10-year primary care plan puts a lie to universal telehealth claims

Yes, we know we have been banging on about this for ages but this week has revealed in living colour just how ridiculous outgoing health minister Greg Hunt’s commitment to telehealth is. Despite masses of spin to the contrary, the Australian government has no intention of instituting universal permanent telehealth, and nor has it gone to Herculean efforts to institute it, as the Medical Software Industry Association ridiculously likes to tout.

The surreptitious release of the grandly titled Primary Health Care 10-year Plan – allegedly published on March 25, four days before the budget but somehow evading everyone’s notice – suggests that there are quite a lot of elements to the plan that the Department of Health wants to hide.

One of them is surely the further restrictions it is putting on MBS-funded telehealth. While Mr Hunt spouts universal permanent telehealth as one of his great legacies – not only that, but apparently one of the biggest reforms to Medicare since it was enacted – repeated policy changes and restrictions show this is simply not so.

Everybody welcomed the MBS items for telehealth when COVID hit and it certainly was an achievement to get the DoH to institute new item numbers, but since then it has been a policy schmozzle. The technology has been out there for yonks but GPs had no idea how to use it – or more importantly, bill for it – and thus resorted to telephone. They were then spooked by what they thought were dodgy online telehealth services and were worried that their regular patients might go elsewhere and get substandard care.

Substandard care is certainly true of some services that diagnose by chatbot, prescribe unsafely and aren’t set up to let the patient’s regular GP have any idea of what was going on, but most telehealth services are staffed by fellows of the RACGP or ACEM and are perfectly capable of providing good care by video.

That didn’t stop the pressure being exerted on what the doctor lobby groups called “pop-up” telehealth companies – most of which had been in business for quite a few years on a paying basis and were nothing of the sort – and demanding restrictions.

The department gave in, bringing in new rules in favour of continuity of care by limiting MBS-funded telehealth to patients who have seen a GP, or a GP from the same practice, in the past 12 months. There were exceptions – homeless people, babies under 12 months, people in COVID hotspots – but it was pretty clear that the department was wilting under pressure from the RACGP and the AMA to ensure pop-up telehealth firms weren’t harvesting the low-hanging fruit.

We were then told that “universal permanent telehealth” had been ushered in, but just how much the DoH folded like a wet suit in the face of this pressure is writ large in the primary health care 10-year plan, which doesn’t just restrict MBS-funded telehealth to a practice the patient has attended in the previous 12 months, but to a practice in which the patient has “voluntarily enrolled”.

Patients will have to attend a specific practice several times over a certain period to qualify, and according to the plan, they will need to preserve their registration by visiting again in a certain timeframe.

This is just nonsense. Medicare is Australia’s public health insurance scheme and was set up to ensure that money was no barrier to accessing healthcare. It seems that despite all of the government’s claims to “Guaranteeing Medicare”, it has a policy that will guarantee nothing of the sort. The RACGP, which supports these moves, should be ashamed.

These restrictions only apply to telehealth at the moment, but there’s scope for them to be extended to a whole host of Medicare-funded services like chronic disease management plans and team care arrangements. Should you be eligible for publicly funded screening services like breast, cervical or bowel cancer screening unless you are registered with one practice? What about heart health checks or free vaccinations? There is no thought given to people moving house, state or country, to people unable to attend a practice, to people who need care right now. Hello emergency departments! Medicare was set up to ensure equitable access to care. The 10-year plan for primary care guarantees nothing of the sort.

There was a lot of attention paid in the lead up to last fortnight’s budget, but it swiftly lost attention, it seems. We asked in our poll question last week whether it was a useful budget for healthcare and health IT. We got a desultory response, we must say. Just a handful of respondents said yes: 88 per cent said no.

We also asked that if you thought yes, what measures did you support? If no, what would you have liked to have seen? Here’s what you said.

Is the Department of Health’s voluntary patient registration scheme the end of publicly funded telehealth?

Vote here or leave your comments below.