MBS incentives for one kind of telehealth consult over another serve only to limit healthcare access for the vulnerable, the college says.
The RACGP has hit back at the MBS guidance that GPs should opt for video telehealth over phone, while voicing concerns over the rise in asynchronous telehealth.
Yesterday, the RACGP submitted its response to the set of 10 principles on telehealth services put in place by the MBS Taskforce to guide the boom in telehealth since the pandemic. The feedback will be considered by the MBS Review Advisory Committee as part of its post-implementation review.
The college’s harshest rating – 1 star and a call for it to be cut from the guidelines – was given to principle 5 suggesting video consults should be preferred over phone.
The RACGP pointed to a lack of research, particularly comparing phone and video consults, and likely effects on access for some of Australia’s most vulnerable populations.
It cited a systematic review of telehealth in primary care, commissioned by the Department of Health and conducted by Bond University, which found that video and phone consultations appeared to provide “equivalent clinical outcomes for many types of clinical encounters, particularly for ongoing clinical care”.
The recommendation noted the wide breadth of uptake of telehealth in Australia over recent years, the vast majority of it through phone calls (94% in 2021-22), which “likely improved access for vulnerable populations who might otherwise not access care, and to restrict this to video risks adverse outcomes for these groups”.
“Given telehealth use in Australia is overwhelmingly phone based, enabling continued access will improve access to care for many Australians, along with expanding patient choice,” the submission stated.
Other research cited by the submission concurred that videoconferencing was limited by access and tech requirements, which disproportionally affected regional/rural areas, and should not be widely rolled out in health.
“RACGP members report that enforcing video use for telehealth is detrimental for several specific groups, including Aboriginal and Torres Strait Islander people, elderly people, people with disability, people experiencing financial disadvantage, and rural populations,” the RACGP said, noting pay-as-you-go, crowded housing, privacy and expense of equipment as outcomes of unequal socioeconomic effect.
But the RACGP championed the continued use of telehealth via phone as a simple and effective method of telehealth, for both GPs and the public, that most Australian have access.
Dr Emil Djakic, deputy chair of the RACGP’s Funding and Health Systems Reform Committee, told TMR that the disparity in the MBS reimbursement for phone versus video was a “totally preposterous” attempt to incentivise video telehealth.
“[Doctors] follow what works. If it doesn’t work, they don’t use it. Using item numbers to create incentives to do things is a fool’s errand,” he said.
“It needs to be made simpler and available and cost-effective.”
Dr Djakic drew attention to the “unnecessary complexity and administrative burden” that is mounting around telehealth as another key gripe for GPs, also named by the RACGP in their submission.
“I fully appreciate the funders’ desire to have accountability and traceability – all the things that make them feel nice and comfortable and safe in their office in Canberra. But the reality is, the increasing burden of those check backs and accountabilities in a system is making the MBS less agile and less deliverable.”
“There’s a time coming – and it’s already happening, obviously – where [GPs] say, Medicare compliance is too difficult.”
Dr Djakic emphasised the importance of Medicare as a funder, but said the complication has to stop.
In its submission to the MRAC the college also expressed concerns around the rise of private telehealth 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 stated.
“[Since] 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.
“Research shows the risks and limitations of telehealth are reduced when there is an existing relationship between the clinician and the patient.”
Commenting on this, Dr Djakic said “This represents a bigger question of the consumption of healthcare information and advice in all of our communities. It’s not Australia, it’s internationally: we are in a remarkably changing environment and sadly dislocated care.”
Dr Djakic pointed to the pit falls of such a care system, commonly seen in the US, “where people consume parts of their care across a range of providers who don’t have any direct interaction. And that ends up being more expensive care, and with a significant loss of some of the issues of quality and safety.”
To address data security concerns the RACGP called for an additional telehealth principle ensuring technology meets security standards and aligns with “medico-legal implications of patient data transfer”.
