Telehealth restrictions a retrograde step

Debate over telehealth continued this week as the new restrictions ordered by the Department of Health came into force in a hurry. Some online appointment booking services are now asking patients trying to book a telehealth conference if they have seen a GP at that practice in the previous 12 months, with one reader telling us she had tried to book a telehealth conference to get a new referral but was knocked back because she hadn't presented there in person in over a year.

We had a lot of debate on the topic on our blog from last week, with numerous examples given of different cohorts of patients, especially vulnerable groups, who will now be prevented from accessing MBS-funded telehealth services just when they were finally given access to them. In an article in this week's MJA Insight, Elwood Family Practice GP Andrew Baird detailed a number of cases where vulnerable patients will be disadvantaged by the new rules and provides a great deal of food for thought.

We think excluding certain groups from MBS-funded telehealth is a retrograde step for equity of access to healthcare that will hopefully be relaxed in future, but we won't hold our breath. Patients can still pay to see a GP at one of the “pop-up” providers and they are not all going to go out of business, but it will be a barrier to those who need healthcare the most.

MBS figures for May were released this week, showing that the total number of MBS consultations reported for the month was 16.6 million, of which 5.4 million or 32.7 per cent were conducted by telehealth. Of that, 4.9m (90.9 per cent) was delivered by telephone and just 493,000 or 9.1 per cent by video conference. On Dr Baird's analysis of GP consultation services, just over 11m B, C and D consultations were held in May, with one third delivered by telehealth. Of those, 97 per cent were delivered by phone.

When introducing the temporary MBS items for COVID, the Department of Health did specify that they applied to video consultations, with telephone allowed only if there was no alternative. At 97 per cent by phone, it's quite obvious that no one is paying any attention to this requirement whatsoever. Come September 30, this might come under some scrutiny from Canberra.

Going by our poll from last week, most Pulse+IT readers think telephone consultations should still attract an MBS rebate – 80.5 per cent of respondents said it should, versus 19.5 per cent against – but we can see new rules attaching to this in future.

In other news this week, change is afoot for one of the biggest players in the acute care market in Australia and New Zealand, with the healthcare assets of DXC Technology being sold to Italian-headquartered, private equity-backed Dedalus Group. Dedalus started out in Italy in the 1980s in finance software but moved into healthcare with the purchase of an Italian general practice management software vendor in the 1990s. Over the years it has added various healthcare-related products before buying Agfa's healthcare IT business earlier this year and now DXC's.

These assets include patient administration systems used in the majority of Australian and New Zealand hospitals such as iPM and webPAS, clinical information systems such as iCM, pharmacy system iPharmacy/ePharmacy, medications management system MedChart, and new additions from DXC's newly rebranded Care Suite. These were part of the purchase that DXC's predecessor CSC made in 2011 when it bought the former ASX-listed iSOFT, which itself was the result of a merger with IBA Health, which in turn had bought smaller companies like Hatrix.

Having been handed around a few times over the years by corporations large and small, we can't really see anything changing for local users under the new ownership. A familiar face is former IBA Health/iSOFT executive Andrea Fiumicelli, who was until two months ago head of DXC's healthcare business before being poached by Dedalus last month as its new CEO. Mr Fiumicelli also used to run Agfa back in the 2000s. He certainly knows the business.

Also under new ownership is Australia's leading scanned medical record company InfoMedix, which has now headed to the cloud to concentrate on being a digital medical record vendor. Digital task management and patient list platforms are also in the news, with locally developed system Cortex set to roll out to New Zealand's busiest emergency department in Christchurch Hospital's new Hagley acute services building, and Melbourne-developed Medtasker going live throughout Royal Hobart Hospital, including the new K-Block theatres. Medtasker is being offered by Telstra Health under a reseller arrangement and this is the largest implementation so far for Medtasker, which also counts Northern Health, Robina Hospital and Whanganui DHB as customers.

South Australia also joined the electronic prescription party with the first eScript token exchanged in Adelaide between Happy Valley practice Chandlers Hill Surgery and TerryWhite Chemmart in Old Reynella. The pharmacy banner is heavily promoting its eScript capability around the country and we watch on with interest as moves begin to implement the Active Script List model that should prove very useful to pharmacists, doctors and patients on multiple medications.

That brings us to our poll question for the week:

Should exemptions be introduced to the new telehealth rules for vulnerable patient groups?

Click here to vote or leave your thoughts below.


-1 # Oliver Frank 2020-07-25 09:01
What should be done is that every citizen is required to name her her or his preferred usual general practice that provides face to face consultations when these are needed, and that will be the only provider of Medicare-subsid ised face to face, telephone and video consultations for that person. If that practice knows that it won't or might not be able to provide any of these services when the patient needs them, it can contract services that will do so, which they will do only if and when the patient's usual practice can't. These other services will be obliged to report to the patient's usual practice all contacts that they have with the patient.
+1 # Lynne Everett 2020-07-25 10:47
Really Oliver? Did none of what any of us said last week have any effect on this idea of "usual doctor" or "regular practice"? Why are you so determined on restricting people's access to health care? Because that's the effect of these restrictions.
The article by Andrew Baird lists 12 different groups of people who are being disadvantaged by these restrictions -- is that not enough people to make you think that perhaps there's a problem? How can a practice "contract services" to another provider if the provider cannot contact that practice? I provided an example last week, and it's not that uncommon a situation. Come to think of it, who precisely will arrange this contracting of services? It doesn't seem to me to be a feasible alternative; I'd go into more detail if I thought it would make any difference.
-1 # Oliver Frank 2020-07-25 12:05
You asked: Why are you so determined on restricting people's access to health care?
Answer: I am determined to change the system so that Australians are more likely to receive continuity of care from a usual GP within a usual practice. The 'freedom' that Australians have to receive Medicare benefits to consult as many GPs in as many different practices as they wish, even in one day, with none of those GPs being obliged to communicate with each other, is allowing if not actively encouraging fragmentation of care and wasteful and sometimes dangerous duplication of investigations and treatments, with no GP or practice knowing or caring whether they are responsible for providing recommended preventive care.

You said: "The article by Andrew Baird lists 12 different groups of people who are being disadvantaged by these restrictions -- is that not enough people to make you think that perhaps there's a problem?"
Answer: I agree that there is a problem, and the current policy-on-the-r un restrictions are not an adequate solution.

You asked: "How can a practice "contract services" to another provider if the provider cannot contact that practice?"
Answer: Why would the other provider have to contact the practice?

You asked: "Who precisely will arrange this contracting of services?" Answer: The patient's usual practice will enter into an arrangement with a service that will provide the care that is needed. This is what general practices have done for many years with after hours services.
+1 # Lynne Everett 2020-07-25 12:58
Thanks Oliver.
" I am determined to change the system so that Australians are more likely to receive continuity of care from a usual GP within a usual practice." The problem here is that this is not necessarily possible for a significant percentage of Australians. I'd prefer a system which doesn't force people into choosing one healthcare provider and doesn't penalise them for not doing so.
"The patient's usual practice will enter into an arrangement with a service that will provide the care that is needed." Again, this is something which may work in an urban setting but isn't going to work for rural and remote areas. Not only are people often transient between States and Territories and multiple services within those areas; I believe the patient has the right to seek out medical care wherever they may be without any involvement by any "regular practice". From what you've said I truly believe you don't have a clear understanding of Indigenous health and the attendant challenges, not unlike the ADHA. And that is only one group of people being disadvantaged by these restrictions.
-2 # Oliver Frank 2020-07-25 14:34
The question that we should ask about any proposed changes to the health system is not: "Will it be perfect?", because that will never be achieved, but: "Will it be better overall than what we have now?".
0 # Kate McDonald 2020-07-25 14:38
Exactly. Patients should be able to access healthcare remotely without these new restrictions because that will be better than we have now.
+2 # Debbie Whitworth 2020-07-25 09:34
This means patients who are usually healthy are refused essential healthcare as they have not seen a GP even though they usually do attend the practice. As an example, my 12 year old son was refused an Face to face appointment because he had flu symptoms. He had a Telehealth appointment a couple of weeks ago however because he had not seen a doctor face to face he was refused another Telehealth appointment. If his condition becomes worse my only option is to take him to an emergency department tying up those resources where his condition does not really warrant it. In the meantime he goes unseen by medical professionals.
0 # Oliver Frank 2020-07-25 09:43
I am sorry to hear that your son was refused a telehealth appointment. My practice would have told you: "Yes we can do this, and our fee is $50. No Medicare benefit will be payable".
0 # Simon James 2020-07-25 10:01
Under the current arrangements, do you have the option for paying for a GP telehealth consultation? In my local ED in NSW, nurse triage costs for people not covered by medicare are billed at $147, and presumably, the costs ratchet up significantly once a doctor gets involved. These costs may well be out of sight/out of mind for Australian patients, but I mention them to illustrate the potential cost to the system if you do end up in the ED as a result of restrictions to the telehealth MBS.
0 # Oliver Frank 2020-07-25 10:10
Yes, all citizens are free to pay for a telehealth consultation.

If a Medicare benefit is going to be claimed by a person in any of the categories specified by the Health Minister, the Medicare benefit is payable only if that telehealth consultation is bulk billed
+3 # Lynne Everett 2020-07-25 10:58
Missed a bit there: "all citizens who can afford it are free to pay...". Considering the number of people who are currently unemployed due to the pandemic, on top of the number of people who already struggle to pay for anything more than absolute essentials, that's another large number of people being disadvantaged.
0 # Oliver Frank 2020-07-25 12:05
I agree.
0 # Alison 2020-07-27 09:05
I have voted yes... but ti depends on your definition of a vulnerable patient..... I DO class someone on long term, high doses of opiates that is requesting continuing scripts -as vulnerable .... AND I think they SHOULD be seeing a provider who can provide consistent ongoing care with an approach that works with them to replace these meds with ones with less life threatening risks.... So - the definition of vulnerable needs to be defined...
0 # Di 2020-08-11 12:17
Telephone consults are acceptable for very minor matters, plus the Doctor needs to know the patient well, so the 12 month rule is excellent. Face-to-face is the only really safe way to practice medicine. Exceptions, of course would be if the patient lived far away, eg: on a cattle station, therefore unable to travel 100's of kms.

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