHR records? Until there is a push by State govts to have public hospital/clinic ian (not just one or 2 of the big metro hosps but all hosps) access the PCEHR to view records meaninful engagement by primary health carers and consumers alike will be hindered.

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