Govt to consider patient to GP telehealth on MBS

The federal government has committed to considering an expansion of the Medicare Benefits Schedule for telehealth items this year, and has also promised to implement video consults for the after-hours GP Helpline and the Pregnancy, Birth and Baby Helpline.

As part of an update to its national digital economy strategy, released by Communications Minister Stephen Conroy at the Digital Productivity Conference in Brisbane today, the government said it plans to undertake a review this year to determine the costs and benefits of an expanded range of MBS telehealth items to include patients participating in video-based consultations with their GP.

The Royal Australian College of General Practitioners (RACGP) recently called for GP to patient video conferences to be introduced to the MBS as an alternative to face-to-face consultations in its pre-election statement, arguing that telehealth services are beneficial particularly for patients with chronic diseases who have difficulty seeing their GP due to transport, mobility and distance issues.

The RACGP argued it would be a cost-neutral exercise as it would be an alternative to in-person consults, not in addition to them.

The government's strategy document states that the Department of Health and Ageing (DoHA) and the Department of Veterans’ Affairs (DVA) will lead a review to determine the costs and benefits of expanding the range of MBS telehealth items to include GP to patient video consults.

It says "the review will ensure that any expansion in telehealth items will target the delivery of services to improve health outcomes and equity, see that consultations are practised in a safe and clinically effective manner, and be a cost effective use of government resources".

Senator Conroy also announced that the government would implement video consultations for the after-hours GP Helpline and the 24-hour Pregnancy, Birth and Baby Helpline in the second half of 2013.

The baby helpline is run by Healthdirect Australia on behalf of DoHA, as is the after-hours GP Helpline, which is triaged by nurses. Healthdirect Australia is funded by the Commonwealth and the states and territories.

The government also said it plans to increase the use of digital platforms to provide aged care services, including expanding the Community Visitors Scheme into home care through the use of technology.

It also promises a boost to the Keeping Seniors Connected program, which provides free access to technology and training on cybersecurity and cybersafety to seniors.

Posted in Australian eHealth


0 # AJ Jack 2013-06-13 11:52
It is great news that the after hours GP Helpline will offer video consultations.
I think having video consultations with a GP is a no-brainer. Many GPs would already have hardware in place or could buy it at very little cost.
What would take a bit of getting used to was setting up a system to allocate patients to appointments with a mixture of actual and virtual waiting rooms, particularly for the drop-in medical centres.
The technology is available and simple to set up. Incorporating it into the workflow of the practice and reducing the 'fear factor' of staff is what will take the time.
For rural many rural GPs who already regularly have video consultations between their patients and specialists, this will not be a problem. City based GPs who have not been exposed to the governments telehealth incentives may take a little more convincing.
Maybe there will be some upcoming work for all the Telehealth Support Oficers around the country being layed off this month.
0 # Phil Coppin 2013-06-13 12:28
This will be a big win for residents in aged care facilities and the chronically ill in rural areas who often ignore their health because of the distances and difficulty of travelling.

But, there MUST not be special MBS items. The technology needs to be transparent so doctors should use the standard items currently on the MBS. This would improve patient outcomes but be budget neutral.
0 # Dr No 2013-06-13 16:23
The biggest issue will be the same one currently faced for Practitioner to Practitioner telehealth - standardising the software used for telehealth consults and ensuring appropriate security. It will need to be the same mandated and freely available software for GP, Specialists AND also now, the public.

Unfortuantely Australia is just no good and standarding these software initiatives it seems. If this goes ahead, lets hope this scheme helps drive some form of standardisation .
0 # Kate McDonald 2013-06-13 16:39
WebRTC might be the answer, Dr No.
0 # AJ Jack 2013-06-14 09:20
Dr No, the questions of standardisation and security are largely furphies.
All mainstream VC software offers encrypted connections. Many are also point to point, meaning an intermediary server is not required once the connection is established.
This means it is more secure than the methods of communication currently used to communicate medical information such as the phone, letter or fax.
There is no need for everyone to use a standard software. You only need the two parties who are communicating for the consultation to be using the same software. Currently over 70% of telehealth practicioners use Skype because it is free and widely used in the community. There are many other free VC software solutions and even the paid solutions such as Vidyo, GotoMeeting, Lync, offer a free client that the other party can use, (although sometimes with limited functionality.)
WebRTC certainly does have a lot of potential. It is currently supported by Google and Mozilla so you need Chrome or Firefox for it to work. Microsoft and Apple have a competing standard. Being able to teleconference straight from the browser would be the most accessible solution for everyone. Even if we end up with two standards, having two different browsers installed is not a big hassle.
The uptake of telehealth in Western NSW has been wide and enthusiastic and patients are seeing the benefits. About 65% of practices offer it and it is available in every town with a population greater than about 5000. This has been achieved without needing to mandate a standard and so far there have been no security issues.
0 # Dr No 2013-06-14 09:29
Thanks Kate. WebRTC looks like a good product (albeit in a line of a number of other good products available). It is a massive advantage being web-based though, that's for sure. Unfortunately I fear, unless the Govt adopts this software and there is some sort of restriction placed on MBS claiming for telehealth stating a specific product like this one (or very small range of free / cheap Govt endorsed products) _must_ be used / proved in order to claim, adopting frequent telehealth across the Country will not work. Without line-share standardisation of some form, it will always be messy, uncontrolled and chucked in the too hard basket for a lot of practitioners. They will keep using Skype with others who use Skype, and that's about it (but I do digress slightly into the wider GP sphere here - sorry). Here's hoping awesome focussed initiatives like the Cystic Fibrosis and the Helpline services at least can standardise as a start.
0 # Dr No 2013-06-14 10:09
All good points AJ Jack. The main problem for many pracitioners, is indeed they end up with numerous different products for telehealth consulting - it becomes unmanageable, especially for Specialists etc who are seemingly always less time-rich (and patience (maybe rather IT savvy) poor!) :-)

I'm all for web based multi platform products - it makes a lot of sense. Is webRTC well costed, does anyone know?
0 # Kate McDonald 2013-06-14 10:19
WebRTC is open source so it will be free, Dr No. Google and Mozilla are designing the standard and funding it all. Take a look at this example of how it works:
0 # AJ Jack 2013-06-14 12:40
Dr No,
WebRTC is a standard, not a product so different people will implement the standard in different ways.
For example, using easyRTC I was able to turn my laptop into a vido conferencing server in about half an hour and allow other people in the office to connect to it and VC each other. If this was on a machine with an IP accessible from the outside world, I could allow anyone to use it.
Similarly, a US company, Freshly Tilled Soil have their own WebRTC server that they have released some plugin code for, to allow you to embed a VC system into your own website. I have it on my website at (Chrome required) have a similar set-up but have enhanced it with randomised names for rooms and optional passwords.
0 # Dr No 2013-06-14 13:36
Ahh I see - yep wrong end of the stick successfully grasped by me initially here! :-)

This is even better (obviously)!
0 # Susan Jury 2013-06-14 16:53
As part of its commitment to consider expansion of the MBS for telehealth items I hope the Feds will consider specialist-end telehealth provision by other clinical specialists such as nurse practitioners and allied health.

As argued by the RACGP this would also be a cost-neutral exercise as it would be an alternative to in-person consults, not in addition to them.
0 # Phil Coppin 2013-06-17 10:11

Under the existing telehealth Medicare items a Nurse Practitioner, Midwives, Aboriginal Healthcare Worker and Community Healthcare Workers are eligible to conduct teleconmsultsat ion using video conferencing.

At this stage allied health are not included.
0 # Susan Jury 2013-06-17 10:27
Hi Phil - you are right, however this is at the patient end. I am referring to the specialist end, where NP's are unfortunately not eligible to bill, even if they have a Medicare provider number.
0 # Oliver Frank 2013-07-25 12:46
Quoting Phil Coppin:

But, there MUST not be special MBS items. The technology needs to be transparent so doctors should use the standard items currently on the MBS. This would improve patient outcomes but be budget neutral.

This is a very important point. Let's not add to the current item number madness.

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