Feros Care trialling paid GP video consults for residents
Residential and community aged care provider Feros Care is taking part in a federally funded trial to investigate whether funding GPs to conduct video consultations with residents will improve patient care.
Originally given the grand name of the Better Health Care Connections: Aged Care Multidisciplinary Care Coordination and Advisory Services Program, the idea is to support older people with complex health needs who would benefit from higher levels of multidisciplinary, coordinated care and treatment.
Nine organisations were funded from 2013, including eight Medicare Locals and Feros Care. In addition to setting up care coordination teams and advisory services, the program has funding for pilots to provide payments to GPs to conduct video consultations with aged care residents.
Feros Care's eHealth and primary care manager Shelly Fletcher said that since the trial commenced, it has conducted 150 telehealth consults with GPs and established a fortnightly virtual clinic between Bay Centre Medical and Byron Bay Feros Care Village.
The trial is part of Feros Care's much larger project, Electronic Village (eVillage), which Ms Fletcher said aims to use technology to transform care by embedding electronic records, secure messaging and teleconferencing as standard practice.
Feros Care has invested heavily in video conferencing, not just for clinical purposes but to keep remote staff connected and to provide extra services for residents. It has upgraded its three RACFs to gigabyte wireless networks to allow residents and staff to access high speed internet virtually everywhere in the village.
It has installed a LifeSize teleconferencing suite that includes the ClearSea mobile video conferencing application used by staff to communicate and also to conduct clinical consultations. In this trial, Feros Care is covering the cost of equipment and ClearSea for GPs, with some installing it on their own devices.
It is also paying GPs for work that they often find themselves doing for free, including discussing a resident's care with a registered nurse over the phone. Under the current MBS rebate, GPs are only paid if they visit the facility in person or the resident makes the trip in to see the doctor.
While the payments in this trial are lower than those for on-site GP visits, they are close to par with the rebates for a patient attending their surgery, Ms Fletcher said.
GPs are paid $25.20 for Level A consults, $44.50 for Level B, $77.90 for Level C and $110.4 for Level D. While these rates are lower than those available for GPs physically visiting the patient – for example, Level A attracts a $72.90 rebate for a GP visiting one patient – they are comparable with the $26.20 for seeing the resident in their clinic.
“On first glance, the discrepancy seems significant,” Ms Fletcher said. “However, as part of the trial we are trying to assess the other cost factors, such as travel (petrol, car) and GP’s time spent out of the practice.
“When a resident needs a medical review but it’s outside the scheduled time the GP visits the facility, be it weekly or fortnightly, either the resident travels to the practice or the GP visits the facility after-hours.
“This makes for a long day for the GP and extended waiting times for the resident. Hence, it’s important to compare the amounts payable between seeing a resident virtually or in the practice. In this instance, the payable amounts are on par. The biggest discrepancy is $4.40 for a Level D.”
Most GPs with patients in residential care spend unpaid time on the phone or answering faxes or emails from aged care nurses. According to Ms Fletcher, not only are GPs not compensated for this work, but nurses can waste hours trying to communicate with the GP.
“The virtual connection has improved escalating care, which traditionally involved an RN sending a fax or calling, requiring the GP to spend time responding without receiving funding,” she said.
“Thanks to the virtual connection the GP can be paid to see and speak directly to the resident with a registered nurse, without leaving their practice. The trial has improved clinical care but also enhanced social connections.”
Since the trial has commenced, GPs and nurses are using video consults for a range of reasons, including discussing pathology and script requests and referrals, as well as case conferences to discuss things like advanced care planning and to escalate care.
Ms Fletcher said recent examples include using video conferencing to allow a resident's son who lives in Sydney to participate in advanced planning with his mother, the GP and the RN.
Another includes conducting a video call with a GP for a resident who had a suspected fractured wrist rather than sending them immediately to hospital or waiting for the GP to visit after hours.
“With a new admission, the previous GP was able to provide a handover to the new GP, RN and was inclusive of the resident,” she said. “The GPs felt this was more useful than reading patient’s notes.”
Scheduling is not a major problem, she said. Apart from the scheduled fortnightly virtual clinic, the process to book an ad-hoc call is determined by the GP's preference.
“In some cases the RN calls the GP’s tablet directly, just like a phone call, and if they are available they answer. Otherwise there is a missed call notification. Alternatively, we phone reception staff and organise an appointment.”
ClearSea enables the GPs and nurses to dial into a virtual conference room, which eliminates the need to coordinate who is going to call who and at what time. It also has shared screen functionality and instant chat, and GPs just need a desktop with a webcam or an iPad.
From the resident's end, Feros Care uses iPads or its custom-built video conferencing robots, which have a larger screen and can easily be manoeuvred to the patient's bedside.
The trial is due to end in 2017, but in the meantime, Feros Care is continuing with its plans to expand the range of telehealth services it provides. It has been involved in several other trials, including the My Health Clinic at Home project, which was aimed at seniors with chronic illnesses living in Coffs Harbour.
That trial involved using a touchscreen device with in-built video camera and peripheral devices to monitor health and wellness at home, as well as in-home video conferencing with doctors, nurses and friends and family.
Ms Fletcher said that program saw over 5000 video calls conducted over an 18-month period.
Posted in Aged Care
Tags: Feros Care