Uptake of telehealth services funded by Medicare in Australia
Victoria Wade A D , Jeffrey Soar B and Len Gray CA Discipline of General Practice, The University of Adelaide, L11, 178 North Terrace, Adelaide, SA 5005, Australia.
B School of Management and Enterprise, University of Southern Queensland, West Street, Toowoomba, Qld 4350, Australia. Email: Jeffrey.Soar@usq.edu.au
C Centre for Research in Geriatric Medicine, University of Queensland, L2 Building 33, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: len.gray@uq.edu.au
D Corresponding author. Email: victoria.wade@adelaide.edu.au
Australian Health Review 38(5) 528-532 https://doi.org/10.1071/AH14090
Submitted: 7 June 2014 Accepted: 31 July 2014 Published: 15 September 2014
Abstract
Objective The aim of this study is to identify the extent to which the Medicare item numbers and incentives, introduced in July 2011, have been effective in stimulating telehealth activity in Australia.
Methods A retrospective descriptive study utilising data on the uptake of telehealth item numbers and associated in-person services, from July 2011 to April 2014, were obtained from Medicare Australia. The main outcome measures were number of telehealth services over time, plus uptake proportionate to in-person services, by jurisdiction, by speciality, and by patient gender.
Results Specialist consultations delivered by video communication and rebated by Medicare rose to 6000 per month, which is 0.24% of the total number of specialist consultations. The highest proportional uptake was in geriatrics and psychiatry. In 52% per cent of video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. There were substantial jurisdictional differences. A significantly lower percentage of female patients were rebated for item 99, which is primarily used by surgeons.
Conclusions Medicare rebates and incentives, which are generous by world standards, have resulted in specialist video consultations being provided to underserved areas, although gaps still remain that need new models of care to be developed.
What is known about the topic? Video consultations have been rebated by Medicare since July 2011 as a means of increasing access to specialist care in rural areas, aged care facilities and Aboriginal health services.
What does this paper add? The uptake of this telehealth initiative has grown over time, but still remains low. For half the video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. Geriatrics and psychiatry are the specialties with the highest proportional uptake.
What are the implications for practitioners? New models of care with a greater focus on consultation-liaison with primary care providers need to be developed to realise the potential of this initiative and to fill continuing gaps in services.
References
[1] Australian Institute of Health and Welfare (AIHW). Medical workforce 2012. Canberra: AIHW; 2014.[2] Gray LC, Edirippulige S, Smith AC, Beattie E, Theodoros D, Russell T, Martin-Khan M. Telehealth for nursing homes: the utilization of specialist services for residential care. J Telemed Telecare 2012; 18 142–6.
| Telehealth for nursing homes: the utilization of specialist services for residential care.Crossref | GoogleScholarGoogle Scholar | 22362837PubMed |
[3] Online MBS. Specialist video consultations under Medicare. Canberra: Department of Health, Australian Government; 2014. Available at http://www.mbsonline.gov.au/telehealth [verified 28 March 2014].
[4] Department of Health and Ageing. Program guidelines: financial incentives for telehealth. Canberra: Department of Health and Ageing; 2013.
[5] LeRouge C, Garfield MM. Crossing the telemedicine chasm: have the U.S. barriers to widespread adoption of telemedicine been significantly reduced? Int J Environ Res Public Health 2013; 10 6472–84.
| Crossing the telemedicine chasm: have the U.S. barriers to widespread adoption of telemedicine been significantly reduced?Crossref | GoogleScholarGoogle Scholar | 24287864PubMed |
[6] Smith AC, Armfield NR, Croll J, Gray LC. A review of Medicare expenditure in Australia for psychiatric consultations delivered in person and via videoconference. J Telemed Telecare 2012; 18 169–71.
| A review of Medicare expenditure in Australia for psychiatric consultations delivered in person and via videoconference.Crossref | GoogleScholarGoogle Scholar | 22362827PubMed |
[7] Australian Government Department of Human Services. Medicare item reports. Canberra: Australian Government; 2014. Available from: http://www.medicareaustralia.gov.au/statistics/mbs_item.shtml [verified 18 February 2014].
[8] Lowry R. The significance of the difference between two independent proportions. 2001. Available from: http://vassarstats.net/propdiff_ind.html [verified 26 February 2014].
[9] Australian Institute of Family Studies. Families in regional, rural and remote Australia. Canberra: Australian Government; 2011. Available from: http://www.aifs.gov.au/institute/pubs/factssheets/2011/fs201103.html [verified 28 March 2014].
[10] Kennedy C, Gray R, McCowan I, Sarquis C, Stenhouse S, Scott A. Establishment of a sustainable telehealth service for pre-admission clinic consultations. Brisbane: Queensland Health, Queensland Government; 2010. Available from: http://www.health.qld.gov.au/telehealth/docs/article_preadmis_pres.pdf [verified 28 March 2014].
[11] Tideman PA, Tirimacco R, Senior DP, Setchell JJ, Huynh LT, Tavella R, Aylward PE, Chew DP. Impact of a regionalised clinical cardiac support network on mortality among rural patients with myocardial infarction. Med J Aust 2014; 200 157–60.
| Impact of a regionalised clinical cardiac support network on mortality among rural patients with myocardial infarction.Crossref | GoogleScholarGoogle Scholar | 24528431PubMed |
[12] Wade VA. Telehealth and equitable access to health care. Med J Aust 2013; 198 594–5.
| Telehealth and equitable access to health care.Crossref | GoogleScholarGoogle Scholar | 23919697PubMed |
