Telehealth rebate a gift to unscrupulous operators

RACGP concerns

Dr Sue Page, a telehealth consultant with the RACGP, expressed concerns that low-cost options could impact on a doctor’s ability to properly diagnose or treat a patient by videoconference.

“If the image is tiny and grainy, it may impact on your ability to make a sound medical judgement, and therefore you may be exposing your patient to risk,” she said.

“You are obviously compromising care if there is some aspect about that patient’s care that requires a good visual feed or a good audio feed and the technology can’t deliver that.”

Dr Nathan Pinskier, a member of RACGP’s e-health working group and former clinical lead with NEHTA, said the national body for medical professionals was concerned about the lack of technical specifications.

He advised Australia’s medical professionals to “proceed cautiously” and not be tempted to “rush in to telehealth with a low-bandwidth solution”.

The college has looked to tie some limited technical considerations into the clinical standards it is preparing, but Pinskier said the college “doesn’t own the technical space” and instead hoped the Government would work with the college and the technology community to solve the problem.

“There is a real risk,” he said. “If you create a model where the trigger event for funding is the first call, there is temptation for some providers to jump in, get a $35 high definition camera and go. It may work fine the first time, but maybe not the second time.

“If services like Skype are proven to not be secure, given that data is transmitted on a peer-to-peer network, someone’s clinically sensitive data could wind up in someone else’s domain, and this could undermine the Government’s telehealth initiative.

“If people lose confidence in the process, it will die. The Government will have funded a white elephant.”

Dr Pinskier said some of the key technical requirements to consider included adequate levels of bandwidth, technical support, failover and redundancy and ultimately – security and privacy.

The challenge would also be to create a state of interconnectivity between various teleconferencing technologies.

“We don’t want to end up a world where specialist and a GP need ten different technology solutions to communicate,” he said. “That’s the risk we currently face.”

The problem had already arisen, with some hospitals refusing to allow open access to their existing videoconferencing solutions - which often used proprietary systems - to outside doctors and specialists.

Doctors would also need to accept the added responsibility of properly identifying a patient in consultation - usually undertaken by a receptionist - as per existing standards for accreditation.

Cautious by nature

Dr Page said it was unlikely that medical professionals would adopt any system “gung-ho” without waiting for some protections around clinical safety.

A similar scheme to encourage telehealth adoption by psychiatrists had been met with caution since their consultations become eligible for MBS rebates in 2002.

Public figures indicated that only 100 sessions have been held per month by the specialists. Some $1.7 million was paid by Medicare items to those participating between 2005 and 2007 for a total of 1,613 online consultations, or an average of $1,000 per consultation.

Dr Glenie feels that the $6000 start-up grant was unnecessary.

“Why they dreamed up that sum of money I can’t say. It might work for a group of 12 doctors in a large surgery, a $600 payment would have been enough for an iPad 2.”

“The Government wants to see things happening, that’s why they have not prescribed how to do it.”