Another shake-up on the table for specialist telehealth

By Geir O'Rourke

30 Oct 2023

Telehealth items would be scrapped so initial specialist consultations only attract Medicare funding when provided face-to-face under the latest MBS revamp being considered by the federal government.

But funding would also be made available for subsequent consultations conducted via telehealth regardless of medium – reversing the government’s decision last year to remove funding for phone services.

The changes have been recommended by the MBS Review Advisory Committee (MRAC), commissioned by Minister for Health Mark Butler to re-examine the full raft of telehealth funding offered under Medicare since the COVID-19 pandemic.

Specialist care has been a particularly contentious area, with items covering phone consults for initial and subsequent attendances and complex initial and subsequent assessments all receiving the axe last July over loud protests from the sector.

However, further changes are needed to “refine the balance of quality and safety”, according to the review, which is currently out for consultation (link here).

It noted uptake of telehealth by specialists continued to be widespread, with phone and video accounting for 11% of all Medicare claims for consultation items in 2022-23.

This was less than GPs, for whom one in every five consults was conducted via telehealth, but around the same as allied health.

In addition, specialists were far more likely to use video, billing video items for 48% of all telehealth consultations compared to GPs who used it just 5% of the time.

The report included a literature review by Bond University which found “no major differences between video and telephone consultations in patient satisfaction, clinical effectiveness or cost-effectiveness”.

Similarly, stakeholders gave strong feedback from different clinical practices that, in many cases, there is no discernable difference in outcome between video and telephone consultations, it said.

Nevertheless, it added: “Despite these research limitations, the MRAC considers it self-evident that video consultations more closely approximate face-to-face consultations than phone consultations, as they give clinicians access to both verbal and non-verbal information.”

“This makes video preferable or necessary in some circumstances, such as with paediatric patients, when diagnosing conditions with visual signs, and whenever observation of the patient is critical.”

But when it came to specialists, the decision on whether to go with phone or video should be up to the clinician’s discretion, the review found.

On the other hand, initial consultations should be made available only face-to-face, given the “telehealth is clearly inadequate when hands-on clinical assessment is needed,” it said.

“The limited research suggests that telehealth can be equivalent to face-to-face care for the management of known conditions of known patients.”

“Telehealth is likely to be less effective for new diagnoses, particularly in cases where clinical information requirements are extensive and/or complex.”

Such a change would also make up for the fact that specialists were not included in the eligibility rules applied to most GP services and required at least one face-to-face consultation every 12 months.

“Requiring an established clinical relationship for non-GP specialist telehealth services would mean individual telehealth consultations as a ‘subsequent’ service only, to ensure continuous, high-value care across these clinician groups,” it said.


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