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Blog: Telehealth policy continues to chop and change for primary care

6 October 2023
By Kate McDonald
Image: iStock

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.

2 comments on “Blog: Telehealth policy continues to chop and change for primary care”

  1. Last week, we asked: Do you think telehealth policy been mishandled by DoHAC? The vast majority of readers said yes: 91 per cent to nine per cent saying no.

    We also asked: If yes, what can be done to fix it? If no, do you think it is running smoothly? Here’s what you said.

    – Stop adding unnecessary layers and steps

    – Scrap bulk billing

    – Less regulatory interference and more market driven solutions


    – Allow ongoing verbal assignment of benefit and remove need to email the completed form which is overly onerous on the admin team.

    – Link it to MyMedicare and make it a bundled payment for aged care residents at least.

    – Ask the practice managers & doctors directly! Don’t rely on whomever is making the current decisions. Put surveys out BEFORE implementing policies & processes to see what others think. Current requirement for getting every pt to sign a bulk billed form is NOT helping, it’s putting more pressure and financial strain on an already struggling sector!

    – Remove ridiculous bulk billing requirements

    – Bring in people at management and policy design level who understand technology and how it can enhance care. Instead of regarding it as an expensive frippery.

    – Stop the need for paper and signatures, it’s old school, wasteful and outdated.

    – Do you really think DoHAC is capable of fixing it? They caused the problem in the first place, it will hake a capability they don’t have to get it right. Don’t forget this is the same mob who have been trying for 13 years to get My Health Record to work and deliver some benefits. They’ve outsourced the problem to ADHA and have completely lost control. Just don’t hold your breath waiting for the Federal government to get on top of healthcare problems. They should just leave it up the the states, fund on a per capita basis and stick to regulation of health care professionals and medicines/devices etc.

    – The Feds need to rethink their role in the delivery of anything…from the very top to the bottom their history of waste, non delivery, delayed projects, over use of contractors is endemic. As a taxpayer we are not getting value for money and it is reflected in poor service delivery. They are too far removed from the issues at hand as many are not recipients of their own decisions. Until this changes nothing will change and we will continue to have the same discussion until frustration leads to work arounds in a broken system. The only people that benefit is the lawyers from the endless Royal Commissions that have become the auditor for those most harmed.

    – Simplfy the process.

    – a) Be consistent b) Make decisions permanent c) Align with Services Australia and present a coherent policy d) Make telehealth both USEABLE and USEFUL for patients and doctors

    – less bureaucracy

    – Make a 2023 Health Insurance act that embraces technology.

    – Chat to the ground floor. Put easy applicable solutions in place which habe no strings attached or suitability of some kind. One rule for all. Keep it simple

    – Sort out the processes at least 3 month in advance of implentation.

    – It is working well and give access for patients who cannot get to the doctor due to transport issues, being unwell. There has never been clear policies and would be great if they do research and provide policy. It saves doctor and patient time; doctors are able to provide service to more patients per day. If Medicare believe there are doctors misusing telehealth they need to audit those doctors instead of hindering valuable patient and doctor time. At the end, patients who do not understand technology or not privileged to have technology will be left behind.

    – There needs to be adequate bureaucracy to make it hard for less honest practitioners to over-claim. I’ve seen terrible MBS over-claiming especially in the aged care setting. I’m sure that practices will be running smoothly when their systems are implemented and practitioners are used to the system.

    – I think realising how important it is and making it work for patients would be a great start

    – After COVID case proof, it should stay more available to patients

    – Scrap the written consent requirement for phone consultation / audio Telehealth entirely – we are all adults and registered GP’s need to be trusted enough to be performing primary health care responsibly.

    • Name - Pulse+IT

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