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Blog: policy on online scripts and telehealth is anything but permanent

27 January 2023
By Kate McDonald
Image: iStock

Our top stories this week concerned the ongoing stoush over the permanence or otherwise of MBS-funded telehealth in primary care and new moves by the Medical Board to restrict patient access to online healthcare through a recommendation on online scripts.

Pulse+IT has whinged at length in the past about the constantly changing goalposts of MBS telehealth items, which were introduced temporarily in 2020 to help GPs manage the early onset of the COVID-19 pandemic and were grandly proclaimed “permanent” towards the end of the emergency.

Former Health Minister Greg Hunt never shut up about it and nor did the Department of Health, with both banging on about “10 years of reform in 10 days”. We are still hearing all sorts of claptrap about it being the “most significant structural reform to Medicare since it began”, including in a new report from the Auditor-General on the department’s expansion of the telehealth program.

The “significant structural reform” quote is from the 2022-23 budget paper and it’s repeated verbatim in the Auditor-General’s report. However, the report itself raises quite a few issues about the implementation of “permanent” telehealth, not the least of which is that the department – admittedly in a time of extreme crisis – introduced the measure without putting in a way to evaluate its worth. Nor did it conduct a risk assessment as to see if there might be any potential problems.

The Auditor-General found that the implementation of telehealth during the pandemic was backed up by good policy advice – which had of course been available to the department through over a decade of pilot studies into its benefits – but we still take issue with the idea of telehealth on the MBS being “permanent”. How can it be so when the rules change every other week?

MBS-funded telehealth in primary care is now restricted only to patients with a regular GP who has been seen by someone from the practice within the last 12 months, with some other items available for allied health, mental health and specialist care. The plan is that telehealth consults will only be available for patients in primary care if they voluntarily register with one practice. It may all be in the name of continuity of care, but it does nothing for access to care.

Similarly for the new moves being mooted by the Medical Board of Australia to change the rules for asynchronous online script consults. These are questionnaire or text-based consults provided by a limited number of specialist online script, medications delivery and telehealth companies, staffed by qualified doctors, for patients who for whatever reason cannot get in to see their GP or any other GP for that matter.

The medical board is seeking to change policy recommendations so that online doctors must speak to the patient before issuing a script, thereby increasing the cost substantially and reducing the efficiency and convenience of these services. We take a bit of issue with this recommendation as the main companies that it will affect are those that know what they are doing and do it well – namely Medmate and InstantScript – while leaving the cowboy end of this emerging industry unscathed.

We have not seen any evidence as to why these particular services are being targeted when there is no evidence they are causing harm, and meanwhile the private and start-up telehealth industry is slowly and unfortunately morphing into a free-for-all for those touting erectile dysfunction, hair loss and weight loss treatments.

Medmate’s founder and medical director is a very well respected Melbourne GP who set the company up to do things right, including online scripts and medications delivery for vulnerable populations. Take a look at what he has to say – along with some of his customers – and see what you think.

While virtual care is being bedded down in hospital and community care as business as usual, the argy-bargy over telehealth in primary care continues. It’s getting rather tedious.

That brings us to our poll question for the week:

Do you agree with the recommendation to restrict online scripts?

Vote here and leave your comments below (anonymously if you like).

Last week, we asked: Is South Australia’s statewide roll-out of Sunrise EMR and PAS a game-changer for its health system? This was pretty evenly split: 47 per cent said yes, but 53 per cent said no.

We also asked what you thought of the benefits – or not – it might bring. Here’s what you said.

4 comments on “Blog: policy on online scripts and telehealth is anything but permanent”

  1. A good article. This type of grinder on the decisoon makers needs to be wound up. Telehealth and its benefits is well documented around the world. Use this knowledge.
    In a ‘lieral’ sense “remote care” is anywhere outside as health care location -GP/Hospital/Clinic/Private rooms so ‘access’ to ongoing care and assessment needs to be evolved. Pateintsd want it and they are the most important component of the healthcare system. We need to give them the information so that they can self-manage their care, 24 hours a day. Telehealth and online scripts are significant com poenents of the needed reforms. With signficant delays in obtaining appointments for “an average 7 mins” consulotation the system needs to give patients greater control and access. Telehealth, online scripts, and ownership of their records (e- or hard copy) is essential.

    • Name - Terry Hannan
  2. It’s all about the Pharmacy Guild pushing pharmacy prescribing to give patients quick and easy access to a pharmacist who can provide the ‘complete one stop health service’ – viz. diagnose, treat, prescribe and dispense.

    • Name - Ian Colclough
  3. The whole system needs a rethink not just the details of when and how telehealth is used. We have a funding centric system not a patient centred system. Fragmentation, waste and stress are the result. Doctors are tied up doing things other members of the team could do. Doctors are stressed that the time available for care is so short under current funding arrangements that things like repeat scripts get overlooked. Modernising Medicare to address the needs of all our population, not the world of 1984, must deliver reduced waiting times to get access to care by the right provider at the right time. Mixed modes of delivery from face to face to virtual must be cemented so that continuity of care and higher quality, more personalised care are possible. Shared data and better access to patient records across the system to enable transitions of care, care coordination and team based care must be a core consideration. So let’s broaden the debate as little gains in isolation will not resolve the challenges which are undermining our health system.

    • Name - Tracey Johnson
  4. So, do readers agree with the recommendation to restrict online scripts?

    A big majority said no: 73 per cent were against, and 27 per cent were for. We also asked why you thought so. Here’s what you said:

    – Going both ways here. Don’t agree that scripts should be provided for medicines without a good clinical assessment. But don’t agree that using a PROM or online based assessment can’t form the basis of that. And that we must open up virtual care and functionality for patients to access electronic prescribing. Patients love it, it’s easy and increases access. Patients are voting with their feet if they are using these virtual services.
    As part of a project expanding electronic prescribing to public patients both the prescribers and patients love and we must open up virtual care and stop adding barriers.
    How is electronic prescribing different to electronic pathology or radiology ordering – and there are a bunch of clinicians who request these without first seeing the patient ????????

    – Prevents business models which will fragment care and reduce continuity / holistic care

    – Should enable consumers to manage own care

    – Our medical system is very over-loaded, so for many obvious prescriptions needed (e.g. UTI, repeats, birth control, etc.) this frees up the waiting rooms of many medical centres and emergency rooms at hospitals.

    – Because it’s unnecessary

    – No one wants this- streamlined healthcare makes sense

    – Lots of unseen harms and opportunity loss when care is fragmented into sections

    – assume that the medical board is attempting to rein in the cowboys, which I support. a F2F via telehealth consultation is likely to be better medical practice than an online questionnaire

    – If we are to provide consumer choice when it comes to access to care, telehealth needs to be another modality rather than a limited or restricted option. Furthermore, by setting the restrictions, the healthcare system is expecting patients to determine the best access for them when they need medical attention/care…. this is a doctor’s job, not a patient’s.

    – Unrestricted online script writing is second only to pharmacist prescribing when it comes to safety.

    – The old guard are stifling competition and future innovation in healthcare.

    – It offers a valuable service to those that do not have the luxury of controlling their own diary.

    – Writing a script is actually a complex process that needs knowledge of patients whole medical history to do it as safely as possible. Let’s promote best practice not just dangerous convenience.

    – This is just GPs protecting their own business. Patients need this service. If scripts cannot be done for new patients who are seen on videocall, then that should also apply to new patients who have GP face to face visits too. It’s totally regressive, illogical, wastes appointments that could be used for more serious issues and smacks of protectionism.
    – GPs need to move with the times.

    – Lack of GPs in rural and remote Australia

    – It suits young busy people. It does not add to cost of hcare. Not everyone can afford a GP these days since many GPS since COVID stopped bulk billing and a $110 cos of consult is a not always possible for an average consumer.

    – Clinical oversight is more effective if the patient is well known to the prescriber. Drug interaction is a significant and costly issue for public health. Indiscriminant prescribing based on only limited information has the risk of exacerbating this problem. Resctrictions on what and who can prescribe are essential to mitigate this risk.

    – Drs know what they are doing to know when appropriate. As long as all GPs are registered for Safescript which our Drs are to prevent Dr shopper patients.

    – It’s there to compensate for the Medicare benefit being unchanged for years. It’s like moving the deck chairs on the titanic. Modernise the entire payment system to make general practice a worthwhile career and relieve emergency rooms.

    – Restricting this makes the experience more difficult for patients

    – Patients are waiting weeks and sometimes months to get an appointment with their regular GP. By restricting the prescribing of scripts via telehealth it puts our most vulnerable patients at high risk of more serious medical events. However, I would agree that an online form is not idea but a video or phone consult with a medical professional would be sufficient. There has been a lot of work within the industry over the last couple of years to keep patients out of the ED, this will see patients lining up again putting more pressure of these departments.

    – Is good medicine

    – The 5% that game the system for nefarious purposes. Lacks clinical oversight.

    – It makes it so convenient, particularly when your regular GP is booked for 3 weeks solid and all you’re wanting is a repeat script. Great for full time workers.

    – No, when will patient access and convenience be considered? I can’t get an appointment with my GP for four weeks. If I can use a reliable service that informs my GP that they’ve issued me a script why not? I was recently caught out where I ran out of my medication the night before travelling interstate to Launceston. My script was at my local pharmacy. Its impossible to get a same day appointment with a GP in Launceston. Fortunately because I know what’s possible with telehealth I used one of the major script providers and was able to get an escript and have my medication issued in Launceston within an hour. I did have some reservations at how easy it was but was reassured when the pharmacist checked my blood pressure at the request of the script issuer. If there are checks and balances in place why not? The reality is that there is a shortage of GPs and if this can alleviate some of these pressures why not?

    – some medication can be prescribed safely online, medical professionals are able to determine what is safe and what is not

    – Need to provide care how the patient needs it. Don’t assume everyone is rorting the system

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