It is time to embrace defragmented virtual care models

Increasing hospital clinic wait lists, patchy communication, and missing information leads to an over-worked and strained healthcare system.
 
Initiatives across Australia, such as Victorian Virtual Specialist Consults (VVSC), provide opportunities for synchronous online consulting between GPs and hospital specialists.
 
However, an outdated Medicare Benefits Schedule (MBS) and slow-moving telehealth policy hamper efforts to strengthen partnerships and patient care.
 
Relying on letters, emails, My Health Record information, and discharge summaries does not allow a meaningful dialogue between clinicians.
 
Virtual case conference models, requiring at least three care providers, support a significant opportunity to develop contemporaneous and actionable plans informed by all stakeholders.
 
However, the strict restriction on other GP consults, specifically the time-based item numbers, to a single provider at any time is irrational.
 
The current legislation prevents a GP and non-GP specialist from consulting together on a case.
 
Instead, the GP and non-GP specialist must consult independently unless choosing to charge entirely privately.
 
Even in that case, it is unclear what is permitted.
 
This collaboration is also not permitted where a GP works via MBS and the hospital via a national weighted activity unit model.
 
The result is an inadvertent push for clinicians to refer to overbooked clinics or search for a third care provider, delaying or overcomplicating discussions.
 
The 2024 Telehealth Post-Implementation Review report makes similar recommendations for policy changes that will benefit the Australian population, including improved virtual models of care.
 
Specifically, Principle 6 has been updated to state:
 
‘[Policies] 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.’
 
This is followed by recommendation 10:
 
‘Reintroducing GP patient-end support for telehealth with a non-GP specialist.’
 
This is not to say this is a complete fix to defragmented care.
 
Some clinical cases must be seen in person, some patients and clinicians will not be comfortable with virtual formats, and aligning clinic times may not be possible.
 
The opportunity is to provide two clinicians, who would be relying on each other’s correspondence anyway to collaborate on diagnosis and management.
 
Both clinicians also stand to gain knowledge, skills and professional relationships that are not easily formed in a classic outpatient clinic model.
 
Already, the SMHS VIC-GP model has shown improvements to waiting list times and travel time for patients. 
 
According to SMHS VIC-GP Director Professor Dominic Mallon, the program has led to patients spending an average of 128 days less on the waiting list, saved 1370 kilometres of travel to appointments and restored two productive days that were previously lost for every referral.
 
‘There was also evidence of GP learning, with a 90% reduction in the number of referrals per registered practitioner in one of the pilot practices,’ he said.
 
Meanwhile in Victoria, similar patterns have been seen with the VVSC, with the initiative’s Director, Associate Professor Joanna Lawrence, reporting that 68% of patients actively waiting on an outpatient hospital specialist waitlist could be cancelled after the consultation.
 
She said 89% of patients who were about to be referred could avoid referral and 99% of non-hospital specialist GPs felt the consultation made a meaningful difference to their patients’ care.
 
With a Federal Election on the way, this matter is highly important to general practice and patients.
 
Facilitating collaborative virtual consults between the patient, their regular GP and the non-GP specialist will centre care back in the community, where patients want to be and provide a new level of continuity in care.
 
VVSC is available across Victoria, and SMHS VIC-GP is currently available for Clinical Immunology referrals but will soon be expanded to other specialties.
 
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