Health care rush may guide future of care
The rush of developments in health care triggered by COVID-19 is opening up significant changes in the health workforce which could bode well for health consumers not only now but in a post-COVID world.
The accelerating demand for urgent health services, doctors, nurses and paramedics is imposing strains that are forcing changes in practices and service organisation. The near-universal introduction of Medicare telehealth this week is a watershed step. It had been called for before the pandemic but traction had proved difficult.
Now the new dynamics have made the move appear not only practical but inescapable given the imperative to avoid coronavirus infection.
A range of health practitioners and service modes will now be eligible for Medicare payments to conduct consultations by phone and video. These will include GPs and some consultation services provided by other medical specialists, nurse practitioners, mental health treatment, chronic disease management, Aboriginal and Torres Strait Islander health assessments, services to people with eating disorders, pregnancy support counselling, services to patients in aged care facilities, children with autism, and after-hours consultations.
As Health Minister Greg Hunt says, people will be able to access support in their own home using their telephone, or video conferencing features like FaceTime to connect with the services covered.
Getting these services at home is a key weapon in the fight against coronavirus while limiting unnecessary exposure of patients and health professionals to the virus, wherever treatment can be safely delivered by phone or videoconferencing. This will take pressure off hospitals and emergency departments and allow people to access essential health services in their home, while supporting self-isolation and quarantine policies.
While the funding of telehealth is scheduled to continue until 30 September, when it will be reviewed in light of circumstances then, we must hope it will lead to longer-lasting arrangements.
The availability of telephone consults along with the spread of information technology and My Health Record should hasten the roll-out of such advances as team-based care where both patients and providers will be, or should be, more dependent on connected approaches to care of, say, chronic conditions requiring the attention of multiple practitioners.
At a time when we want people with complex chronic conditions to be supported to self-manage effectively from home, it is good to see that under this week’s announcement there is movement towards more support for the primary care nursing workforce through telehealth.
As the Australian Primary Health Care Nurses Association has argued, telehealth for nurses will mean that more Australians will get faster access to the urgent healthcare they need.
The Australian College of Nursing has also made a case for nursing solutions in response to COVID-19. It has urged three measures to make the most of nurses. These include removal of funding barriers to the delivery of nursing care to promote nurses working to their full scope of practice outside hospitals; supporting changes so nurses can engage in more home visits and telehealth consultations in the community which would help avoid hospital and general practice visits; and ensuring protective equipment for nurses including those working in residential aged care facilities, community health and non-government organisations.
There are inherent professional and administrative obstacles in the path of such changes as there are to team-based and more holistic approaches. These barriers are a legacy of the founding tenets of Medicare which was designed to insure for episodes of acute care by an individual doctor.
A recent example of the rigidity of the system was a government letter sent to GPs warning against co-billing Medicare for physical and mental health issues. This may have been merely reflecting Medicare rules to deter excess billing and the department has since said it is not suggesting it is inappropriate to address physical and mental issues in the same consultation.
But it was a concerning episode for health consumers and for doctors. A patient who has both diabetes and anxiety should be able to discuss both issues in one consultation with their GP. A cancer patient who is depressed due to their extensive treatment regime or the side effects of their medication needs to have these issues considered collectively, not in isolation.
Patients with chronic conditions benefit from team-based, integrated care focused on patient outcomes. But in most cases Medicare neither rewards team efforts nor patient outcomes.
We must ensure that the goals of necessary long term reform of the health system are not left by the wayside because of COVID.
Indeed the COVID-triggered developments could provide a springboard of reality for Minister Hunt’s Primary Health Care 10-Year Plan, and for a myriad of other person-centred service innovations driven by a clinical workforce with a newfound ingenuity for which we thank them and a much more permissible policy environment.