Medicare-reimbursed psychiatric consultations before and after telehealth expansion in Australia: a time series study

Luke Sy-Cherng Woon; Paul A. Maguire; Rebecca E. Reay; Murthy Mittinty; Tarun Bastiampillai; Jeffrey C. L. Looi

doi:10.1071/AH24196

RESEARCH ARTICLE (Open Access)

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Medicare-reimbursed psychiatric consultations before and after telehealth expansion in Australia: a time series study

Luke Sy-Cherng Woon

^A ^B ^* , Paul A. Maguire ^A ^C , Rebecca E. Reay ^A , Murthy Mittinty ^D , Tarun Bastiampillai ^C ^D and Jeffrey C. L. Looi

^A ^C

+ Author Affiliations

- Author Affiliations

^A Academic Unit of Psychiatry & Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra, ACT, Australia.

^B Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia.

^C Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia.

^D College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.

^* Correspondence to: luke.woon@anu.edu.au

Australian Health Review 48(6) 617-625 https://doi.org/10.1071/AH24196

Submitted: 19 July 2024 Accepted: 1 October 2024 Published: 22 October 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objective

Telepsychiatry consultations grew rapidly with increased total consultations and reduced face-to-face consultations following the pandemic-triggered expansion of Medicare Benefits Schedule (MBS) telehealth items. It was unclear how much telehealth expansion independently impacted overall and face-to-face consultation trends after accounting for lockdown severity.

Methods

We extracted monthly MBS Item Reports for psychiatric consultations (January 2012–December 2023). The monthly average Stringency Index (SI) for Australia represented lockdown severity from January 2020 to December 2022. A dichotomous variable denoted telehealth expansion (March 2020 onward). We constructed consecutive multiple linear regression models for combined consultations and face-to-face consultations to include seasonality, trend, SI, and telehealth expansion. We compared model performance using information criteria.

Results

Median monthly total consultations increased from 148,413 (Interquartile range, IQR: 138,219–153,709) pre-expansion (January 2012–February 2020) to 173,016 (IQR: 158,292–182,463) post-expansion (March 2020–December 2023). Contrarily, median monthly face-to-face consultations decreased from 143,726 (IQR: 135,812–150,153) to 99,272 (IQR: 87,513–107,778). Seasonality and trend were present in both time series. The time series regression model with expansion but excluding SI best explained all consultations, while both telehealth expansion and SI were significant in the best-fit model for face-to-face consultations.

Conclusion

MBS telehealth expansion was associated with total and face-to-face consultations independent of lockdown severity changes. Policy changes allowing wider access to new telehealth services have possibly led to increased uptake of psychiatric care and addressed previously unmet needs.

Keywords: access to care, health policies, interrupted time series analyses, outpatients, psychiatry, remote consultations, telehealth, telepsychiatry.

References

1 Department of Health. Australians embrace telehealth to save lives during COVID-19. 2020. Available at https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/australians-embrace-telehealth-to-save-lives-during-covid-19

2 Department of Health. COVID-19 Temporary MBS Telehealth Services. 2021. Available at https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/0C514FB8C9FBBEC7CA25852E00223AFE/$File/Factsheet-COVID-19-Spec-27.04.21.pdf [accessed 28 April 2023].

3 Department of Health and Aged Care. MBS Telehealth Services from 1 July 2022. 2022. Available at http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-telehealth-1July22 [accessed 28 April 2023].

4 Smith AC, Armfield NR, Croll J, et al. A review of Medicare expenditure in Australia for psychiatric consultations delivered in person and via videoconference. J Telemed Telecare 2012; 18: 169-171.
| Crossref | Google Scholar |

5 Looi JC, Bastiampillai T, Pring W, et al. Lessons from billed telepsychiatry in Australia during the COVID-19 pandemic: rapid adaptation to increase specialist psychiatric care. Public Health Res Pract 2022; 32: e3242238.
| Crossref | Google Scholar | PubMed |

6 Looi JC, Allison S, Bastiampillai T, et al. Australian private practice metropolitan telepsychiatry during the COVID-19 pandemic: analysis of Quarter-2, 2020 usage of new MBS-telehealth item psychiatrist services. Australas Psychiatry 2021; 29: 183-188.
| Crossref | Google Scholar | PubMed |

7 Snoswell CL, Arnautovska U, Haydon HM, et al. Increase in telemental health services on the Medicare Benefits Schedule after the start of the coronavirus pandemic: data from 2019 to 2021. Aust Health Rev 2022; 46: 544-549.
| Crossref | Google Scholar | PubMed |

8 Looi JC, Allison S, Bastiampillai T, et al. Increased Australian outpatient private practice psychiatric care during the COVID-19 pandemic: usage of new MBS-telehealth item and face-to-face psychiatrist office-based services in Quarter 3, 2020. Australas Psychiatry 2021; 29: 194-199.
| Crossref | Google Scholar | PubMed |

9 Sreedharan S, Mian M, Giles S. Mental health attendances in Australia during the COVID-19 pandemic: A telehealth success story? Asia Pac J Public Health 2021; 33: 453-455.
| Crossref | Google Scholar | PubMed |

10 Yeatman T, Enticott J, Lakra V, et al. Equitable psychiatry, telehealth, and the COVID-19 pandemic: Analysis of national data. Front Public Health 2023; 11:.
| Crossref | Google Scholar |

11 Services Australia. Medicare Statistics. 2022. Available at https://www.servicesaustralia.gov.au/medicare-statistics?context=22 [accessed 2 September 2024].

12 Mathieu E, Ritchie H, Rodés-Guirao L, et al. “Coronavirus Pandemic (COVID-19)”. Published online at OurWorldInData.org. 2020. Available at https://ourworldindata.org/coronavirus [accessed 14 May 2024].

13 Hale T, Angrist N, Goldszmidt R, et al. A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker). Nat Hum Behav 2021; 5: 529-538.
| Crossref | Google Scholar | PubMed |

14 R Core Team. R: A Language and Environment for Statistical Computing. 2023. Available at https://www.R-project.org/

15 Posit team. RStudio: Integrated Development Environment for R. 2023. Available at http://www.posit.co/

16 Hyndman RJ, Athanasopoulos G. Forecasting: Principles and Practice. 2nd edn. OTexts; 2018.

17 Busso M, Gonzalez MP, Scartascini C. On the demand for telemedicine: Evidence from the COVID-19 pandemic. Health Econ 2022; 31: 1491-1505.
| Crossref | Google Scholar |

18 Hagi K, Kurokawa S, Takamiya A, et al. Telepsychiatry versus face-to-face treatment: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2023; 223: 407-414.
| Crossref | Google Scholar |

19 Australian Institute of Health and Welfare. Prevalence and impact of mental illness. 2024. Available at https://www.aihw.gov.au/mental-health/overview/prevalence-and-impact-of-mental-illness [accessed 14 May 2024].

20 Woon LS-C, Allison S, Bastiampillai T, et al. Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study. Australas Psychiatry 2024; 32: 204-209.
| Crossref | Google Scholar | PubMed |

21 Della DF, Allison S, Bidargaddi N, et al. An Umbrella Systematic Review of Seasonality in Mood Disorders and Suicide Risk: The Impact on Demand for Primary Behavioral Health Care and Acute Psychiatric Services. Prim Care Companion CNS Disord 2023; 25: 22r03395.
| Crossref | Google Scholar | PubMed |

22 Rizavas I, Gournellis R, Douzenis P, et al. A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion? Healthcare 2023; 11: 2155.
| Crossref | Google Scholar | PubMed |

23 Posternak MA, Zimmerman M. Lack of association between seasonality and psychopathology in psychiatric outpatients. Psychiatry Res 2002; 112: 187-194.
| Crossref | Google Scholar |

24 Singh GP, Chavan BS, Arun P, et al. Seasonal pattern of psychiatry service utilization in a tertiary care hospital. Indian J Psychiatry 2007; 49: 91-95.
| Crossref | Google Scholar | PubMed |

25 Ali S, Rosychuk RJ, Dong KA, et al. Temporal Trends in Pediatric Mental Health Visits: Using Longitudinal Data to Inform Emergency Department Health Care Planning. Pediatr Emerg Care 2012; 28: 620-625.
| Crossref | Google Scholar | PubMed |

26 Zhang F, Wagner AK, Ross-Degnan D. Simulation-based power calculation for designing interrupted time series analyses of health policy interventions. J Clin Epidemiol 2011; 64: 1252-1261.
| Crossref | Google Scholar | PubMed |