Telehealth Extended - But Chronic Illness Still Invisible
The government has announced that Medicare rebates for telehealth services will be extended until the end of 2021. The rebates for these services were due to expire at the end of June.
While this extension is welcome, it is a far cry from the “permanent part of the Medicare system” which the Health Minister, Greg Hunt, in November 2020 said that telehealth was to become.
Vulnerable patients, especially those with chronic illnesses like ME/CFS, have come to rely on telehealth services, and need the certainty of knowing that these vital services will be available to them in the future.
People who are housebound or bedbound with chronic illness have long been both invisible to and failed by our medical system. As advocate Ricky Buchanan put it in her 2018 report, Just Invisible: Medical Access Issues for Homebound/Bedridden Persons, “This problem is that the entire medical system has been designed and based around physical attendance, and that it treats non-attendance almost exclusively as a problem of patient noncompliance…if you are homebound/bedridden and you live in the community, then the healthcare system treats you as if you do not exist and should not exist.”
In 2019, the federal government announced a 10 year plan to rollout telehealth services within the Medicare system. This was a welcome step, however housebound and bedbound people were not prioritised as part of this rollout. MEANA and Emerge Australia launched a letter-writing campaign, asking the government to include these patients within the prioritised groups. The government’s response was that the rollout was complex, and by limiting it initially to patients over 70 (and not including those with more complex needs), it allowed for details to be ironed out and for the rollout to be done more rapidly. Once again, homebound and bedbound people were invisible.
Fast forward to 2020 and what a difference a pandemic makes! Suddenly, what was to take 10 years, was implemented across the entire nation in a matter of weeks.
Telehealth was instantly popular with both patients and GPs. GPs reported that telehealth allowed them to see their patients more regularly, feel closer to them by seeing them in their own homeand to continue practising safely during the pandemic. Patients reported that the convenience and time saving, as well as the safety of not sitting in a waiting room with sick people, were valued benefits. Needless to say, telehealth was also especially popular with the ME/CFS community, with 82% of respondents to Emerge Australia’s survey reporting that telehealth resulted in improved access to healthcare.
Telehealth was so popular in the broader community that many pop-up telehealth services appeared. In response to concerns raised by the AMA and others about the level of care provided by these pop-up clinics, the government then introduced restrictions to telehealth services in July 2020, whereby patients must have seen the GP (or another GP at the clinic) face-to-face within the past 12 months in order to be eligible for the telehealth rebate. The move was welcomed by then RACGP President Dr Harry Nespolon.
The new restrictions meant that, once again, homebound and bedbound people, who arguably have the greatest need for telehealth services, would lose access to medical care if they were unable to attend a GP clinic at least occasionally. In a recent telehealth summit, it is understood that the current RACGP President, Dr Karen Price, acknowledged that these restrictions have meant that some patients have “fallen through the gaps”. Indeed.
The Health Minister continues to dangle the prospect of making telehealth permanently part of Medicare, recently saying that “The government continues to work with peak bodies to co-design permanent post pandemic telehealth as part of broader primary care reforms to modernise Medicare and provide flexibility of access to primary and allied healthcare services”.
But five months after the last announcement about the permanence of telehealth, it is hard to see this as anything more than yet another an announcement from an announcement-prone government. It’s not permanent until it’s signed on the dotted line. And throughout this process, the needs of those who are housebound and bedbound, who need telehealth services the most, continue to be overlooked.
Help make your voice heard by writing to your local MP and asking them to make telehealth services a permanent part of Medicare, and to waive the requirement of face-to-face appointments for patients who are housebound or bedbound.