Telehealth

What is telehealth?

From 1 July 2011, Medicare and DVA rebates and financial incentives are available for telehealth. The new telehealth rebates are available for patients in most areas who access a consultant physician and paediatrician (CPP) via a videoconference. The new items are for consultations between a patient and a CPP where the patient is accompanied by a health professional who provides clinical support to the patient or assists where an examination may be required.

What constitutes a telehealth video consultation?

A telehealth video consultation under these arrangements involves a patient (accompanied by a health professional providing clinical support) and a consultant physician, paediatrician or medical specialist participating in a consultation via both an audio and video link.

To bill an MBS item for a specialist video consultation (items 99, 112, 149, 288, 389, 2820, 3015, 6016, 13210, 16399, or 17609) all of the following conditions must be met:

• an associated item that relates to the consultant physician, paediatrician or medical specialist’s service must be billed;
• the service must be rendered in Australia;
• the service must be provided via video conferencing (where both video and audio communication between the patient and specialist occurs);
• the patient must be an eligible patient.

How do the telehealth items work?

As an example, a GP refers a patient to a consultant physician or paediatrician, who decides the consultation may be done by videoconference. When the video consultation occurs, the consultant physician or paediatrician, who is remotely located from the patient, bills the relevant attendance item, e.g. 110, and also bills the associated telehealth item 112.

Note the “derived fee” for item 112 is 50% of the Medicare fee for item 110. That is, item 110 has a Medicare fee of $145.20, so the “derived fee” for item 112 in this case would be $72.60. The “derived fee” is capped to a maximum of $100, so if associated with an item 132 (Medicare fee of $253.90) the “derived fee” would be $100, not 50% of $253.90.

In addition, this service also triggers a telehealth incentive payment and, if it is the first telehealth service billed by the specialist provider, a one-off “on board incentive” payment is also generated. If the service is bulk billed, a bulk bill incentive payment will also be made.

Which health professionals can participate in a telehealth video consultation?

There are telehealth items for consultant physicians, paediatricians and medical specialists as well as items for a range of health professionals who provide “patient end” services (that is, provide clinical support to the patient while the patient is participating in a videoconference consultation with a CPP or specialist – see “Who are patient end practitioners”).

A list of the new telehealth items is available here; a table mapping the new telehealth items to the existing attendance items is available here.

The new telehealth items are “derived items”; that is, the telehealth item is charged in addition to the base item. For example, if a consultant physician or paediatrician undertakes an video consultation for which an item 110 is charged, then an item 112 is also charged in recognition of the additional time and complexity associated with undertaking a consultation via videoconference.

For consultant physicians and paediatricians, the new telehealth item 112 is associated with existing attendance items 110, 116, 119, 132 and 133.

For geriatric medicine items 141 and 143, there is a new telehealth item 149. For medical specialists, new item 99 is associated with specialist attendance items 104 and 105. For consultant occupational physicians, new item 389 is associated with existing attendance items 385 and 386.

How do you participate in telehealth?

There is no need to formally lodge any application for participation in the telehealth initiative as the first use of one of the new telehealth Medicare item numbers identifies to Medicare Australia that a consultant physician or paediatrician is participating in the telehealth arrangements.

What incentives are available for telehealth video consultation?

In addition to the new telehealth items, participation in telehealth video consultations attracts two types of additional incentive payments: an “on board incentive” and a “service incentive”.

“On Board Incentive”

The “On Board Incentive” payment is a one-off, lump sum payment that is available direct to a practitioner when the first telehealth item is registered with Medicare for that practitioner. This payment is highest in the first year to encourage early take up of telehealth.

The “On Board Incentive” payment is $6,000 in the first year of the program, dropping to $3,300 in 2014/15, if your first telehealth service is delivered in that year.

“Telehealth Service Incentive”

There are also “Telehealth Service Incentive” payments that are paid each time an eligible practitioner provides a telehealth service. These payments are ongoing for the four years of the program and will be paid quarterly by Medicare direct to the practitioner. The “specialist rate” applies to consultant physicians, paediatricians and medical specialists who participate in telehealth video consultations. The “patient end” payment is for the health professional who is with the patient at the time of the video consultation with the medical specialist.

The Telehealth Service Incentives are designed to encourage Eligible Practitioners (consultant physicians, paediatricians, medical specialists and patient-end practitioners) to continue to provide telehealth Services.

Medicare Australia automatically accrues telehealth service incentives to a practitioner each time a Medicare benefit is paid for a telehealth MBS Item billed against their provider number (by using bulk billing and patient claims data). Practitioners then receive a single payment each quarter for all telehealth service Incentives they have accrued.

“Bulk Billing Incentive”

There is also an extra “bulk billing incentive” that is available each time a telehealth service is bulk billed. The bulk billing incentive is also automatically accrued to a practitioner each time a Medicare benefit for a telehealth MBS item is bulk billed.

All of the above incentive payments are on a sliding scale over the four years of the program and it is unclear whether any incentive payments will continue beyond 2015. For those interested in participating in telehealth consultations, there is a significant advantage in commencing in 2011/12.

What other incentive payments are available?

For Residential Aged Care Facilities

There is a one-off, lump sum payment available to eligible residential aged care facilities that register with Medicare Australia as having the capacity to host video consultations. The payment is made upon lodgement of the first successful claim for hosting a videoconference consultation. The incentive payments are the same as those available to practitioners, namely:

Residential aged care facilities are also eligible for payment of a “telehealth hosting service incentive”, which is a monthly, ongoing payment based the total number of telehealth consultations by the residential aged care facility over the proceeding month.

More information on the telehealth incentive payments is available here.

Who are “Patient-End Practitioners”?

“Patient-end practitioners” are GPs, other medical practitioners, participating nurse practitioners, participating midwives, Aboriginal health workers and practice nurses to provide face-to-face clinical services to the patient during the specialist video consultation. There are 23 new MBS items be available for “patient-end” services.

Are there specific technology requirements for Telehealth?

While Government has said it has not established clinical standards and is not mandating any particular technological solution for telehealth, it has set down a number of requirements relating to security and privacy in the transmission of video, data and documentation. These are set out on the MBS online website.

The Government also notes that the decision to use, or not to use, telehealth together with the choice of particular hardware or software methods for consultation should rest with the clinician. In making their choices, clinicians should consider any legal (privacy and security), safety and clinical effectiveness implications.

The AACP is currently developing further information that may assist in setting up video equipment that complies with the security and privacy requirements for telehealth. This will follow shortly.

A number of bodies, including the Medical Board of Australia and Standards Australia, have issued recommendations or guidelines concerning telehealth consultations. These can be found on the MBS Online website. Please note that these are not Government requirements.

USEFUL LINKS

The following links to MBS Online provide further details on the telehealth initiative.

Overview for Medical Specialists

Questions & Answers for Medical Specialists

Telehealth Program Guidelines

Telehealth eligible service areas

Clinical Practice and Technology for Telehealth

Guidance on Security and Privacy Issues