Telehealth move is ‘more MBS cost cutting’

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Culling MBS items for initial videoconsults for non-GP specialists will worsen access, especially in the bush, and cost more longer term, the AMA says.

While the AMA supports telehealth MBS changes that may quash the ability of businesses to exploit exemptions to the prior-relationship rule – here’s looking at you, tele-only Ozempic prescribers – it strongly opposes moves that may jeopardise access.

Yesterday, the AMA released its submission to the MBS Review Advisory Committee’s telehealth post-implementation review, which was commissioned by the DoHAC last November.

The review, which closed to submissions yesterday, expanded on an initial review of 10 guiding principles for telehealth – which the AMA had declined on principle to make a submission on – to include 10 further recommendations.

Among the recommendations was the removal of MBS items for initial videoconference consultations for non-GP specialists.

“The MRAC has not provided any real justification for this proposal, which will limit patient access and fundamentally contradicts the first ‘principle’ of MBS telehealth items being ‘patient-focused’,” the submission reads.

“For a number of specialties, an initial telehealth consultation can provide an opportunity to arrange necessary diagnostic tests – providing the basis for a much more informed subsequent consultation – often proceeding on a face-to-face basis.”

According to the AMA, by referring the patient to a non-GP specialist, the GP is sharing the continuity of care by integrating the non-GP specialist into the care team.

While the association acknowledged the restrictions on movement that spurred the creation of telehealth items during the pandemic may be no longer in place, obstacles to access remain rife, especially for rural and remote patients.

“The AMA has heard of specific concerns regarding the impact this recommendation would have on access to psychiatrists and developmental paediatricians for people living outside metropolitan centres,” the group says.

The association says it fears that the recommendation is “driven purely by a desire to introduce cost restraints on the MBS … This is not only bad policy for the health of Australians, it is bad economic policy as limiting access will only lead to people presenting in worse health in other parts of the system.”

While it is not a substitute for face-to-face care, the submission says further embedding telehealth across the public and private sectors may save the health system around $14 billion a year, according to their research.

The AMA is “disappointed” that the review didn’t identify which patients are most disadvantaged by the current system and how to improve this inequity.

It also hopes for further exploration of how asynchronous telehealth may be “positively integrated” into healthcare, especially for management of chronic conditions, and potentially funded through MyMedicare.

The group reiterates that the 10 principles outlined by the MRAC to govern telehealth were “sound” but served no long-term function and were unnecessary seeing as all MBS billing should be governed by similar principles.

However, the AMA largely supports eight out of the 10 recommendations, including reintroducing the ability to use phone services for patients receiving continuing care.

“This is in line with the AMA’s longstanding position that telehealth should ideally be provided by a practitioner with a long-standing relationship with the patient, as outlined in the 10 Minimum Standards for Telemedicine,” the submission says.

A longstanding objection of the AMA has been condition-specific items which have never been subject to the established-relationship rule, such as nicotine cessation MBS items.

“These items have only served to create an industry entirely based around prescribing vaping products, which we expect will continue beyond the cessation of these items as privately billed consults.”

The AMA strongly opposed the creation of nicotine cessation MBS items from the get-go and suggests a “proactive communication campaign to ensure that people understand that they will need to either have a telehealth consult with their usual GP or see a GP face-to-face to be eligible for an MBS rebate” for a vape prescription.

The group also supports making GP-provided bloodborne virus and sexual and reproductive (BBVSR) telehealth services, as well as eligibility exemptions for mental health treatment items, permanent MBS fixtures and doing away with exemptions for non-directive pregnancy counselling services.

Additionally, it supported extending requirements for a prior relationship with the patients to nurse practitioner and midwifery MBS telehealth items.

“There are specific examples in the weight loss industry where, for example, nurse practitioners have adopted telehealth-only models of care that extend to the prescribing of medications including Ozempic,” the group said.

“The AMA does not support these types of telehealth models which fragment care and undermine continuous, whole-person care, regardless of prescriber.”

It also supported better remuneration for admin associated with complex patients, potentially through MyMedicare.

The final recommendation, which the AMA strongly supports, was the reintroduction of MBS items for GP patient-end support, and the extension of this item to include nurses and allied health professionals.

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