Surgeons advocate for telehealth services beyond March 2021

MedTech News: The Royal Australasian College of Surgeons (RACS) is advocating for the continued listing of specialist telehealth items on the Medicare Benefits Schedule (MBS) past the current review date of 31 March 2021.

RACS commissioned a report in December 2020 to investigate patient and surgeon satisfaction toward telehealth services, and barriers and facilitators to its implementation.

Overall, patients were satisfied with telehealth for delivery of healthcare. The key benefits were time and cost-savings, with less travel time and time away from work reported but the same quality of care compared to standard face-to-face care.

Surgeons were also satisfied with telehealth, reporting shorter consultation
times and the potential for increased efficiency. Triage and advice delivered by nurses over the telephone contributed to a reduction in clinician workload rather than a reduction in face-to-face appointments.

Telehealth accounted for 14% of specialist/surgeon consultations from March to September 2020. Telephone was the preferred telehealth medium, accounting for 80% of interactions.

In comparison to specialists, general practitioners (GPs) used the telephone for approximately 97% of telehealth consultations. It is unclear from the MBS data whether the preference for the telephone modality is patient or provider driven.

Significant barriers to the widespread implementation of telehealth include the inability to perform a physical examination, technology issues and patient privacy. No significant safety and clinical utility issues with telehealth were identified.

Various aspects of surgical care may be more suited to telehealth. For example, videoconference was acceptable when physiotherapists were required to monitor physical assessment or performance after knee arthroplasty. A study noted it was possible to ‘perform a near-full neurological exam remotely via telemedicine.

The cost of implementing the technology required for telehealth was mentioned as a barrier. Many of these costs relate to initially setting up the practice for telehealth and should be considered a one-off cost. It was noted that some business versions of video software require a subscription, which can result in ongoing costs to the practice. The introduction of audio-only telehealth MBS item numbers may dispel implementation cost as a barrier to service provision in Australia.

The introduction of telehealth item numbers with fewer restrictions has not increased total specialist/surgeon claims. Telehealth consultations peaked in April 2020, but this coincided with the lowest number of specialist consultations overall. This low number of total consultations in April may be attributed to the beginning of COVID-19 restrictions in Australia.

Telehealth usage as a percentage of total specialist consultations has continued to decline since April.

Telehealth offers the opportunity to provide equitable healthcare remotely, reducing travel costs and childcare needs for patients, while offering medical care as effective as standard care, keeping both patients and healthcare workers safe.