As we ease into our ‘new normal’ and learn to manage our practice through COVID-19, we have had to manage the risks of face-to-face consultations for doctors, patients, and practices.
According to Avant's recent survey of members, more than 85 percent of doctors said they are interested in continuing to provide care via telehealth. It is important to consider how the support team can continue to administer the doctors’ practice under the telehealth umbrella.
When can care be provided by telehealth?
The Medical Board of Australia Guidelines for technology-based consultations outline the steps and standards of care expected in providing care via telehealth. It is important that practices offering telehealth are familiar with these guidelines. Importantly, the doctor needs to be satisfied it is safe and clinically appropriate to conduct the consultation via technology.
While there will always be a question of clinical judgement for the doctor, practices are finding it helpful to develop a policy on when they will offer telehealth consultations, which they can review and modify as circumstances change. This helps administrative staff advise patients, manage their expectations and ask the right questions to triage bookings appropriately.
For example, when Avant surveyed members, some commented they were finding telehealth useful to be able to follow up on consultations, results, prescriptions and referrals when required. Others find telehealth valuable for monitoring patients with chronic conditions, reviewing medications or discussing management plans, particularly for vulnerable or remote patients.
However, respondents also noted that telehealth could not work for all types of consultations, and it was crucial to have the option to bring patients into the clinic for a face-to-face consultation and examination. The Department of Health has confirmed doctors using telehealth item numbers must also be able to make arrangements for patients to have face-to-face consutation, if the patient requires a physical examination that cannot reliably be conducted remotely.
When you are developing your practice policy, broad factors to consider will be:
The COVID-19 situation in your region
One key factor to consider will be whether your area is identified as COVID-19 affected, or your patients are subject to restrictions because of state or territory public health orders. The COVID-19 situation continues to fluctuate, so your policy may change according to the local situation at any given time.
The patient's current situation
The Medical Board guidelines make it clear that doctors are expected to be satisfied it is safe and clinically appropriate to conduct the consultation via technology. Factors to consider are whether:
- the patient requires a physical examination that cannot reliably be conducted remotely
- the doctor knows the patient and can access their medical records
- the patient is able to manage the technology and can communicate effectively with the doctor
- the doctor can obtain sufficient information from the patient (or someone assisting them) to make a diagnosis and provide treatment
- the doctor can be satisfied the proposed treatment is not contra-indicated.
When was the patient last seen?
Generally, doctors working in general practice can only bill telehealth consultations under Medicare if they have an existing relationship with the patient. However, there are some exceptions for people experiencing homelessness or living in a COVID-19 affected area.
Doctors can still provide telehealth services to patients who have not been seen by the doctor or at the practice in the last 12 months, but this must be privately billed and no Medicare item number applied. How well the patient is known to the practice is also likely to affect your ability to identify the patient and for the doctor to assess whether telehealth is appropriate.
The temporary COVID-19 MBS item numbers allow services to be provided by videoconference, or telephone if video is unavailable. If videoconferencing is unavailable, this may also affect the doctor’s decision about whether they feel they have been able to obtain sufficient information about the patient’s condition and whether it is safe to provide care via telehealth.
Telehealth and issues related to COVID-19: COVID-19 resources page
Guidance on when you can offer a telehealth consultation: On the line: seven tips for consulting via telehealth.