There are two cost considerations. The first is the cost of medical consumables or devices. In many cases these are already funded via home care packages, medical consumables schemes or the Prostheses List (in the case of privately-insured patients). It is possible that other components such as peripheral devices (e.g. vital signs monitors) could be rented and remain the property of the supplier. The second is the cost of the service (data transmission and monitoring). These costs are either inconsistently funded, or not funded at all.
Current funding for telehealth
- MBS items for telehealth were introduced in July 2011, however the definition of telehealth was limited to video consultations
- Geographical eligibility for telehealth items has been recently restricted
- Consultations between GPs and patients in their home are not funded
- Vital signs and remote monitoring of medical devices are not funded.
What is needed
- Comprehensive telehealth policy that incorporates funding for a range of home consultations and assistive medical technologies - including remote monitoring of vital signs and implantable medical devices.
Remote monitoring of vital signs and medical devices is a health equity issue. It is also an issue about the future sustainability of the healthcare system. Currently rural and remote patients do not have equal access to health services. Long term follow-up of patients with implantable medical devices is necessary to monitor and optimize device function and to identify clinical and/or device-related problems. Studies have shown that remote monitoring can be used to replace 50–63% of in-clinic visits without adversely affecting patient outcomes . Approximately 90% of cardiac patients who attend a clinic for routine monitoring do not require changes to either their device or their medical treatment . A range of implantable medical devices can now be monitored remotely for clinical or device assessment. In Australia the only tangible barrier to the use of such technologies is lack of reimbursement.
How can telehealth be funded?
A range of medical devices can be used for telehealth and remote monitoring. In some cases a nurse, GP or allied health professional may be able to assess data, but in the case of implantable medical devices a specialist would need to review data. For this reason MBS item numbers need to be flexible enough to cover data monitoring by a range of health professionals.
Three options could be considered to achieve these outcomes:
- MBS item numbers based on existing items with an included loading for remote monitoring
- Capitated costing model, whereby a clinician is paid once per year per patient to provide the service
- Improved capitated model (flat fee per quarter).
Proposed reimbursement models are designed to ensure that the overall budget impact is cost neutral and predictable. Option 1, whilst simple, may result in over-servicing of patients. Capitated models, on the other hand, ensure there is no over servicing as healthcare professionals are paid for a service regardless of the number of data transmissions or reviews. Option 2, the capitated costing model, is budget neutral proposing an annual fee based on current utilisation. The flat fee per quarter model, option 3, proposes significant long term cost savings to the Commonwealth budget by limiting the number of claims and reducing unnecessary office visits.