Telehealth extended but details remain limited

Anastasia Tsirtsakis

26/04/2021 4:45:49 PM

The RACGP has cautiously welcomed the six month extension but is still waiting to confirm the policy’s final details.

GP on the phone.
The Federal Government is working with peak bodies to co-design permanent post-pandemic telehealth.

The Federal Government has confirmed GPs will be able to offer Medicare-subsidised telehealth consultations until at least 31 December.
The current arrangement is due to end on 30 June, but Federal Health Minister Greg Hunt said the Government plans to include an extension in May’s Federal Budget, as it continues to work with peak bodies to ‘co-design permanent post-pandemic telehealth’.
‘Over the last 12 months, telehealth services have been life-changing for many in need of support,’ Minister Hunt said.
‘The extension will ensure that Australians can continue to see their GP, renew scripts and seek mental health support from the safety of their own home. This allows vulnerable Australians to feel protected and supported during these unprecedented times.’
Townsville GP and RACGP Rural Chair Dr Michael Clements told newsGP while he is pleased the Government has recognised telehealth as an important part of modern general practice, GPs and patients need greater clarity going forward.
‘I’m disappointed that we haven’t seen it just locked in, in a permanent ongoing fashion,’ he said.
‘We would love to have seen the permanency around it so that we can do our planning that’s best going to support our rural, remote communities and vulnerable patients that need it most.’
Dr Michael Wright, Chair of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), also welcomed the announcement, but says the college is still waiting to see the final details of the policy.
‘It’s important that GPs and their patients can continue to access flexible care,’ he told newsGP.
‘But one of the concerns for the college is that we’ve been strongly advocating that longer consultations – like the [Medicare Benefit Schedule] Level Cs and Ds – need to be available so that patients can continue to access longer care by telehealth, when necessary.
‘Hopefully the extension continues with the same criteria as before.’
The RACGP has been a strong advocate for Medicare-subsidised telehealth, having played a key role in its rollout last year, and the uptake indicates patients also see the many benefits.
From 13 March, 2020 to 31 March, 2021, more than 54 million telehealth services were accessed by 13.5 million patients.
Dr Clements says emerging evidence continues to show the value of the service, including the benefits of longer consultations for patients with chronic and complex health needs, and mental health issues.
‘GPs recognise that to get the best from our patients and to give our best to our patients within the complex area of mental health, the most important thing we can give them is our time,’ he said.
‘That’s time for the patient to reflect, connect and respond, and it’s time for the GP to give the patient an opportunity to take their own pace as they reveal what’s going on in their mind.
‘It takes time for people to reveal past trauma, it takes time for people to reveal the real reason they’re there and perhaps the real reason behind their long-term headaches – all of these things take additional time and GPs are well skilled to pick that up.
‘But if we’re trying to use or manipulate the consults around the patient’s rebate then that can be difficult because remember, most of the patients that need most of our time are those that can least afford it.’
Meanwhile, Dr Clements says video consults should not be preferenced over telephone consults, and that both should be funded to 100% of the Medicare rebate.
‘While video health sounds great, the reality is that in rural and remote areas, and for some of our most vulnerable populations, access to the IT and internet stability for video really does put it out of reach of many,’ he said.
‘So we need to ensure that both the telephone and video are treated equally under Medicare.’

Telehealth-extension-article.jpgRACGP Rural Chair Dr Michael Clements says it is clear telehealth will be useful well beyond the pandemic.

Any cuts to consultation rebates, Dr Clements says, will be felt most by vulnerable populations – those who most benefit from telehealth and simultaneously are also the least likely to be able to afford it.
‘There’s the perception amongst people in Canberra that GPs are using these phone items for quick scripts and easy work, but the reality is that we’re still carrying the burden of chronic disease management and mental health care with the blunt tool of Medicare,’ he said.
‘If we think about those that most benefit from telehealth, it’s those that find it difficult to get out to the general practice, who can’t find carers for their elderly parents or for their children.
‘It’s those in domestic violence relationships where they can’t think of an excuse to get out to the GP. It’s those rural and remote patients who have to drive for hours before they can get that visit; and it’s those with palliative care or such debilitating mental health conditions that they’re too afraid to leave the house.’
As part of the RACGP’s 2021–22 Federal pre–Budget Submission, the college has also called on the Government to improve patient access to general practice services by ensuring that rebates are indexed annually.
‘To avoid any recurrence, like the damage of the previous Medicare freeze,’ Dr Wright said.
‘Telehealth has been a crucial part of Australia’s successful COVID-19 response and has allowed GPs to provide necessary care for their patients without needing to attend in person. So this was a long overdue reform.’
While the current telehealth model was born out of the implications of COVID-19 and will continue to assist GPs to respond to the resulting healthcare needs, Dr Clements says it is clear the service has proved it will be useful well beyond the pandemic.
‘We need to stop thinking of this as a COVID measure … as if it’s something that we don’t need once COVID disappears,’ he said.
‘Telehealth is something that we’ve been advocating for. We’ve now got evidence that it works, and it supports the most vulnerable of our population. It does need to be here to stay.’
The Federal Budget is expected to be delivered on 11 May.
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Dr Peter JD Spafford   27/04/2021 7:16:29 PM

I think the move is sensible. Why telehealth was valued as the same as face to face in the first place was non -sensical. GPs have always been able to phone their patients. Why the taxpayer has to pay for this is strange. Let us not forget that Medicare is a payment to the patient to assist in the affordability of medical services, it is a rebate to the patient not a payment to the doctor. The more Australian General Practitioners think that the Government is funding their service through Medicare, the more we will struggle to recruit registrars and keep practices open, telehealth or not.

Dr Vincent Edwin Russell   27/04/2021 8:19:09 PM

I’m not aware of any evidence that places Telehealth on an equal footing as face to face consulting with regard to quality outcomes. Indeed, much vital clinical information is lost in the Telehealth consult. Why is it that it’s okay to have 70000 people attend a football match but still infer that visiting the GP is not safe? Telehealth should be reserved only for those who genuinely are unable to attend the GP practice.