Training Module: Version 2 Updated June 2012

Transcription

1 Training Module: What is Telehealth? Version 2 Updated June 2012

2 What is Telehealth? The use of video conferencing equipment, software and the internet to provide a real-time audio-visual clinical consultation between a patient and a specialist at a distant location. 2-21

3 What can Telehealth offer? Increased remote patient access to specialists and other health professionals Reduces the need for patients to travel to Perth Educational opportunities for medical practitioners and other clinical staff 3-21

4 Why now? In July 2011 the Australian Government Department of Health and Ageing (DoHA) introduced new Medicare Benefits Schedule (MBS) item numbers, service, bulk billing, hosting and on board financial incentives to encourage the use of Telehealth consultations. 4-21

5 Who can participate? Specialist and consultant physician services which are provided via video-conferencing where the patient is located: In remote, regional or outer metropolitan areas In an Aboriginal Health Service, regardless of location At a residential aged care facility (RACF), regardless of location From 1 November 2012 there must be a minimum distance of 15 kilometres between the specialist and the patient. The minimum distance rule does not apply to eligible Aboriginal Medical Services or Residential Aged Care Facilities. Medicare benefits are not payable for services provided to an admitted hospital patient. 5-21

6 Who can participate? Patient-end services may be supported by a medical practitioner, nurse practitioner, practice nurse, midwife or Aboriginal health worker where they are co-located with a patient who is receiving a specialist service and where the support is deemed clinically necessary in consultation with the specialist. 6-21

7 Out patient services General practice rural, remote & outer metro Aged Care Facility regardless of location Aboriginal Medical Service regardless of location Telehealth Medicare Benefits Schedule items are available via: GP / Nurse Practitioner / Practice Nurse / Midwife / AHW* Specialist, consultant physician or consultant psychiatrist *Patient-end services do not have to be supplied. They may be supported by a general practitioner, nurse practitioner, practice nurse, midwife or Aboriginal health worker where they are co-located with a patient who is receiving a specialist service and where the support is deemed clinically necessary in consultation with the specialist. 7-21

8 The MBS Financial Incentives Incentive Telehealth on-board incentive $6,000 $4,800 $3,900 Service incentive (specialist) $60 $48 $39 Service incentive (patient-end) $40 $32 $26 RACF hosting service incentive $60 $48 $39 Bulk billing incentive $20 $16 $13 From 1 July 2012, on-board incentives will be paid in two instalments. The first installment is payable after claiming the initial telehealth service and the second installment is payable after 10 telehealth services have been claimed. Telehealth service incentives and bulk billing incentives are paid quarterly. Residential Aged Care Facilities (RACFs) are required to apply for incentives using the appropriate application form. 8-21

9 Medicare Benefits Schedule Items In addition to the start up, service, bulk billing and hosting incentives health professionals can access telehealth MBS item numbers which provide benefits for Medicare and Department of Veterans Affairs patients. There are 23 MBS item numbers that let medical practitioners, nurse practitioners, midwives, practice nurses and Aboriginal health workers provide support to a patient during a consultation. There are also 11 derived fee item numbers available to specialists, consultant physicians and consultant psychiatrists that, when claimed with an existing attendance item number, let that consultation be claimed as a video consultation. 9-21

10 Billing as a specialist, consultant physician or consultant psychiatrist The schedule fee for a Telehealth video consultation is based on two MBS items; that is, the existing specialist item number and a Telehealth item which derives its schedule fee as an additional 50% of the base (existing) item. For example: Item 104 [existing specialist referred consultation] $ Item 99 [professional attendance via video conference by a specialist] (50% of the schedule fee for item 104) = $ The rebate is then 85% of the derived fee ($41.95) 10-21

11 Billing as a rural or outer metro GP for a Telehealth attendance at consulting rooms Level B: Fee - $48.05 (Item 2126) Bulk bill incentive: Fee - $6.90 (10990 <16 or concession card holder bulk billed) OR Bulk bill incentive: Fee - $10.45 (10991 <16 or con. card holder bulk billed, in rural and remote) Telehealth Bulk bill incentive: $20 Telehealth Service incentive: $40 Total: $ $ if bulk billed Level C: Fee - $93.20 (Item 2143) Bulk bill incentive: Fee - $6.90 (10990 <16 or concession card holder bulk billed) OR Bulk bill incentive: Fee - $10.45 (10991 <16 or con. card holder bulk billed, in rural and remote) Telehealth Bulk bill incentive: $20 Telehealth Service incentive: $40 Total: $ $ if bulk billed 11-21

12 Billing as a rural general practitioner for a Telehealth attendance other than at consulting rooms Level B (Item 2137) Schedule fee for 2126 (Level B Telehealth attendance at consulting rooms) plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients it is the fee for item 2126 plus $1.90 per patient. For example: Item 2126 $ ($25 1 [patient seen] = $25) = $73.05 Item 2126 $ ($25 5 [patients seen] = $5) = $53.05 Item 2126 $ ($1.90 x 7 [patients seen] = $13.30) = $61.35 Plus Bulk bill incentive: Fee - $6.90 (10990 <16 or concession card holder bulk billed) OR Bulk bill incentive: Fee - $10.45 (10991 <16 or con. card holder bulk billed, in rural and remote) Telehealth Bulk bill incentive: $20 Telehealth Service incentive: $

13 Billing as a rural or outer metro GP for a Telehealth attendance at a residential aged care facility. Level B (Item 2138) Fee for item 2126 (Level B Telehealth attendance at consulting rooms) plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients it is the fee for item 2126 plus $3.20 per patient. For example: Item 2126 $ ($ [patient seen] = $44.95) = $93.00 Item 2126 $ ($ [patients seen] = $8.99) = $53.94 Item 2126 $ ($3.20 x 7 [patients seen] = $22.40) = $70.45 Plus Bulk bill incentive: Fee - $6.90 (10990 <16 or concession card holder bulk billed) OR Bulk bill incentive: Fee - $10.45 (10991 <16 or con. card holder bulk billed, in rural and remote) Telehealth Bulk bill incentive: $20 Telehealth Service incentive: $40 RACF hosting incentive: $60 (payable to the RACF) 13-21

14 The RACGP recommends a dual-care consultation process 1. The general practitioner refers a patient to a specialist. A video consultation is proposed and confirmed if safe and appropriate 2. A booking checklist is completed and sent to the specialist with the referral. General information about the video consultation process is given to the patient. 3. The general practice video consultation coordinator liaises with the specialist to book the video consultation 4. A test call is made prior to the video consultation to check interoperability 5. The patient arrives 15 minutes early at scheduled location, date and time 14-21

15 6. The Video consultation takes place. The GP/other clinical support, specialist and patient introduce themselves at commencement of the consultation The general practitioner / clinical support and specialist both document the dual-care consultation 7. The specialist provides a verbal summary to confirm diagnoses (where possible) and ongoing management and responsibilities or specific follow-up action 8. Consultation concludes 9. The specialist sends the general practitioner a follow-up letter confirming any decisions made and a management plan to complete the clinical handover cycle 10. The practice seeks patient evaluation on the video consultation process 15-21

16 How do I set up Telehealth? Decide what you are going to use Existing desktop computers, laptop, mobile unit Camera and microphone For desktop computer and mobile unit (not needed for most laptops) Wireless router or network connection? If using a network, are your existing firewalls ok? Can your existing internet connection handle more usage? Consider a new internet connection dedicated for telehealth? What software? Skype, Scopia (WACHS), Telstra package, many more 16-21

17 Things to consider When setting up and conducting a consultation using Telehealth, consider the following: Internet connection and reliability Camera and microphone location Sound and visual clarity Seating arrangements, room set-up Patient preference and safety Security, confidentiality and privacy 17-21

18 Western Australian General Practice Telehealth Advisory Group (WA GP TAG) Established in December 2011 Collaboration between Rural Health West and The Royal Australian College of General Practitioners WA Faculty (RACGP WA). Members include Western Australian general practitioners, Aboriginal Medical Services and other representative organisations

19 The WA GP TAG aims to: Build a collaborative, state-wide advisory group which addresses Telehealth initiatives and patient held electronic health records in general practice Assist Rural Health West and The Royal Australian College of General Practitioners (WA Faculty) to link Commonwealth and State Telehealth initiatives to the Western Australian general practice workforce Gather feedback and identify the needs of the general practice workforce during the implementation and operation of Telehealth initiatives and patient held electronic health records Provide a forum for rural, remote and indigenous health workforce at a state level on key Telehealth issues which require an inter-organisational, collaborative approach Provide a forum for medical specialists to link with general practice Telehealth initiatives 19-21

20 e-advance WA Rural Health West has been granted funding for two Telehealth Support Officers for a 12 month project named e-advance WA. Project aims include: Dissemination of information to eligible health practitioners in WA covering technology needs and identifying a range of equipment options, connectivity and support; Providing a communication link in information sharing conduit between the WA GP TAG and health practitioners in outer metro and RA 2 5; Provide hands on and help desk style support; Develop an on-line information page, gather feedback and identify the needs of the general practice workforce; Map and promote accredited training modules; Provide an e-bulletin, blog and a forum for telehealth related services inc Medicare rebates; and Generally support and promote the roll-out of telehealth. The Rural Health West e-advance WA Telehealth Project is funded by the Australian Government Department of Health and Ageing

21 References The Royal Australian College of General Practitioners, Implementation guidelines for video consultations in general practice. Version 2.0, October 2011 Department of Health and Ageing, Medicare Benefits Schedule. March 2012 ** Tatnell, Karin, Australian Association of Practice Managers, Preparing for Telehealth in your Practice. Presented at Taking on Telehealth March 2, 2012 All fees quoted are from the May 2012 MBS and are subject to change 21-21