Telehealth: sustaining video conferencing in “COVID-19-normal”

THE COVID-19 pandemic has had an impact on various societal levels but has also led to concerns about the quality and safety of patient care being delivered. Further, it has led to decreased access and use of health care services, particularly primary care services.

To address the decreasing in-person consultations and improve safety for health care practitioners and patients, telehealth — an approach to delivering health care at a distance — emerged as a remarkably important and valuable tool. Telehealth allowed for timely access to care and supported efforts to prevent the transmission of SARS-CoV-2 by reducing in-person contacts at health clinics.

Telehealth is not new for Australian health care, it has existed for decades. However, uptake before the COVID-19 pandemic was generally low due to limited funding support. Medicare Benefits Schedule (MBS) items for telehealth were previously available only to specialists providing care to patients in rural areas. GP telehealth consultations were not eligible for Medicare and, therefore, were not eligible to receive any payment

With the advent of COVID-19, the situation has changed. In response to restriction of movement during the pandemic, the Australian Government announced changes to MBS items to support the use of telehealth-based care. Temporary Medicare items for telehealth consultations, for both audio and video, were introduced so they can be used by allied health, GPs, nurse practitioners, and other specialists. As a result, between 13 March 2020 and 6 May 2021, more than 83 800 providers used telehealth services, and 57.5 million COVID-19 MBS telehealth services were delivered to 13.7 million patients, with $2.9 billion in Medicare benefits paid. As per a survey by the Royal Australian College of General Practitioners of 1782 GP Fellows, compared with the same period in 2019, there was a dramatic increase in the number of telehealth services in 2020 and 2021. For example, 97% of the GP respondents provided telehealth care compared with just 15% before the COVID-19 pandemic. Also, in the same survey, 67% of GPs reported a positive attitude towards the use of telehealth, with 89% of them citing “The MBS items now support me to use telehealth” as the most common reason behind the positive attitude towards telehealth.

Not only did providers show a positive attitude, but patients also embraced the virtual modality of care. A survey by software comparison company, Capterra, reveals that 79% of patient respondents said they would continue using telehealth after the COVID-19 pandemic for various reasons, including not having to travel and pay for travel costs and taking time off work. In addition, a majority (72%) said telehealth was able to solve their medical problems; 27% and 23% of respondents revealed there was less waiting time before their appointment and less waiting time overall compared with visiting the medical facility, respectively.

Since their inception, telehealth MBS items have has gone through numerous changes ranging from no bulk-billing requirements to extension until 31 March 2021, with the Australian Government finally extending the subsidies until 31 December 2021. Yet telehealth is now clearly popular with patients and providers. Will telehealth survive post-pandemic?

Undeniably, telehealth cannot replace the in-person model of care, but it can complement it. Given the fact we are not out of the COVID-19 pandemic yet, and don’t know when it will be over and when the next pandemic will hit, it is vital that we do not let telehealth-based care die out. Rather, we must take this opportunity to redesign health care delivery and optimise the role telehealth will play in health care delivery in the future.

Telehealth may have a promising future in Australia considering the Minister of Health announced telehealth will become a permanent part of the Medicare landscape, bringing hope for its sustainability, despite uncertainty around future funding arrangements. Nonetheless, the sustainability will depend on how telehealth is incorporated in Medicare and MBS items.

Inclusion in Medicare is necessary, but on its own insufficient, to sustain telehealth care.

One insight from the COVID-19 pandemic is that most telehealth consultations were delivered through phone calls, even though for policymakers the preference is for video consultations. Video offers advantages over audio consultation as it leads to improved decision making and diagnostic accuracy, fewer medication errors, and reduced readmission rates. In addition, compared with audio consultations, video consultations allow better personal connection and allow for some aspects of physical examination, which is of paramount importance in the management of many conditions.

Going forward, it will be critical to nurture and pay more attention to the development and uptake of video consultations to realise their full potential. MBS policy changes and support from the federal government would be the primary drivers for this change. Currently, audio and video consultations are reimbursed at the same rate in Australia. By contrast, in some states of the US, providers reimbursed telephone consultations at a lower rate than face-to-face or video consultations. These funding arrangements might contribute to the high uptake of video consultations in the US compared with Australia.

However, many GPs have complained that they do not have the hardware and software to enable video-based telehealth services. Therefore, in parallel, support for GP practices to adopt video-conferencing infrastructure should be made available. The Australian Government has funded two web-based video conferencing platforms. One is Attend Anywhere, a web-based video conferencing tool that exists for public hospitals and charities to access at no cost. The second is Healthdirect Video Call under the Healthdirect Video call COVID-19 GP Program that is available to be accessed by GPs free of cost because of the pandemic, until 31 December 2021.

However, it remains unclear what the cost incurred by GP practices would be for using Healthdirect video call after December 2021. The program was initially set up as a pilot program offering a free trial until 30 June 2020, to eligible Primary Health Care Networks with reference to the point: “The cost of running the video call service after the pilot period has finished is yet to be determined by the Department”.

The critical step to promote video consultation uptake would be to fully fund a web-based video-conferencing platform in the long run and incentivise GPs to use such platforms. GPs or practice managers would likely consider a fully funded or subsidised video platform as a cost-saving measure, and incentivisation would be realised as a revenue source, thereby driving the uptake.

In summary, to realise the benefits of telehealth and video consultations in the long term, a national initiative driven by the Australian Government to provide financial incentives and funding for the uptake of video consultations and allow reimbursement of video consultations at a higher rate is required. This will lead to stronger and longer sustainability for the videoconferencing model of care, which would be beneficial in the “COVID-19-normal” period.

Dr Jeetendra Mathur is the Co-founder and Project Manager of Medi-AI. His extensive experience in the health care industry involves working in various medical specialties, including emergency medicine and burns/plastic surgery at large public and corporate hospitals in both India and the Maldives.

Associate Professor Sandeep Reddy is the Director of the MBA (Healthcare Management) program at Deakin University. In addition to a medical degree, he has qualifications in medical informatics, management, and public health. He has managed various health service projects and formulated high level policy in Australia, New Zealand, and Europe.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.