Medicare loves a Zoom call under the proposed consolidated, national MBS telehealth program.
The new year will herald changes to telehealth with a permanent, Medicare-funded program, but restricting new patients and longer consultations to video conferencing.
Rural loading for telehealth is also removed along with it the incentive for health providers to target more remote patients.
From 1 January 2022, rheumatologists and other non-GP specialists will no longer receive Medicare payments for telephone calls to new patients. Longer phones calls for more complex consultations are also not eligible for telehealth. Even existing patients will have to use video calls if their consultation is likely to take more than 20 minutes, they have two or more morbidities and require preparation or review of treatment plans.
The exceptions to this rule are psychiatrists who can still have initial consultations with new patients over the phone. This also applies to doctors and nurses providing ante- and post-natal care and First Nations health practitioners. Some other exemptions are allowed including emergency and blood borne disease patients.
Doctors will also have to adhere to a new 30/20 rule for phone consultations. If a doctor has more than 30 telephone consultations in a day, for more than 20 days in a year, they will be referred to the Professional Services Review. This rule also applies to GPs.
A Department of Health spokesperson said “the new 30/20 telephone rule will also be introduced for GPs and consultant physicians to deter consistently high proportions of services provided by telephone only. These rules will help ensure patients continue to receive high quality and comprehensive Medicare services, including when provided by telehealth.”
The push towards video consultations may disproportionately affect rheumatology patients. Although about half of rheumatology patients are keen to continue telehealth post-pandemic, one in five were consistently dissatisfied with their telemedicine experience. Challenges using video technology, access to smartphones or the internet were barriers for these dissenting patients.
The removal of rural loading for health services may also create inequity for remote patients as health service providers will lose the strong financial incentive to engage with rural patients who often have technology barriers yet face days of travel to see a rheumatologist.
According to a Department of Health spokesperson, the 50% loading items introduced in 2011 applying to rural services were initially intended to encourage uptake of video telehealth and adopt new technologies at a time when they were novel and expensive. This is no longer the case and there has been much higher use of the new covid telehealth items by specialists since they were introduced.
Inpatient telehealth services provided during covid lockdowns will no longer be available.
The patient-end support items associated with the 2011 telehealth program will only continue to be available where support is provided by an Aboriginal Health Worker, practice nurse or optometrist.
There will be no changes to the MBS schedule fees for the items that are continuing and rebates for equivalent face-to-face, video and telephone services will be the same.
On Monday, Health Minister Greg Hunt announced a $106 million budget to establish this permanent telehealth program. For more information see Changes to MBS Specialist Telehealth from 1 January 2022.
