Welcome to national Telehealth Awareness Month, where we celebrate the great gains in virtual care over the last few years while still grappling with the archaic nonsense that has kept the sector back for two decades now. Fantastic stuff!
Telehealth Awareness Month kicked off with this very nice opinion piece by Chris De Sair from the Royal Flying Doctor Service Victoria, which bucks the trend of other RFDS services by investing heavily in primary care telehealth services for its relatively small geographical footprint.
Chris made a point of highlighting digital literacy as a problem his service is facing, considering almost half of its patients are over 55, and a lot of time is spent on the phone talking through technology issues before a telehealth appointment can even be booked.
We were pondering these hurdles when a bit of a hoo-ha brewed up online this week, following the issuing of guidance by the Department of Health and Aged Care on what seemed like new rules for general practices to get consent from patients to bulk-bill telehealth consults. It appeared at first glance that an old fashioned bureaucratic nightmare was brewing up, with GPs forced to jump through innumerable hoops and bury themselves in reams of paperwork just to be able to offer vulnerable patients basic telehealth services.
Some even claimed that such was the load of bureaucracy that many practices would simply not bother offering bulk-billed telehealth as an option. Considering many practices don’t bother at all with telehealth this is not the disaster it seems, but it turns out that the guidance wasn’t new, did not actually put an extra burden on practices and was a bit of a beat-up.
But what it very much did do was highlight just how ridiculous the rules around assigning the benefit for Medicare rebates under the 1973 Health Insurance Act are. Having to jump through so many hoops that do not apply to private billing, simply due to the Medicare bureaucracy’s existential fear of the very thought of encouraging over-servicing, means innovative solutions that are proven to improve health outcomes and reduce cost are often kneecapped before they even start.
Telehealth is the perfect example. DoHAC has put barrier after barrier in front of telehealth provision in Australia, and even when it did open up due to the pandemic, it has made an absolute hash of consistent policy since then. From dragging its feet in the face of over-servicing fears to requiring absolutely rigid rules on video conferencing standards in the face of massive technological advancement, to the unrelenting patting themselves on the back personified by former health minister Greg Hunt’s “we’ve made telehealth permanent” nonsense, the department has dropped the ball on telehealth.
Far from encouraging telehealth, the department has stifled it at every stage, not helped in the slightest by both the RACGP and the AMA and their constant attempts to basically kill off telehealth with silly requirements on who qualifies to provide and to receive virtual services, how it should be done and how it should be paid for. The drama over restricting telehealth to known patients means we have no sympathy for the college or the AMA’s whinging on this.
Having said that, goodness knows what any grown adult thinks of the absolute load of codswallop issued today by the department. It is probably one of the daftest statements on telehealth we have ever come across.
The department did itself even fewer favours at the start of the week with a bit of confusion over its latest triumph, the MyMedicare voluntary enrolment scheme. Communicating process changes such as these through the PHNs is a good idea as they are much closer to the ground, but we understand that even the PHNs were caught short on what practices need to do on October 1 to prepare for MyMedicare.
Basically, practices wanting to take part in the scheme have been encouraged to register since July, with patient enrolment to start in October, but despite numerous webinars and factsheets, no one seemed to be aware that an extra step was needed on Sunday to flick the switch in PRODA.
It is certainly not a big deal in the scheme of things as few patients tried to register, but there’s no doubt the kerfuffle seriously annoyed the scheme’s most important advocates – GPs. The department has been making great strides in improving processes and communications, particularly in aged care, so it’s disappointing to see small problems like these arise when they simply shouldn’t.
And finally, the department’s very poorly explained national prescription delivery service (PDS) appears to have overcome its final hurdle, with the ACCC likely to give approval to the transfer of prescription data from MediSecure to eRx this month. Despite some rearguard action from GP groups griping about their favoured MediSecure system not getting a look in, the department made it clear some time ago that it was intent on a nationalised system and chose what they say is the most cost effective option in eRx.
While never explaining exactly why it favoured a direct funding model when the existing, interoperable prescription exchange services worked perfectly well – minus the silly fee reconciliation process that pharmacies had to go through that are too complex to even get into – the department has made its decision, and there’s no going back now.
Meanwhile, everyone staffing New Zealand’s telehealth service Whakarongorau Aotearoa are all on strike. It’s all tickety-boo.
It also brings us to our poll question for the week:
Do you think telehealth policy been mishandled by DoHAC?
Vote here or leave your comments below.
Last week we asked: Should compliance with agreed standards be mandatory for aged care software? Yes, said everyone: 100 per cent. (We received no no votes.)
We also asked, If so, how should such a scheme work? If not, why not? Here’s what you said.