Telehealth and mental health consultations
On 1 November 2017 Medicare Australia released new item numbers for patients in rural and remote locations to claim rebates for video consultations through the Medicare Benefits Schedule ‘Better Access to Psychiatrists, Psychologists and General Practitioners’ (Better Access) initiative. This means that rural and remote patients can now access Mental Health Treatment Plan consultations with a Psychologist through the use of video consultations.
On 1 November 2018, the Federal Government announced new telehealth item numbers for the provision of treatment in connection to a mental health care plan for rural and remote patients by General Practitioners accredited by the General Practice Mental Health Standards Collaboration (GPMHSC) and registered with Medicare as a Provider of Focussed Psychological Strategies (FPS).
A psychological therapy service delivered via video conference requires both a visual and audio link to be established between a patient and their eligible health professional. Eligible patients are required to have a Mental Health Treatment Plan and be located Modified Monash Model areas 4-7. The patient must also be located more than 15kms from the GP as part of the session. This new provision is part of recent government announcements to provide better access to mental health services to rural and remote people.
Further information on the new items can be found on the Department of Health website. If you are interested in becoming an FPS Provider, please read further information on GPMHSC website.
The aim of this eResource
There are a number of existing resources that can assist General Practitioners (GPs) in the development of telehealth within their practice. This eResouce has been developed to consolidate this information in a single web page.
- support GPs the implementation of the telehealth sessions to improve access to therapies under the Better Access Initiative
- encourage multidisciplinary communication and the use of the telehealth platform
- promote the role of the GP in mental health shared care decision making with carers and consumers
The new MBS numbers and talking to your patients about telehealth
The Australian Psychological Society (APS) has also developed a resource for consumers to assist understanding their eligibility to access sessions through the new telehealth item numbers GPs in navigating the new item numbers. Further information can be found on the APS website.
What is telehealth
According to the RACGP ‘Implementation guidelines for video consultations in general practice: A telehealth initiative’:1
Telehealth is healthcare ‘at a distance’. It is the electronic transmission of health information and images in the delivery of both clinical and non-clinical health-related services, using a range of telecommunications technologies. The RACGP uses the term ‘telehealth’ in these guidelines to refer to video technology for video consultations conducted in real-time among a GP (or practice nurse/Aboriginal health worker), a patient and/or a specialist in another location. The video consultation will involve real-time visual and audio.
The following three components are included in the broad definition of a video consultation:
The clinical consultation is not performed in a traditional physical meeting, but via a videoconferencing platform (hardware or software).
Information is transmitted electronically to a patient, or a healthcare professional at a second location.
The healthcare professional accompanying the patient employs clinical skills and judgement to provide healthcare and feedback to both the specialist and the patient.
By general definition, telehealth can be delivered via technologies that are either asynchronous (ie. store-and-forward such as email, or still images such as radiology or photographs of skin or wounds) or synchronous (ie. in real time such as video consultation). Regardless of how telehealth is defined, the focus should be on the patient and healthcare delivery, not the technology.1
Useful resources to assist in the set-up of telehealth in practice
The RACGP guidelines Implementation guidelines for video consultations in general practice: A telehealth initiative are designed to assist general practitioners (GPs) and their staff in establishing video consulting within their practice.
The RACGP has also produced Guidelines for interprofessional collaboration between general practitioners and other medical specialists providing video consultations. These guidelines relate to real-time video consultations, where a patient and their usual GP (or another support clinician) are at the patient-end of the consultation and another medical specialist is at a distant location. The guidelines aim to assist GPs and other medical specialists to provide safe, high quality healthcare in a telehealth setting.
The RACGP Standards for General Practices 5th edition (the Standards) references to video consultations throughout as examples for practices to offer alternatives to home or other visits. It also provides information on considerations needed when offering video consultations, such as
- patient safety
- patients’ clinical needs
- clinical effectiveness
- patient preference
- location of the practice
- availability of telehealth facilities
- conditions of your professional indemnity insurance.
The Standards provide brief guidance around technology-based consultations:
“You can conduct technology-based patient consultations (e.g. via telephone and internet-based video services such as Skype) in place of face-to-face consultations. When conducting a technology-based consultation, the practitioner must:
- confirm the identity of the patient using three patient identifiers (e.g. their full name, date of birth,
and address) - advise the patient of the security risks associated with technology-based consultations
- obtain the patient’s prior written consent, if possible, before the consultation takes place.
The Medical Board of Australia’s Guidelines for technology-based patient consultations provides further information that you may find useful. You may also wish to obtain advice from your medical defence organisation regarding the suitability of providing advice by telephone or electronic means.”
The ACRRM Standards for Telehealth5 framework provides a guide to understanding a range of issues relating to deployment and use of telehealth products and services based on video consultations. The ACRRM Standards for Telehealth took a three-dimensional approach to defining a framework for decision-making and implementation around these aspects.
The first dimension covers technical aspects, including software and hardware components. The second dimension covers clinical usage aspects, including both supporting the clinical process and considerations of appropriate. The third dimension involves the health services context within which the videoconferencing activity occurs.
The RANZCP also have detailed information for telepsychiatry on their website. The information includes professional standards from RANZCP and the Medical Board of Australia (MBA), the set-up and use of telepsychiatry as well as e-learning, presentations and information for patients. While this is aimed at Psychiatrists, the information may assist General Practitioners in developing multidisciplinary relationships in primary mental health care.