Telehealth remains on track to become a permanent fixture on the Medical Benefits Schedule (MBS), despite the Department of Health delaying making items permanent for a second time, with temporary arrangements to remain until 30 June.
It appears the government needs more time to finalise subsidies with peak doctor groups, having not yet knuckled down the best approach for video and phone rebates and whether to treat remote, rural and regional doctors differently.
Telehealth is costing doctors money. For Melbourne-based rheumatologist, Dr Daniel Lewis, who sees half of his patients via telehealth and 95% of those via Zoom, the costs are significant.
“The bottom line is I can only see half as many patients with Zoom than I could face-to-face. There is a significantly higher administration burden. We need to register the patient, help them with technology, do the paper admin after the consult, email a summary of advice, and then email prescriptions to a pharmacy. It is very laborious and time consuming.
“We’re paying for this extra administration time and my income has dropped significantly. There should definitely be a higher surcharge for video consults to cover these costs, and I don’t think patients are going to pay more,” Dr Lewis said.
Similar concerns were raised last year. Peak doctor groups will be pushing for the government to step up and subsidise these new outlays.
They will also be appealing for a higher loading for video over phone, with video delivering better quality consultations. Sydney-based rheumatologist, Dr Andrew Jordan, who is currently seeing around one in ten patients via telehealth, supports this approach.
“I am accepting of a lower rebate for phone consultations versus video consultations, however I would still like phone consultations to be rebatable in some form,” Dr Jordan said.
Dr Lewis expects the government will keep the loading the same for video but drop them for phone, and is concerned this would see more specialists use phone as a way of achieving higher turnover, a result he described as “bad medicine”.
Rheumatologists outside of metropolitan areas will be hoping Dr Lewis is right about the video loading remaining. Doctors in regional, rural and remote areas can claim a 50% loading for video, under Item 112, provided the patient is more than 15 kilometres away. The government currently pays this loading and groups like the Australian Rheumatology Association (ARA) are concerned it could be removed from a permanent items list.
“The unintended consequences of removal in funding may be further reduction in services to these already-underserviced areas in rheumatology,” ARA President Professor Catherine Hill said.
Dr Lewis pointed out the administrative burden for video is the same regardless of location, but technology costs could be higher in more remote areas. However, Dr Jordan points out that many technology platforms – such as COVIU, FaceTime and Skype – are available with “virtually no setup costs”.
The government has some tough calls to make and is likely to be hesitant to dive deeper into its thinning pockets. One piece of evidence it could use in its favour is a recently published paper by Monash University that found the chances of rheumatologists making a diagnosis using telehealth in 2020, compared with face-to-face consults in 2019, dropped dramatically from 57% to 29%.
It is a worrying finding and sheds light on the need to use telehealth wisely.
“I find telehealth is challenging for new patients, as we gain a lot of information from a quality physical examination,” said Dr Jordan. “On the other hand, telehealth allows me to easily follow up about simple enquiries. Healthcare has been inhibited in the past by difficult access to doctors for these types of enquiries.”