susan jury - royal childrens hospital melbourne - telehealth funding
DESCRIPTION
Susan Jury, Telehealth Program Manager, Royal Children’s Hospital Melbourne delivered this presentation at the 15th Annual Health Congress 2014. This event brings together thought leaders and leading practitioners from across the Australian health system to consider the challenges, implications and future directions for health reform. For more information, please visit http://www.informa.com.au/annualhealthcongress14TRANSCRIPT
How funding impacts on telehealth and its role in health reform
15th Annual Health Congress - considering the challenges, implications
and future directions for health reform
Sydney, March 2014
Susan Jury Telehealth Program Manager
Royal Children's Hospital
Paulette Kelly State-wide Paediatric Telehealth
Program Manager (Victoria)
Overview
1. Costs, savings and revenue generation
(study results)
2. The role of telehealth in health reform
3. How current funding models both help and
hinders the use of telehealth
4. Possibilities for expanding telehealth use
without increasing costs?
Costs, savings and revenue generation
(study results)
Aim: To determine if telehealth follow-up to children with
highly complex nephrological disease was acceptable &
beneficial to stakeholders and if so, at what cost
compared to face-to-face.
The study:
• 50 telehealth video-consultations with 30 children over 16 months
• 3 nephrologists and all with a local GP or paediatrician (total of 25 regional
clinicians)
• All children also had face-to-face during this time
Findings
1. Telehealth offers convenience for families
2. Revenue generation for telehealth will drop
substantially but remains viable
3. Service funding and delivery models would benefit
review
4. Medicare boundary changes have excluded patient
groups in need
5. Telehealth can enable the local clinician to become
a true partner in care
6. A range of factors impact on ‘patient
appropriateness’ for telehealth
We know that telehealth
saves money and time (to the patient)
This cost is commonly carried by Travel Assistance Schemes.
• Average cost savings per consult $602
($525 including outer metro – original boundaries)
• Maximum $4,015 for one patient
across 10 consultations
• >$26,000 saved across 25 patients over 16 months
Cost savings (family or travel assistance scheme)
RCH end dr:
Est. cost per consultation $18
Additional revenue $40
Patient end dr:
Est. cost per consultation $40
Additional revenue $29
Patient / TAS:
Est. savings per consultation $525+
The role of telehealth in health reform
Telehealth offers much more than saved money for patients
Telehealth benefits the patient AND health services
1. Overcome barriers to access • (eg distance, disability, risks of infection, psycho-social, socio-economic)
2. Improve rural / regional access to specialist services
3. Help enable integration between 1°, 2° and 3° care
Improving rural / regional access to specialist services
• More convenient
• Promotes earlier intervention
• This should decrease # of appointments needed + decrease
emergencies (and use of emergency services)
• Convenience should reduce hospital FTA rates (non-
attendance)
The role of telehealth in health reform
Enabling integration between 1°, 2° and 3° care
• Encourages local care through partnership
• For this appointment
• For future and ongoing care
• Encourages use of local services (pathology, imaging)
• More cost effective
• More timely and convenient
• Increases local capacity through increased confidence and
competence in more complex care – regional workforce
The role of telehealth in health reform
Benefits of 1°-2°-3° care integration
Example: Joerg – history of allergy
• Child 4 hours drive away
• 1st appointment by telehealth includes local GP
• Due to allergy concerns has not received vaccinations
• Detailed consultation by allergist resulted in:
• Utilising local (cheaper) services & better use of tertiary
services – initial local allergy testing under guidance of allergist
before follow up appointment face-to-face at the RCH
• A more competent / confident regional GP – better ongoing
local care for for this and other families
• A vaccinated child – went to local hospital to receive vaccination
under controlled circumstances
• Three saved hospital visits
• Home based (eg sleep studies, EEG)
• Outreach
• Transition to adult care
• Preadmission clinic
• Discharge planning
• Palliative Care
• Allied health, nursing • (eg pain team, HITH physio)
• Screening clinics
Telehealth & health reform – telehealth offers
novel approaches to care
…from +ve impacts
of telehealth on
the cost picture….
to -ve impacts
Example: Oncology Geelong
• 6 children w leukaemia in Geelong region (1 hour from Melbourne)
• Each child 8 appointments pa could give chemo locally with RCH
input and avoid an RCH visit (48 apts pa)
THEN:
• Every month for 3.5 years – could do locally
• 5 years surveillance – every 6-8 weeks, then 4 pa then 3 pa then 1 pa
– a total of 16 appointments could manage locally
Additional benefits of using telehealth:
• Psycho-social, local involvement for other ongoing
• Use local services
• Avoid RCH……
The impact of geographical restrictions
How current Medicare funding both helps
and hinders telehealth provision
A current example: nephrology follow up by telehealth
• By the most expensive doctor
• Takes 30 minutes including set-up
• Excludes Allied Health
• No great financial incentive
for local paediatrician
• Excludes local allied health
participation
How current Medicare funding both helps
and hinders telehealth provision
Other examples
• Dermatology specialist end nurse practitioners
• Highly skilled, more cost effective
• Neurology multi-disciplinary clinics
• No scope for regional AH involvement – therefore care
remains at the RCH
• GP repeat referrals / scripts
known patients
• By telehealth, impact on family,
time off school / work
• Aged care
Non-MBS funding
Hospital to hospital telehealth activity
• Current arrangements:
• The health practitioner with the patient claims for a Tier 2
specialist clinic service item. The clinician at the remote end
cannot claim.
• July 1st IHPA changes:
• The remote service provider can claim – the health
practitioner at the patient end cannot claim
• NABF weightings are untested
• (Not introducing in Vic for 1 year+)
Unintended consequences of the July 1st
Tier 2 funding changes
• Unattractive for consultations including more than
one provider (eg multi-disciplinary or inter-specialty)
• Discourages engagement of local services
• Always problematic when funding one end or
participant only
Telehealth benefits the patient, State and
Federal governments – why limit it?
• Helps keep people out of hospital
• Supports patient self management and health literacy
• Avoiding admission
• Earlier discharge
• Enables a more supported primary care workforce
• Less need for referral
• More involved
• Knowledge & skills sharing
• Supports a more efficient health service
• Less duplication of tests
• Less delay in follow-up
• Better continuity of care
Summary: Telehealth simply offers another way
of accessing services… yet plays a significant
role in health reform. Why limit it?
Can we increase use without increasing costs?
• Remove geographical boundaries? (+/- added incentives
for metro)
• Offer telehealth for ANY activity as an alternative not
additional service option?
• Increase use local services and providers, multi-
disciplinary etc
• Support the most appropriate provider? (may not be the
most expensive)
• Allow providers at both ends to count the service item in
non-MBS telehealth? (hospital to hospital)
• Fund paediatricians appropriately when with the patient
during sub-specialist consults?
• Out-of-pocket billing guidelines?
Summary: Telehealth simply offers another way
of accessing services… yet plays a significant
role in health reform. Why limit it?
Can we increase use without increasing costs?
• Review funding for travel, eg outreach programs & patient
travel assistance schemes? – including ambulance transport in
aged care
• Improve proactive rather than reactive access to GPs
through use of telehealth
• Ensure telehealth is a countable activity through other
funding sources (NABF etc) – including other telehealth (eg
store & forward etc) – can be an effective and efficient way of
providing quality healthcare.
Summary: Telehealth simply offers another way
of accessing services… yet plays a significant
role in health reform. Why limit it?
Can we increase use without increasing costs?
Susan Jury
Telehealth Program Manager
Royal Children's Hospital
www.rch.org.au/telehealth
Tel (03) 9345 4645
Paulette Kelly
State-wide Paediatric Telehealth
Program Manager (Victoria)
Tel (03) 9345 5644