The delivery of healthcare at a distance, using information communications technology (telehealth) can be used to connect and provide patient care, assessments, education and supervision. It has traditionally been associated with overcoming barriers to health service provision in rural and regional areas, for primary care and as a means of supporting the ‘hospital in the home’ initiatives for hospital-admitted patients or managing a patient’s ongoing care after discharge from hospital. However, in order to enable social distancing, the federal government recently introduced new Medicare items during the COVID-19 pandemic to fund telehealth services for patients in metropolitan parts of the country. Private health insurers have also recognised the provision of allied health services such as tele-physiotherapy and the provision of treatment outside of the hospital setting. These are important developments in the use of telehealth services that may change community expectations about how healthcare can and should be delivered in the future. However, it remains to be seen whether public and private funding of telehealth services will be implemented permanently after the pandemic is over.
New Medicare rebates for telehealth and telephone attendances
On 13 March 2020, temporary telehealth items were included onto the Medicare Benefits Schedule (MBS) to allow people to access essential Medicare funded health services via videoconference or telephone while in isolation in their homes and reduce the risk of community exposure to COVID-19. These items are specified in the Health Insurance (Section 3C General Medical Services – COVID-19 Telehealth and Telephone Attendances) Determination 2020 and will only be available until 30 September 2020.
The newly Medicare-funded telehealth consultations:
- Can substitute for consultations that are currently available on a face-to-face basis under the MBS if the services cannot be provided due to COVID-19 restrictions;
- May be given by GPs, specialist medical practitioners, nurses, participating midwives and allied health providers and can include treatments relating to chronic disease management, antenatal and postnatal pregnancy support, eating disorder management, autism and disability services, mental health services or psychiatric consultations;
- Are for outpatient services only (in contrast to ‘hospital in the home’ initiatives);
- Can be general in nature so do not need to relate to the diagnosis or treatment of COVID-19; and
- Attract the same level of Medicare rebates as those paid for face-to-face consultations.
Consultations can be via videoconference or telephone/audio only services if video is not available. Providers of the telehealth consultations do not need to use specific equipment, provided the solution meets the clinical requirements and satisfies privacy laws, as telehealth providers are subject to the same clinical and legal obligations and the same regulation by the Australian Health Practitioner Regulation Agency as the equivalent face-to-face provider. Conducting consultations via telehealth not only protects patients from increased risk of exposure to infection, but also protects our health professionals and provides a safer working environment while ensuring the continuity of our health system.
Private Health Insurance cover and telehealth
Prior to the recent introduction of lockdown measures, most private health insurers only paid benefits for ‘General Treatment’ (i.e. non-hospital treatment or ‘Extras’) if the treatment was given in person. Members could generally not claim benefits for tele-allied health services. The mandatory isolation and social distancing requirements forced the closure of many allied health clinics, which prevented their members from accessing treatment that would be covered by their Extras policy. Consequently, many private health funds have temporarily relaxed their requirement that consultations be given in person to attract Extras benefit payments for remote consultations via video or audio link. Benefits may be paid for physiotherapy and psychology if the treatment meets certain conditions specified by the relevant private health insurance fund. This supplements the Federal Government's expansion of telehealth Medicare services, which private health insurers are not permitted to cover. COVID-19 has also incentivised the private health sector to establish or accelerate programs to provide hospital treatment at home. This model of care allows health insurance members to receive treatment in their home that would otherwise take place in a hospital setting, such as chemotherapy or rehabilitation after surgery.
The benefits beyond the pandemic
The temporary measures introduced by the federal government and the private health sector to allow funding of allied health services and hospital treatment in the home in certain situations has allowed a greater number of people to experience the benefits of this model of care. Studies have shown that remote health increases access to services, convenience, integration and quality of care and a reduced burden on some aspects of our health system. Patients in particular can experience the reduced burden and time of travel to consultations when feeling unwell and in need of rest; there is no driving on congested roads, searching for parking and waiting in clinic reception areas surrounded by other infectious patients. The provision of treatment at home can reduce the risk of immune-compromised patients being exposed to infections passed on by other patients, healthcare workers and the hospital/clinic environment itself.
The future of healthcare delivery in Australia
Hospital and clinic-focussed services dominate the provision of health care in Australia. Increasing hospital admissions, and the increasing cost of each admission, is a critical factor in the increasing cost of health care. The recent state of emergency and lockdown measures declared throughout Australia in March highlighted how vulnerable businesses and essential services can be if face-to-face contact is relied upon as the sole means of service delivery. Resilience to future service disruptions, whether due to a pandemic or other emergency situation, may require more permanent changes to our healthcare system and the legislation that governs it. Research has long found that, where clinically appropriate, home and community-centred care may be a more cost-effective alternative to hospital-centred care, particularly for the treatment of chronic or recurrent conditions. Therefore, in addition to allowing business continuity in times of crisis, a shift to more flexible service delivery and the funding of telehealth services may also result in more cost-effective and affordable health care, allowing our limited hospital resources to be applied where they are most needed.