Govt review backflips on changes to specialist telehealth

Telehealth

By Geir O'Rourke

20 Jun 2024

The expert committee examining the future of MBS telehealth has hit reverse on its proposal to require all initial specialist consults take place face-to-face, citing a backlash from stakeholders.

But it has recommended Medicare funding for subsequent consultations conducted via by phone as well as video – reversing the government’s decision two years ago 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 had been a key are of contention, with items covering phone consults for initial and subsequent attendances and complex initial and subsequent assessments all receiving the axe in 2022 over loud protests from the sector.

In a consultation paper released last year, the committee suggested this should go further, arguing changes were needed to “refine the balance of quality and safety”.

Reasons included the fact that, unlike those for GPs, specialist telehealth consults did not have a 12-month rule or other eligibility requirement based on prior face-to-face services, while telehealth was “clearly inadequate when hands-on clinical assessment is needed”.

“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.”

However, the committee appears to have changed its views in response to feedback from groups like the AMA and RACP.

“The MRAC acknowledged stakeholder feedback that a draft recommendation for initial non-GP specialist consultations to be in-person only could disadvantage many patients, especially those who need to travel long distances to see a non-GP specialist,” it said in its final report released last week.

“The MRAC acknowledged that there are circumstances where patient care would not be negatively affected by a telehealth service with a non-GP specialist for an initial consultation.”

“Thus, the MRAC recommended that the current eligibility and exemptions not be changed for non-GP specialists.”

To address any disadvantage the patients may experience, it strongly recommended the reintroduction of patient-end support for telehealth consultations with non-GP specialists with no geographical limitations.

The decision was welcomed by RACP president Professor Jennifer Martin, who described the outcome as a win for college advocacy and called on the government to implement the report’s recommendations with respect to specialist care.

“We’re happy to committee has listened to feedback,” she said.

“To deny a patient a Medicare rebate because they choose one medium over another creates a real equity issue.”

She stressed there remained situations where telehealth would be inappropriate, particularly if a physical examination was required. There would also be certain occasions when a video consultation may be appropriate, but not a phone call.

Nevertheless, this should be a matter of specialist discretion, rather than Medicare policy, Professor Martin argued.

“Our position is it should be up to the specialist and the patient to decide how to conduct their consult,” she said.

The report recommended the government adopt the following principles to “guide the development and implementation of MBS telehealth policy:

MBS Telehealth Principles

Telehealth items in the MBS should consider the following:

  1. Should be patient-focused and based on patient need, as determined by shared decision making between the clinician and the patient.
  2. Must support safe, private and quality services for patients, aligning with the clinical requirements of the equivalent face-to-face service and demonstrating clinical efficacy.
  3. Should be provided in the context of coordinated and continuous care between patient and clinician.
  4. Must not create unintended consequences or perverse incentives that undermine the role of face-to-face care.
  5. Options of telephone, video and face-to-face consultations must be offered to patients, though the type of service is subject to Principles 1 and 2. Video should be encouraged over phone where it will provide a better patient and/or provider experience.
  6. Should support optimal clinical engagement with the patient by allowing clinician participation at both ends of the MBS telehealth consultation, if appropriate, enabling rebates for support by both the treating clinician and patient-end clinician.
  7. Amendments to MBS telehealth should follow sufficient advance notice of changes to MBS items for clinicians and patients to adjust.

 

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