MBS co-payments could ensure sustainable telehealth market

A new telehealth industry group has recommend that a co-payment capability be introduced to the telehealth MBS item schedule, as well as a broadening of the range of clinical services available under publicly funded home care packages and hospital in the home, to extend the use of telehealth and ensure a sustainable market.

Launching a white paper in Canberra this morning, the One In Four Lives industry group argues that a national telehealth strategy be developed to take full advantage of the potential of telehealth, which it says can dramatically cut hospital admissions for chronic conditions and as a result slash public hospital costs by around $4 billion a year.

The One in Four Lives white paper was written by Lisa Altman of BT, Shehaan Fernando of Philips, Anywhere Healthcare's Sam Holt, the University of Western Sydney's Anthony Maeder and George Margelis, executive director at MPT Innovation Group Gary Morgan, and ‎Suzanne Roche, general manager of policy and government relations at the Australian Information Industry Association (AIIA).

The group says the name of the new body reflects the fact that more than seven million Australians, or one in four, are now or will eventually be affected by chronic health conditions.

The authors argue that it is time to move beyond pilots and funding for individual programs, and “instead support a more flexible funding model for telehealth that will allow the whole of the health industry to develop cost effective models of care”.

“The real challenge in telehealth today is not the development of the appropriate technology, which is already widely available,” the paper states. “The real challenge in telehealth today lies in creating sustainable, profitable business models that can meet the needs of governments, services operators, clinical practice and patients.

“Any new model will need to utilise a hybrid of government and user pays funding for telehealth to be sustainable and scalable.”

It makes six recommendations, the first of which is the development by the federal government of a national telehealth strategy for a sustainable market.

It also recommends that MBS telehealth items continue to be supported for consults provided by GPs, specialists and residential aged care facilities, but with a co-payment capability introduced otherwise.

“[We recommend] the introduction of the ability to claim the Medicare rebate at point of consultation – as with the traditional model – with the patient charged only the gap between the specialist fee and the rebate.”

The group argues that the healthcare industry cannot expect to operate telehealth services that are 100 per cent reliant on government funding.

“They must develop services that offer consumers an improvement on existing models of care that will warrant some level of co-payment in lieu of other costs that may be associated with long waiting times, travel or worsening health.

“The introduction of some level of co-payment is likely to have a positive effect both in terms of industry’s willingness to invest in the sector and on the value consumers place on telehealth services,” although it warns that without well-devised government funding decisions the costs of telehealth will become too great for providers to deliver and for patients to afford.

It also recommends that:

  • the eligibility for existing MBS attendance items be broadened to allow for coordinated care through multidisciplinary teams using technologies such as store and forward and the remote monitoring of vital signs for chronic conditions
  • home care packages provided on a consumer-directed care basis allow for clinical services from GPs and specialists as well as the existing services from nurses and allied health
  • the delivery of acute care in the home be broadened beyond prescribed conditions such as DVT and cellulitis to fund all clinically appropriate acute care services
  • the Productivity Commission review the complete funding structure for healthcare, including the MBS, activity-based funding and private contributions, in light of a national telehealth strategy, with a 'best practice repository' established to evaluate the relative successes and failures of existing programs.

It argues that many countries around the world that are struggling with increasing healthcare costs have introduced reform agendas including the adoption of new models of care and enabling technologies, which has led to the creation of substantial eHealth strategies including telehealth.

“Australia’s eHealth plan has notably omitted this area, and despite the introduction of the MBS video consultation items and a considerable number of localised independent clinical and commercial activities in telehealth, there has been no clear government direction on how the telehealth landscape should unfold,” they write.

“With appropriate high level direction setting driven by a national strategy or set of sectoral strategies, telehealth could be marshalled to play a major role in enabling changes to the service models and the delivery required to respond to the needs of both the primary and acute sectors.”

Posted in Australian eHealth

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