Telehealth during & post the COVID-19 Pandemic
We wrote originally about the rise of the telehealth due to the constraints Covid-19 placed upon health professionals and their patients. As we head to the second half of 2022 we thought it worthwhile to refresh this blog as telehealth is no longer a new phenomenon and is clearly here to stay.
During the pandemic, 281 new temporary Medicare Benefits Schedule item numbers were added to the MBS schedule for videoconference or telephone consultations between patients and general practitioners (GPs), specialists, allied health and nurse practitioners. Access to this funding was significantly enhanced, by removing geographical and patient-risk factors from the original eligibility criteria.
Since 2020 there has been a significant increase in Australian practices in the use of telehealth consultations with more than 4.3 million health and medical services having now been delivered to a total of more than three million patients through the telehealth MBS items introduced by the Government. This continues to rise.
So what is telehealth?
The Royal Australian College of General Practitioners (RACGP) defines telehealth as “a method of delivering healthcare that involves the use of information and communications technology (ICT) to transmit audio, images and/or data between a patient and a healthcare provider”. The Government’s response to COVID-19 on 10 July 2020, on the recommendation of several organisations such as the Australian Medical Association (AMA) and the RACGP, the Minister for Health announced that, from 20 July 2020, telehealth GP providers would need to have an existing and continuous relationship with a patient to provide Medicare-subsidised telehealth services.
Exemptions to these requirements include patients living in a COVID-19 impacted area, as defined by separate state and territory public health orders.
By ensuring that the practitioner and the patient have an existing relationship, the system aims to ensure that patients continue to receive quality and continuous care from a practitioner who has knowledge of the patient’s medical history and requirements moving forward. It is intended to encourage the practice of good medicine.
Prescriptions following telehealth consultations can be mailed or emailed to the patient or the patient’s pharmacist.
Vulnerable people, and those in home isolation can order their PBS and RPBS prescriptions remotely and have these items delivered to their homes to reduce their potential exposure to COVID-19.
What are the benefits of telehealth since COVID-19
Healthcare provider benefits
- Reduced travel, expense and time away from home
- Higher patient reach, due to fewer location and travel barriers
- Reduced patient ‘no-shows’
- Real-time assistance with difficult cases and emergencies
- Improved allocation of consulting rooms within a practice where there is limited availability
- Opportunity for staff to work remotely and
- For professional development, such as informal knowledge transfer through increased collaboration, networking and case conferencing opportunities.
Patient benefits
- Improved access to healthcare, i.e. greater equity
- Reduced travel, expense and time away from home
- Reduced waiting times supporting faster diagnosis and appropriate treatment
- Improved continuity and quality of care
- Local treatment from a known healthcare provider, under specialist supervision and
- Increased opportunity to contact their healthcare provider between face-to-face consults.
Practice manager benefits
- Service delivery growth opportunities
- Improved clinical workflows and increased practice efficiency, e.g. time savings;
- More cost-effective delivery of service through higher patient flow and time savings; and
- Improved coordination of care and service integration.
What are the potential risks of telehealth
- Limitations with performing comprehensive physical examinations and other more substantive clinical services
- Possibility for technical difficulties
- Risks of misdiagnosis
- Security breaches and regulatory barriers
- Potential to adversely affect continuity of care - online interactions can be more impersonal and dangerous in that the virtual provider does not have the benefit of a complete history and physical examination to aid with diagnosis and treatment
- Potential of other persons being in the consultation when the practitioner is unaware
- Higher expectation on the practitioner to act in accordance with the Medical Board of Australia’s Good Medical Practice: A Code of Conduct
- Difficulty in obtaining medical history: doctors engaging in “instant consults’, or issuing ‘instant scripts’ or electronic prescriptions are unlikely to have access to the patient’s medical history.
What are the recent changes to telehealth
From 1 July 2022, more permanent MBS telehealth arrangements remain in place and provide for a wide range of telephone and video services by qualified health practitioners and support safe and equitable telehealth services, informed by the MBS Review Taskforce Principles. Previous temporary arrangements ceased on 30 June 2022.
MBS telehealth items are available to be provided by GPs, medical practitioners, specialists, consultant physicians, nurse practitioners, participating midwives, allied health providers and dental practitioners in the practice of oral and maxillofacial surgery.
Patients in areas declared a natural disaster, for example, in response to recent flooding can access telehealth services from any GP. Eligible regions are State or Territory Local Government Areas identified as a natural disaster at the time of the service.
What does the future of telehealth services look like?
Telehealth faces many legal and regulatory hurdles including variations in rules, regulations, and guidelines for practice.
This variability contributes to the confusion for providers engaged in the practice of telehealth. Health care providers should keep risk management strategies in mind and familiarise themselves with potential telehealth legal risks and implications. This means implementing better checks and balances in terms of their management systems from the outset.
This will ensure best practices for patient care and to avoid licensing or litigation issues. Telehealth regulations vary greatly by State and are constantly emerging and evolving. This creates unclear understandings regarding standards and guidelines among health care organisations and groups on a national platform.
The rapid expansion of telehealth, especially during the COVID-19 pandemic, paired with changing rules and guidelines creates increased potential for liability and legal issues. It's vital that Healthcare Providers and Practice Managers have awareness of and maintain compliance with State and Federal legal requirements whilst using best practice guidelines to provide patient safety. This means regularly keeping up to date with state regulation and having adequate legal advice along the way.
If you are a healthcare provider or practice manager and have questions about telehealth and would like to speak to one of our medical law lawyers in relation to the current permitted telehealth activities, please contact us today +61 3 9822 8588 or email our team here who can also assist you.
