Reading the fine print: Medicare telehealth changes to disadvantage rural and remote populations

To the Editor: The rapid uptake of telehealth has been a cornerstone of the response to the coronavirus disease 2019 (COVID‐19) pandemic, and has ensured the provision of essential health care despite restrictions and lockdowns. Although not new technology, telehealth has dramatically increased in prominence and received broad acceptance by doctors and patients alike. Given its success, the Australian Government has confirmed the permanent retention of multiple telehealth item numbers within the Medicare Benefits Schedule (MBS).1

However, it is concerning that this announcement also contained the fine print that the long‐standing MBS incentive for providing telepsychiatry consultations to rural and remote patients will be abolished. This is despite patients in rural and remote communities experiencing well established difficulties accessing health care and having poorer outcomes than their metropolitan counterparts.2

Telehealth consultations have occurred in psychiatry since well before the COVID‐19 pandemic, and have filled an important gap in the workforce by increasing services available in rural and remote areas.3 Video‐based consultations are particularly suited to psychiatry as the key skills of history taking, mental state examination, and psychotherapy do not require physical proximity. Delivering diagnostic assessment and psychological treatment via telehealth have long been demonstrated to be effective and tolerable.4,5

The MBS item number 288 was introduced in 2011 as an adjunct billing code that attracted a 50% loading for psychiatric consultations conducted via telehealth for patients located in a rural or remote setting, aged care facility, or Aboriginal health service. This loading incentivised bulk‐billing of these telehealth assessments. The deletion of this item number from 1 January 2022 will likely result in two adverse consequences: i) fewer telepsychiatry consultations to rural and remote locations will be bulk billed, and ii) telepsychiatry appointments that previously were only available for rural and remote patients will increasingly be offered to metropolitan patients. This will ensure fewer and less affordable options.

The cessation of the rural loading for telehealth assessments is a retrograde step that is likely to further entrench long‐standing inequities in both access to care and patient outcomes for psychiatric patients who do not live in the cities. The 288 item number should be reinstated or replaced with an alternative funding mechanism to ensure bulk billed consultations continue to be available for rural and remote patients.