Video conferencing telehealth MBS item numbers precede guidelines

Medicare Australia has commenced subsidising video consultations for patients in rural, remote and outer-metropolitan areas, as part of a $620 million telehealth initiative.

The telehealth program will cover 62 per cent of the population, with only patients living in inner metropolitan areas excluded. General practitioners who work further than 20 kilometres from capital city centres as well as specialists will receive a $6000 Telehealth On-Board Incentive, to be paid after the first video consultation is performed. On an ongoing basis, specialists will receive a 50 per cent loading, and general practitioners a 35 per cent loading for the sessions.

Prior to the changes to the Medicare Benefits Schedule introduced on 1 July, Medicare Australia required that for a consultation to be claimable, it had to be ‘face to face’.

A study undertaken by Access Economics found that the introduction of teleconsulting in Kingaroy in rural Queensland saved $125 per visit avoided when compared with the costs associated with sending patients to Toowoomba.

The Royal Australian College of General Practitioners (RACGP) has been commissioned by the Department of Health and Ageing (DoHA) to create a Telehealth Standards Task Force in order to develop clinical standards in the telehealth arena, with the initial primary focus on video conferencing. The task force will evaluate standards in relation to: Patient safety, security and privacy; the education and training of staff who are involved in the video conferencing process; what should be done with the information from the session; what should be included in medical records; who should be involved in consent processes; and a guide for patients to allow them to make informed decisions relating to telehealth services.

The clinical standards for general practitioners are expected to be completed and released by October this year.

With the funding arrangements preceding the existence of related clinical and technical guidelines, the RACGP has advised practices to defer any video conferencing purchasing decisions.

"My advice is to just wait, let’s get it right," says Dr Nathan Pinskier, eHealth spokesperson for the RACGP. "We’re doing a lot of working with the College to define all of those requirements and we will provide some implementation advice around this as well. The College will provide a complete member package. It’s not going to happen tomorrow but we hope in the next month or so we will have some really useful information. We want to work through it to delivering this in a medically safe and sustainable fashion, while also leveraging new technologies — particularly when NBN it is available."

Despite the current uncertainty, Dr Pinskier is positive about the potential of the new telehealth arrangements.

"The current challenge is to try and address all of these outstanding issues but it is a potentially exciting opportunity because it does deal with the issues around equity and access, particularly in areas of disadvantage and those that suffer from the tyranny of distance. Patients who previously haven’t been able to see a specialist will now potentially have access to those services. What we don’t want to do is get it wrong because we use the wrong technology or the wrong processes and we don’t want to create clinical risk. We want to improve clinical outcomes and clinical pathways."

Posted in Australian eHealth

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