Hunt for the Man from SNOMED River

Australia's Health Minister Greg Hunt had a nice little announcement yesterday, revealing that since March 13, there have been 10.4 million services delivered to 5.71 million patients by telehealth, with $536.5 million benefits paid, and close to 70,000 healthcare providers have used telehealth services.

It's a pretty enormous number and comes as Greg himself is being lobbied pretty hard to continue with MBS-funded telehealth in the future. GPs in particular seem to like it although they are champing at the bit over the requirement that COVID-19 patients and vulnerable groups be bulk billed. The move is on now to keep some form of publicly subsidised telehealth, with the AMA yesterday issuing a strong call for it to be retained.

One of the reasons most often touted for Medicare disapproving of keeping telehealth on the MBS except in specific circumstances is over fears that doctors will rort the system. An example from last week was a LinkedIn post by Shane Solomon, the chairman of the Independent Hospital Pricing Authority, who had a poor experience with a telehealth service that billed Medicare for a 20 minute-plus consult even though it only went for four minutes and 45 seconds.

(The AMA and the RACGP have both been arcing up recently over what they are calling corporate telehealth companies or pop-ups, which despite that name have been around for some time and are probably experience a surge at the moment.)

Another barrier is the strange obsession Medicare has with doctors seeing the same patient twice in one day. There are legitimate reasons for that but Medicare seems to think it is evidence of rorting.

One solution put forward this week in what proved to be by far the most read article on Pulse+IT came from Medicare billing specialist Margaret Faux and health informatician and coding expert Heather Grain, who argued that one way to overcome the reticence is for practitioners to add SNOMED codes to their claims. This would provide more transparency about reasons for attendance and justification for claims, assuaging Medicare's innate suspiciousness and at the same time providing an extremely valuable data set that people have been agitating for for years.

While GPs may baulk at the idea of having to find the right code in a drop down menu in their PMS, in reality there is technology out there that automates this process, so when the doctor fills in the reason for attendance data field, the correct code is automatically returned and there is no extra burden on busy doctors.

The RACGP's minimum requirements for general practice data recommends the development of a GP reference set in the SNOMED clinical terminology for core general practice data, and many of the Australia's practice management systems have mapped their coding systems to SNOMED. New Zealand retired the Read codes it used to use with SNOMED last year.

We think the idea has a lot of merit and we'd be interested in your thoughts. If healthcare providers want to continue to be able to see patients remotely and get paid for it, perhaps a bit of give and take is need to overcome some of Medicare's compliance concerns.

Telehealth time has certainly come and we'll have more on this next week, including a story on how hospitals and specialists can use existing telehealth technology with patient reported outcome measures, as well as a story on a very interesting new use case for physiotherapy by telehealth to provide prostate cancer programs using the Physitrack app integrated with Cliniko's practice management system and Stripe for payments.

The pandemic has also given impetus to electronic ordering as this example from New Zealand suggests, and to digital and electronic prescriptions. On the latter, we note that the Pharmacy Guild has backed down from its baffling opposition to the eScript roll-out and is now making a bit more sense.

And in late breaking news, the Australian government has announced that BreastScreen WA is the first breast screening service in Australia to connect to My Health Record. The service has provided online results to women through a portal since August last year.

It comes as the Australian Digital Health Agency announced that 95 per cent of public pathology providers were uploading to the system. Some of the large private providers are as well.

That brings us to our poll question for the week: Should coding with SNOMED be a requirement for continuing with MBS telehealth billing?

Sign up to our weekend edition or Pulse+IT Chat to vote, or leave your thoughts below.

Last week, we asked: Do you expect to see hospital services continue with remote monitoring after the pandemic? This was a close run thing: 52 per cent said no, 48 per cent said yes.


0 # Klaus Bartosch 2020-05-23 10:22
95% of these are “phone” based consults and not video consults. The real question should be “should phone based MBS consults be withdrawn and only video consults be supported ongoing”? It would be interesting to understand what clinical evidence their is that suggests phone based consults are as affective as video based?

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