‘Against the evidence’: scholars slam specialist telehealth revamp

By Geir O'Rourke

5 Feb 2024

A plan before the federal government to scrap Medicare funding for initial specialist consultations conducted via telehealth is unsupported by evidence and would undermine access to care, it is being argued.

The recommendation was put forward late last year by the MBS Review Advisory Committee (MRAC) as part of a suite of reforms into the funding model for non-face-to-face care under Medicare.

Others included re-establishing funding for specialist subsequent consultations over the phone and inserting an official statement of ‘telehealth principles’ into the MBS to guide doctors.

But while the changes may appear only administrative in scope, the effect would be to limit patient access and cause confusion among providers by contradicting Medical Board of Australia guidance, according to the authors of a recently-published paper.

“These recommendations particularly underestimate the role of telehealth in rural and remote Australia and did not take into account high patient satisfaction with telehealth assessment and treatment during the ongoing coronavirus disease 2019 (COVID-19) pandemic,” they write in Australian Health Review (link here).

The authors, led by psychiatrist and ANU academic Associate Professor Jeffrey Looi, describe the proposed statement of principles as particularly egregious, pointing out no similar guidelines are articulated for telehealth items claimed by allied health practitioners, nor indeed for any other section of the MBS.

Moreover, the recommendation to cease reimbursement for all initial consultations by non-GP specialists would have a significant detrimental impact on patient access, the authors argue.

“This recommendation runs against the substantive evidence-base for rural and remote telehealth effectiveness in Australia, especially during the COVID-19 pandemic, with substantive evidence of patient satisfaction with telehealth-mediated care,” they write.

“The effectiveness of telehealth consultations has been demonstrated across a range of medical specialties, including, but not limited to, pre- and post- operative assessment in surgery and in mental healthcare.”

In this context, the recommendation also appears to contradict medical board guidelines which explicitly allow for initial consults via telehealth, according to the authors.

Quoting directly from the board’s guidelines, they note it “does not expect a patient to have had an in-person appointment with a doctor before they have a telehealth appointment”.

Furthermore, they note the current guidelines specifically state: “The Board recognises the important role that telehealth can play in accessing episodic and emergency care, particularly in rural and remote settings, for patients who are unable to travel for an in-person consultation, to support inclusive care, and when patients may not be able to consult with their usual doctor. These guidelines do not prevent or discourage one- off telehealth consultations.”

The authors go on to say: “Therefore, the recommendation directly contradicts practice guidelines from the Medical Board of Australia, and may be regarded as administrative action that effectively restricts the Medical Board of Australia’s recommendations for good medical practice.”

“The MRAC recommendations are not based on healthcare research evidence and have the potential to lead to suboptimal medical practice according to the Medical Board of Australia’s guidelines for telehealth.”

“It is our view that these recommendations should be withdrawn.”

Public consultation on the MRAC’s report closed in November and the government is yet to release its response.

 

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