Health increases telehealth bounty for specialists

$216.3 million more up for grabs in incentives and rebates over online consultations

The federal Department of Health and Ageing has poured an additional $216.3 million to fund its telehealth consultations scheme until 2015, with expectations around ten per cent of the nation’s practitioner workforce would take part in the scheme within five years.

The initiative, announced during the 2010 federal election and confirmed in November last year, set aside $402.2 million to provide rebates for regional and remote patients consulting with doctors through videoconferencing or other technological means until the 2013-2014 fiscal year.

Of that funding, $50 million was confirmed at the time to be spent adding videoconferencing capabilities to the after hours GP helpline and providing training to that staff for its use.

According to strategic direction papers released by the department alongside the 2011-2012 federal budget this week, at least $71.9 million of the remaining funding would be used to incentivise practitioners and specialists to take part in the scheme, with $198 million going towards rebates for patients under the Medicare Benefits Scheme.

Under the forward estimates to 2014-2015, an additional $216.3 million would be made available for the scheme during that fiscal year, with $167.7 million expected to be spent on rebates during that period.

A spokesperson for the department confirmed Roxon’s initial announcement in November did not include funding estimates for the 2014-2015 fiscal period, explaining the absence of funding in the announcement.

The papers also revealed set key performance indicators for the scheme, with the department expecting around 2.7 per cent of specialists would offer consultations online under the initiative when it is offered from 1 July this year. This is expected to grow in use, and subsequently in funding, to ten per cent by 2015.

Should the project meet demand, the use of telehealth services for online consultations would increase dramatically from the approximately 100 telepsychiatry sessions currently held per month since a Medicare-based incentive was offered to professionals in 2002.

Some $1.7 million was paid in Medicare items to psychiatrists between 2005 and 2007 for around 1613 online consultations, or an average of $1000 per consultation.

“We have around 26,000 general practitioners in Australia,” telehealth spokesperson for the Royal Australian College of General Practitioners, Dr Sue Page, told Computerworld Australia.

“If each of them just did one item once a year, that’s 26,000 items. If you’ve only got one per cent, that’s 2600 so that’s already more than twice the items we’re having for telepsychiatry at the moment.”

According to departmental papers, the scheme would be available for consultation between patients and general practitioners or specialists in metropolitan areas, but could also be used for consultation between doctors, nurses and health workers in rural and remote areas, potentially increasing its usage further.

Page said the key performance indicators and inherent funding was realistic from the department, but that envisaged use of online consultations had not been fully realised by either the government sector or practitioners themselves.

She said the scheme would likely be most successful when used for consultations between practice nurses at regional and metropolitan hospitals, or for post-operative checkups with regional patients.

However, to encourage success, the system would need to be easily installed and maintained.

“If [GPs] have to think about it too long and they have to plan it too long then it starts to take up too much time, bearing in mind they’re in a workforce shortage area and their mind is always on the main game; the patient in front of them,” Page said.

“An absolute gobsmacking barrier would be if the hospitals insisted on staying with their ISDN line. It’s not cost-effective if you’re having to pay between $40 and $200 an hour for these high-grade medical imaging use over ISDN lines.”

Alternative telehealth technologies and setups have been trialled by state and federal governments, with one key project in the Northern Territory recently receiving its first round of funding from the state budget.

A $5.2 million trial of the technology in Victoria found the 100 megabit per second links installed by Telstra for telehealth ultimately weren’t needed to videoconference between 16 rural hospitals and equivalent ones in Melbourne. These were dialled back to 20Mbps.

However, rural health industry bodies told Computerworld Australia that connectivity remained a gaping hole in the Federal Government’s push for increased use of telehealth services, and would remain a huge barrier to take-up for small GP clinics in areas where they are most required.

Follow James Hutchinson on Twitter: @j_hutch

Follow Computerworld Australia on Twitter: @ComputerworldAU

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