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Scrap preference for video telehealth consultations: RACGP


Jolyon Attwooll


26/07/2023 4:16:15 PM

The college has said the current MBS principle lacks evidence and could compromise access to care.

Video GP consultation
Only a small minority of telehealth consultations are taking place by video.

The RACGP has questioned an existing MBS principle stating that video telehealth consultations are preferred to those carried out by telephone.
 
In a submission to the MBS Review Advisory Committee (MRAC), the college this week outlined its opposition to telehealth guidance suggesting GPs ‘should prefer video over phone, as video offers richer information transfer, with fewer limited exceptions being allowed over time’.
 
It is one of 10 existing principles put in place and published by the MBS Taskforce in late 2020 following the dramatic surge in telehealth in the early stages of the pandemic.
 
This year, Federal Health and Aged Care Minister Mark Butler requested MRAC carry out a ‘post-implementation review’ of the principles, with the RACGP invited to give feedback. 
 
The resulting submission highlights a systematic review of primary care telehealth by Bond University, which suggests that both video and phone telehealth ‘appears to provide equivalent clinical outcomes for many types of clinical encounters, particularly for ongoing clinical care’.
 
According to the RACGP, evidence for video consultations is ‘an emerging space’, with an overall lack of literature comparing video and phone consultations, despite some studies citing its benefits.
 
‘The option of telehealth phone consultations has likely improved access for vulnerable populations who might otherwise not access care,’ the college states. ‘[Restricting] this to video risks adverse outcomes for these groups.’
 
Similar views were expressed in Deakin University-led research that was published in a Medical Journal of Australia (MJA) article earlier this year, which also queried the evidence behind a decision to stop MBS funding for longer Level C telephone consultations.
 
‘These data indicate that there is a barrier to increasing the uptake of video-based items in socio- economically and geographically disadvantaged areas,’ the authors of the MJA article wrote.
 
‘Overall, the removal of telephone consultations potentially disadvantages groups of patients who tend to have higher healthcare needs, such as those from rural and regional areas, those facing socio-economic disadvantage, older Australians, and some minority or priority groups.’
 
In 2021–22, more than nine in 10 GP telehealth consultations occurred via phone, with only 6% taking place via video, according to the RACGP.
 
Several other concerns with the current principles are also outlined, including complexity of the MBS items, with the submission describing abrupt changes in the early changes of the pandemic as ‘a persistent feature of the telehealth expansion’.
 
It also expressed reservations about the rapid expansion of telehealth-powered businesses.
 
‘The RACGP has significant concerns regarding the proliferation of profit-driven, asynchronous, telehealth businesses that do not provide a link to a patient’s usual general practice, which is essential for continuity of care,’ the submission states.
 
The college highlighted the importance of patients having ‘an ongoing therapeutic relationship with a usual GP’ and directed particular criticism towards companies encouraging patients to use ‘asynchronous requests for medication via text, email or online where a face-to-face or real-time telehealth consultation have not occurred prior’.
 
It described those processes as ‘not good practice’ that add to the fragmentation of care.
 
‘[As] many of these services are not eligible for accreditation against the RACGP’s Standards for general practices, assuring their safety and the quality is a challenge,’ it also noted.
 
‘There are additional concerns with privacy and the inappropriate use of patient data, both during and after a consultation.
 
‘Research shows the risks and limitations of telehealth are reduced when there is an existing relationship between the clinician and the patient.’
 
Earlier this year, the Medical Board of Australia (MBA) published its own telehealth guidelines, which will take effect from September and largely echo the college’s views.
 
‘Prescribing or providing healthcare for a patient without a real-time direct consultation, whether in-person, via video or telephone, is not good practice and is not supported by the Board,’ the updated guidelines state.
 
‘This includes asynchronous requests for medication communicated by text, email, live-chat or online that do not take place in the context of a real-time continuous consultation and are based on the patient completing a health questionnaire, when the practitioner has never spoken with the patient.
 
‘Any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and the management of the patient was appropriate and necessary in the circumstances.’
 
According to the RACGP, an extra telehealth principle should be introduced given the rise in data security breaches to ensure technology meets ‘legislated clinical, privacy, safety, security and evidentiary standards, along with adhering the medico-legal implications of patient data transfer’.
 
Further investment into general practice and research into the impact of telehealth will ‘support GPs and other health professionals delivering high-quality, equitable and safe telehealth consultations,’ it states.
 
The RACGP previously outlined its position on telehealth in a submission to the Australian National Audit Office (ANAO) last year.
 
The feedback sent this week will be considered by MRAC for potential changes to the principles.
 
The committee, which includes clinician and consumer representatives, is due to provide advice to Minister Butler by the end of 2023.
 
The full submission to MRAC is available on the RACGP website.
 
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MBS phone consults telehealth video consults


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Dr Richard Peter Shorrock-Browne   27/07/2023 10:24:34 AM

I have commented on these articles over and over again.
As a GP, I am an amateur geriatrician...80% of my patients are over 65 yo, 30% over 80 yo. At least 20% of my patients do not have a smart phone or a computer, just the wall phone. I am well set up for Video Calls, but a significant proportion of my most vulnerable patients cannot access this.
I have had multiple suggestions that "they are all skyping their grandkids on their iPads since Covid" by people with vested interests. I can assure you not all of them are.
Classic example yesterday evening DVA patient, old, frail, depressed, no family: 90 minutes of counsel and care (on the phone) after 8.00pm for which I am rewarded $40.00!
The people making these policies clock off at 5.00pm to spend time with their families, and have no responsibility of duty of care to the very patients they will exclude from telehealth. I have known these patients for 20 years, we don't need to see each others faces for effective counsel.


Dr Maureen Anne Howard   28/07/2023 12:09:54 PM

Dr Shorrock-Browne, there is a mental health item you can claim for a 'long' phone cons, it's 92127, ( no longer ones though), as long as the consultation is related to mental health, which it sounds as though it would have been for your frail, depressed patient. The situation should be changed, allowing us to provide appropriate and correct care with phone consultations, and be properly remunerated for it, including after hours.
I have cared for veterans of WW1, WW2, Vietnam and more recent conflicts, and appreciate your care for your patient.