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Expansion of MBS telehealth items and uptake

Expansion of MBS telehealth items and uptake

What changed?

  • The COVID-19 pandemic led to an unprecedented uptake in telehealth across the whole healthcare system in Australia. This was largely facilitated by the rapid expansion of broad-scale Medicare Benefits Schedule (MBS) items, covering General Practitioner (GP), specialist and allied health consultations.
  • Most GP practices offered consultations via telehealth. However, of the telehealth consultations conducted by both GPs and specialists, the vast majority were carried out via telephone, rather than videoconferencing, despite Department of Health recommendation that videoconference services are the preferred substitute for face-to-face consultations.1,2
  • Telehealth has enabled health care workers in both clinical and non-clinical roles to work remotely during the pandemic, thereby minimising infection risk to both patients and clinicians.

Impact of change

  • The expansion of the telehealth MBS item numbers has supported continuity of cancer care throughout the pandemic and enabled telehealth to be utilised across the whole Australian healthcare system.3
  • Telehealth offers benefits regarding choice, convenience and safety for both the patient and clinician,4,5 and potentially reduces rural-urban disparity in cancer care.6
    • Use of telehealth contributes to the reduced exposure to SARS-CoV-2 for healthcare providers and patients, and particularly immunocompromised patients. 
    • Telehealth reduces barriers in access to quality of care for patients who are unable to physically attend appointments due to health concerns (such as cancer-related morbidities) or distance (such as people living in rural and remote areas accessing specialist care).4
    • Telehealth enables patients to interact with multiple health professionals (such as primary care providers, specialists, nurses, allied health professionals and carers) simultaneously in any consultation.
  • Patients and clinicians reported administrative, coordination, software and network issues, particularly in relation to the uptake of video consultations,7 and challenges in using telehealth for some aspects of care, including:
    • when receiving or delivering a cancer diagnosis
    • communication about changes to care
    • lack of privacy for patients in their home when discussing personal matters
    • inability for some aspects of clinical care to be delivered remotely (such as physical examinations).7

These challenges may have been heightened in cases where the patient and health professional did not have a pre-existing relationship.7

How can high-value changes be embedded or enhanced?

The following strategies were identified in Australian and international literature and by leading Australian cancer experts and consumers. This list is provided to prompt considerations and future strategies to support high-value cancer care in the Recovery phases of the COVID-19 pandemic. 
These strategies are listed at the system-, service-, practitioner-, and patient-levels and are intended to be used by a range of cancer control stakeholders across Australia to support high-value cancer care and improve outcomes for people with cancer. 

System-level strategies

  • Considering the revision, retention and refinement of the new MBS telehealth items to become part of ‘business as usual’8 and to strengthen the role of telehealth in routine service delivery.9
  • Developing system-wide mechanisms, and standards to facilitate transfer of information normally conveyed during face-to-face consultations, such as prescriptions, investigation requests, and written information.
  • Developing clear governance, policies and procedures to guide safety and quality in cancer telehealth consultations and clarify the  ethical, clinical and legal responsibilities of clinicians, technology providers and healthcare organisations.10
  • Evaluating satisfaction among telehealth providers to improve the quality of the delivery of care through telehealth and inform the development of policies, governance and funding models.11

Service-level strategies

  • Strategically investing in sustainable information technology infrastructure,7, 11,  and technical and administrative personnel to support the safe and efficient delivery of cancer care via telehealth, preferably by videoconferencing, including the prioritisation of data security and patient privacy, record-keeping, and transfer of information (prescriptions, investigation requests, patient information leaflets, etc.12
  • Developing standards (or expanding existing standards) for the use of telehealth.8 
  • Developing and/or distributing guidance for health professionals on the appropriate and effective use of telehealth for cancer care, including the Department of Health COVID-19 Telehealth Items Guide.2

Practitioner-level strategies

  • Improving health professional digital literacy, capabilities, and acceptability of the use of telehealth services through educational and training programs.13,14
  • Improving health professional capabilities in providing culturally safe telehealth consultations for Aboriginal and Torres Strait Islander people and people from culturally and linguistically diverse backgrounds. Health professionals should seek support from a culturally-trained health worker, or interpreter if required, to improve cultural safety and communication with patients during telehealth consults.7
  • Increasing effectiveness of patient-clinician communication through training programs and the development of standardised procedures for telehealth appointments and contingency plans (such as appointment delays; actions required if the connection drops out during a consultation).7 

Patient-level strategies

  • Understanding patient experience of receiving care through telehealth to inform better quality care. 
  • Incorporating the collection of patient-reported outcomes into telehealth service delivery models to identify areas of need for patients.11 
  • Improving patient digital and health literacy.
  • Improving patient access to telehealth solutions including providing access to telehealth coordinators, providing devices to patients, and facilitating health consultations in safe and accessible locations such as in local hospitals and outpatient clinics, Aboriginal Medical Services, community centres, general practice clinics and libraries (with or without a clinician present).7,13,14
  • Facilitating access and technical support to utilise telehealth, including for Aboriginal and Torres Strait Islander people and people from culturally and linguistically diverse backgrounds, people with diverse needs and people with disabilities (including people with vision or hearing impairment5).8,9

 

References

[1] MBS Online. COVID-19 Temporary MBS Telehealth Services. Accessed: June 2020; http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB

[2] Department of Health. COVID-19 Telehealth Items Guide. Department of Health, Canberra, ACT, 2020.

[3] Royce TJ, Sanoff HK, Rewari A. Telemedicine for Cancer Care in the Time of COVID-19. JAMA Oncol. 2020. doi:10.1001/jamaoncol.2020.2684.

[4] Fisk, M., Livingstone, A., Pit, SW (2020). Telehealth in the context of COVID-19: Changing perspectives in Australia, the United Kingdom and the United States. J Med Internet Res. doi: 10.2196/19264

[5] Burbury K, Wong ZW, Yip D et al. Telehealth in Cancer Care- during and beyond the COVID-19 pandemic. J Int Med. Forthcoming 2020.

[6] Heifetz LJ, Koppel AB, Kaime EM, et al. Addressing rural disparities in cancer care via telehealth. J Clin Oncol. 2020; 38:15 doi:10.1200/JCO.2020.38.15_suppl.e19090

[7] National cancer expert or consumer participant, Cancer Australia COVID-19 Recovery and cancer roundtable. Meeting minutes unpublished. 30 June 2020.

[8] Duckett S. Coming out of COVID-19 lockdown: The next steps for Australian health care. Grattan Institute, Victoria, 2020.

[9] Wong ZW, Cross HL. Telehealth in cancer during COVID-19 pandemic. Med J Aust. 2020. https://www.mja.com.au/journal/2020/telehealth-cancer-during-covid-19-pandemic

[10] Mathur J, Zammit G, Phelps G. Telehealth: call for formal clinical governance framework. Accessed August 2020; https://insightplus.mja.com.au/2020/34/telehealth-call-for-formal-clinical-governance-framework

[11] Slavova-Azmanova N, Millar L, Ives A, Codde J, Saunders C. Moving towards value-based, patient-centred telehealth to support cancer care. Deeble Institute for Health Policy Research, Deakin, ACT, 2020.

[12] Wosik J, Fudim M, Cameron B et al. Telehealth Transformation: COVID-19 and the rise of Virtual Care. J Am Med Inform Assn. doi: 10.1093/jamia/ocaa067.

[13] Smith AC, Thomas E, Snoswell CL et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. doi: 10.1177/1357633X20916567

[14] Chan A, Ashbury F, Fitch MI et al. Cancer survivorship care during COVID-19 – perspectives and recommendations from the MASCC survivorship study group. Support Care Cancer. 2020:1-4. doi: 10.1007/s00520-020-05544-4