‘Robust framework’ key to telehealth best practice: RACGP

Michelle Wisbey

17/11/2023 3:49:14 PM

As telehealth guidelines are put under the microscope, the college says any government changes which fragment care will put patient safety at risk.

A doctor sitting at her desk speaking on the phone
One-third of Australians had a telehealth consultation in 2021–22, with more than 80% of these carried out by a GP.

‘Medicare in its current form is becoming increasingly fragmented and difficult for GPs to navigate’, according to a new RACGP submission aimed at helping to shape the future of telehealth.
Genuine GP–patient conversations, consultation funding, pregnancy counselling, and mental health billing were all amongst the college’s top priorities, as part of its response to the Medicare Benefits Schedule (MBS) Review Advisory Committee’s (MRAC) Telehealth post-implementation review.
After telehealth boomed throughout the pandemic, the Federal Government review was designed to investigate current video and phone consultations settings, as well as Medicare funding and items.
Now, in response to its draft review, released in September this year, the RACGP has revealed its long list of recommendations to ensure best practice patient care is carried out.
‘The benefits of telehealth have been clearly demonstrated, with significant uptake and strong demand for continued flexibility from patients and GPs across the nation,’ the RACGP’s submission said.
‘Around one-third of people had a telehealth consultation in 2021–22, with over 80% of these consultations occurring with a GP.
‘This reflects the widescale adoption of telehealth across Australia in 2021 and its permanent integration into the healthcare system during and post-pandemic.’
In its submission, the RACGP said that in order to assess whether a patient’s need is genuine and clinically appropriate for telehealth, a GP and patient must work in partnership, and that any model should avoid fragmentation of care.
But while telehealth has cemented itself as an ‘essential part of the healthcare landscape’, the submission says face-to-face care is still the optimal mode of service delivery.
It recommends telehealth should preference continuity of care between patient and clinician, or with a clinician from the same practice.
It also calls for MBS funding not to distinguish between telehealth phone or video consultations provided in real time. 
In 2021–22, the vast majority of GP telehealth consultations took place over the phone – 94% compared to just 6% via video.
‘Allowing patients multiple ways to access their regular GP considers a person’s preferences and life circumstances, including where they live, their level of comfort with technology, access to technological devices and data, and socioeconomic status,’ the submission said.
However, the RACGP is not supportive of the draft review’s recommendations to discontinue exemptions to GP telehealth eligibility requirements for non-directive pregnancy counselling services.
It said this will limit access to safe and affordable reproductive health and pregnancy care for women.
‘We still have a long way to go before we see safe, affordable and accessible reproductive health and pregnancy care available to all people in Australia, irrespective of their geographical location,’ the submission said.
‘Access to sexual and reproductive health and pregnancy care is a fundamental human right and we must keep moving forward on this issue.’
The RACGP also does not support the MRAC’s recommendation to make telehealth GP mental healthcare planning and review items non-exclusively linked to MyMedicare. 
MRAC said that ‘while MyMedicare could apply to planning and review items’, it is essential that treatment services, ‘including the 20+ minute GP mental health consultation and focused psychological strategies’ continue to be exempt from telehealth eligibility requirements.
‘This approach ensured that GP mental health treatment services by phone and video were as accessible as allied mental health professionals and consultant psychiatrists,’ MRAC said.
But the RACGP’s submission strongly opposes this, saying continued provision of mental health care planning and review items is essential to ensure equity, whether or not a patient is registered with MyMedicare.
The submission comes at a contentious time for telehealth, with the RACGP currently fighting for long-term telehealth bulk billing changes in the wake of the pandemic.
Last week, the Federal Government announced updates to its highly controversial Services Australia changes, confirming that the department would go ahead with the RACGP’s proposal to make DB4E and DB20 forms available in Rich Text Format (.rtf).
This was a move welcomed by the college, but, as the submission states, there is still much work to be done to create a more streamlined telehealth system.
‘Patients are also struggling to identify and locate highly specific services delivered by different health professionals with less connection to their GP,’ the submission said.
‘Many GPs find the growing number of MBS item numbers, including those specific to telehealth, difficult to navigate and are hesitant to claim unfamiliar items to avoid accidental, incorrect claims and potential compliance activity.’
Consultation on the Telehealth Post Implementation Draft Report closed on 6 November, and will now be reviewed by the committee.
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