The following press release appeared a few days ago.
Telehealth Fees Unveiled
Patients in rural, regional and outer metropolitan areas will benefit from an increase in telehealth services with greater access to Medicare funded medical specialist video consultations available from 1 July this year.
6 June 2011
Patients in rural, regional and outer metropolitan areas will benefit from an increase in telehealth services with greater access to Medicare funded medical specialist video consultations available from 1 July this year.
Minister for Health and Ageing Nicola Roxon said that under the Gillard Government’s $620 million telehealth initiative, patients will be able to ‘see’ their specialist close to home without the time and expense of travelling to major cities.
“Improving access to specialist healthcare close to home is a key priority for the Gillard Government and Medicare funded telehealth services will remove distance and cost as a barrier,” Minister Roxon said.
“Telehealth is going to provide huge benefits to patients in rural, regional and outer metropolitan areas but also to health practitioners who, from July 1, will be able to access increased Medicare rebates for telehealth services.
New Medicare items will allow a range of existing consultation services to be provided via video conferencing and additional rebates on top of these items recognise the increased complexity of providing a service to a remote patient. There will be a 50% additional rebate for the specialist service and a 35% additional rebate for the service provided by the practitioner at the patient end.
“We recognise the time, complexity and administration involved in telehealth services so rebates will now also be available for the health professional located with the patient including GPs, nurse practitioners, midwives, practice nurses and Aboriginal health workers,” Minister Roxon said.
“Ensuring that telehealth services are available around the country is critical to delivering quality healthcare to all Australians so generous financial incentives to encourage all health professionals to incorporate telehealth services into their day to day practice including a $6,000 incentive when a health practitioner provides their first consultation will be provided.
“We encourage bulk billing with extra telehealth bulk billing incentives to be paid at a rate of $20 each time a practitioner bulk bills a service in the first year.”
The new Medicare items have been developed through intensive collaboration with key stakeholders including peak medical colleges and associations.
The rollout of telehealth will benefit greatly from the opportunities provided by the National Broadband Network and is a key part of the National Digital Economy Strategy.
The release and contacts are here:
http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr116.htm
Before commenting in a little more detail it is worth just noting this previous release and the date - Just a decade ago!
Telehealth joins e-health reform agenda
Professor Richard Smallwood, Chair of the National Health Information Management Advisory Council (NHIMAC), announces telehealth's move into the e-health reform agenda.
10 July 2000
Telehealth joins e-health reform agenda
Telehealth has taken a front row seat in health care delivery in the 21st century with today's announcement of its move into the broader e-health reform agenda.
Professor Richard Smallwood, Chair of the National Health Information Management Advisory Council (NHIMAC), said the Australian New Zealand (ANZ) Telehealth Committee (formerly an Australian Health Ministers' Advisory Council sub-committee) would become a sub-committee of NHIMAC - a step which acknowledges the important role telehealth plays.
The ANZ Telehealth Committee will advise Australian Health Ministers on national telehealth policies and strategies that are aligned with sound clinical practice and business objectives, and that link to the broader health reform and health information technology agendas -in particular, the strategic framework Health Online - A Health Information Action Plan for Australia.
"Health care is entering a challenging and exciting new age. A range of innovative and ever changing technologies offer huge potential to improve the delivery and quality of health care, and ensure better results for patients," Professor Smallwood said.
Telehealth involves the use of information and communication technologies to provide health services at a distance. Telehealth will have an important place in the health system of the future where there will be greater co-ordination of care, sharing of electronic records, and enhanced communication between geographically separated service providers.
"The role of telehealth in the delivery of everyday health care is growing. We are using the best that technology can offer to ensure that distance poses less of a barrier to receiving quality health care," he said.
"There is no better way to use the astounding innovations that telehealth offers than to meet the health needs of remote Australians."
A key task for the ANZ Telehealth Committee will be the development of a Telehealth Plan, which will identify strategies for action over the next five years. The Committee will identify issues and opportunities concerning telehealth at the national level; provide advice on a way forward; and focus on key areas requiring further development such as standards, funding and financing options, legal and regulatory issues, and data and evaluation issues.
More here:
Besides the obvious question about “What’s changed in a decade?” I was struck by the amount being expended ($620 Million over 4 years) especially when compared with the planned and uncertain e-Health funding of $477M to end in June 2012 unless renewed at some level.
There was some press reporting of this announcement here:
Govt couples telehealth rebates with $6000 set-up payment
6th Jun 2011
THE Government will soon pay GPs $6000 to set up video-conferencing equipment, and another $40 each time they assist during a patient's telehealth session with a consulting specialist.
The incentive payments will be available from 1 July for practitioners who attend the telehealth consultation at the patient end, when the consultation takes place outside the "inner-metropolitan" centres or in a residential aged care facility or an Aboriginal medical service.
RACGP telehealth standards working group member Dr Nathan Pinskier said while it was encouraging to see telehealth being given priority, there were a number of issues for GPs to consider before "jumping in".
Dr Pinskier said practitioners had to consider how they would fit telehealth into their practice, whether the specialists they worked with would be equipped with the same videoconferencing platform, and how they could ensure the communications were secure enough for clinical information to be shared.
More here:
http://www.medicalobserver.com.au/news/govt-couples-telehealth-rebates-with-6000-setup-payment
and here:
Specialists paid to embrace telehealth
Medicare rebates for telehealth services will begin on 1 July
- AAP (AAP)
- 06 June, 2011 14:48
Medical specialists who provide videolink consultations to patients in remote areas will be paid a 50 per cent bonus in an effort to encourage them to adopt the new technology.
Under Labor's $620 million telehealth initiative both city specialists and any healthcare worker physically with the patient will receive additional Medicare rebates.
Federal health minister Nicola Roxon said GPs, nurses, midwives and Aboriginal health workers who sit with patients during their video consultation will receive their usual Medicare fee plus an extra 35 per cent.
"New Medicare items will allow a range of existing consultation services to be provided via video conferencing and additional rebates on top of these items recognise the increased complexity of providing a service to a remote patient," Roxon said in a statement.
More here:
http://www.computerworld.com.au/article/389118/specialists_paid_embrace_telehealth/
A key question that ran through my mind was to ask where the aggregate business case for this investment resided - accepting that there are definitely examples of various telemedical interventions that do work well - and how the planned scale of investment was arrived at.
The only obvious public information I can find comes from an Access Economics Report.
I discussed this in a blog about this time last year.
http://aushealthit.blogspot.com/2010/08/is-this-credible-study-or-bit-of-spin.html
The bottom line was, as far as I could read they really did not know just what the cost / benefit looked like.
These 4 paragraphs from the exec summary say it all - the last paragraph especially.
“Tele-health offers the potential for significant gains to Australia’s population, especially for people who are elderly or who live in rural or remote communities. Unfortunately, however, despite a myriad of tele-health studies, it is difficult to measure such benefits. Tele-health studies to date have been constrained by poor economic and health data and methods.
Most studies have, however, shown that tele-health is cheaper and faster (and at least equally effective) compared to transporting patients or health care providers over large distances.
Thus, it should be possible to estimate time and money savings at a national level, if not health gains.
- There does not appear to be sufficient data to estimate the benefits of online training for rural / remote medical professionals.
Using a combination of a national level United States (US) study into one aspect of tele-health (tele-consulting) and a national level Australian study that was mostly based on EHRs but had tele-health components, Access Economics estimates that steady state benefits to Australia from wide scale implementation of tele-health may be in the vicinity of $2 billion to $4 billion dollars per annum.”
The report is on-line here for your reading pleasure!
For this level of uncertainty to attract that amount of money really is amazing.
I know there are lots of good things going on in the telehealth / telemedicine space and I am keen to see technology deployed sensibly, but this amount of money runs the risk of attracting some less than ideal projects.
I have to say that in what I have seen there are not any really detailed plans about how each modality of telehealth / telemedicine is to be deployed nationally although I know of a NSW Health Hunter / New England Strategy that certainly provides more detail and can be found on the web.
The following from a 2008 Gartner Presentation is also hardly encouraging however (Page 7) for a strong return on a scattergun approach.
The evidence base for telemedicine is weak
– AHRQ study
· Store-and-forward services: "the evidence for their efficacy is mixed"
· Home monitoring: "required additional resources and dedicated staff"
· VTC: "most effective for verbal interactions"
– JAMIA study
· Effects on patients' conditions: inconclusive
· Patient compliance is high
· Effect on resource utilization is mixed
· Minimal evidence of economic benefit
The conclusions on Page 22 also seem pretty sound to me!
Recommendations
- Treat telemedicine as a business opportunity and assess the business viability of each telemedicine application:
- Telemedicine isn't just a clinical opportunity, it's a business growth opportunity
- Nominate a business lead for telemedicine services and ensure that person has the backing of clinicians
- Ensure that your telemedicine projects include a business case to ensure long-term funding
- Understand that telemedicine isn't just throwing technology at an existing process. You need to understand the different roles and relationships that it requires — different salary structures, training, workflows.
- Create a road map for telemedicine applications that assesses them according to their adoption potential, impact and time to value.
The whole presentation is found here:
http://www.gartner.com/it/content/578100/578114/vh_hc_feb.pdf
For all this money I just hope we have some careful and thorough evaluation, against reasonable criteria, done regularly as the money is spent. I leave it as an exercise for the reader to assess just how likely that is to happen!
I won't even bother mentioning we are years away from ubiquitous NBN deployment so the time frames have also to seem a bit stretched - unless the NBN is not actually needed.
David.
