Telehealth

Telehealth is known as the transmission of health information and images via a range of telecommunication technologies. MBS rebates for telehealth video consultations commenced in July 2011. Video consultations are an alternative to face-to-face consultations and may be of particular benefit for patients and practitioners located in rural and remote telehealth eligible areas.

Medicare now provides incentives and rebates for medical practitioners to engage with patients via video consultations in specific circumstances. Patients must be located in rural and remote areas, or in eligible aged care facilities or Aboriginal medical services throughout Australia. Rebates are also available for clinical services provided by a health professional who is present with the patient during the video consultation.

Practices may investigate the opportunity to utilise telehealth technology in certain situations outside of those circumstances covered by the MBS rebates. In these circumstances, practices are not bound by the guidelines defined by Medicare but will be required to meet ethical and professional standards. If practices are going to utilise telehealth they should ensure that they adopt appropriate protocols to ensure that they will be covered by their medical and practice insurance.

Medicare rebates are available for video consultations where a patient consults with a specialist in specific circumstances and if clinically appropriate. There must be both a video and an audio link.

A specialist must be satisfied that it is clinically appropriate to provide a video consultation to a patient. Advice from the referring practitioner may assist in this decision and the referring practitioner and specialist should be satisfied that adequate care can be given in the absence of an examination being performed by a specialist. This will need to be determined on a patient-by-patient basis as well as a specialist-by-specialist basis.

Medicare rebates for specialist consultations are available across the full range of medical specialties. There may be a general practitioner, midwife, nurse practitioner, Aboriginal health worker or practice nurse providing services on behalf of a general practitioner, present to provide “patient-end” services. The practitioner at the patient end, if any, may conduct parts of the examination under direction from the specialist.

General practitioners providing the patient-end services are ordinarily entitled to a Medicare rebate. However, general practitioners who provide direct telehealth consultations with patients cannot claim the Medicare rebate but can charge privately.

All users and practitioners should keep full notes of their consults with patients as though the patient was sitting in the room with them. Practitioners at the patient-end must keep records of the consultations that specifically document:

1. that the service was performed by video conference

2. the time taken to conduct the consultation

3. the people who participated in the consultation.

Avant’s Practitioner Indemnity Insurance Policy provides cover for claims made against a practitioner by a patient or a patient’s family in relation to the practitioner providing telehealth. Telehealth is defined in the policy as “Healthcare or Unpaid Healthcare to, or in respect of a patient who is not in the same place, that uses any form of technology, to enable it to be provided, including video-conferencing, internet and telephone”. This cover excludes claims that arise as a result of telehealth provided to, or in respect of, a patient outside Australia or claims that involve proceedings brought overseas. Cover is otherwise subject to the terms, conditions and exclusions of the policy.

There are many other issues to be aware of when undertaking telehealth consultations, including follow-up of patients, technology issues, security and privacy of information, consent and communication.