THURSDAY, 2 APRIL 2020
Telehealth
Exercise & Sports Science Australia (ESSA) Telepractice Policy Statement
A reminder to read this statement if you are or intending to use telehealth for compensable schemes and for private practice. This statement was released on Friday 27 March, 2020 and is available here. Please print out and complete the Tele-service provider checklist. Retain this on your files.
Telehealth - Department of Veteran's Affairs (DVA) The fee schedule was released yesterday (Wednesday 1 April, 2020) with the same item numbers.
Phone consultations can only be provided when video conferencing is unavailable.
Please note, group and aquatic sessions should not be delivered at this time and cannot be provided through telehealth. The rules on treatment cycles still apply and a telehealth session counts as one session under the 12 treatment cycle.
Please read the Notes for Allied Health Provider: Exercise Physiologists here which confirm that DVA clients can only be bulk billed. The FAQs on rules for Exercise physiology services through DVA is here.
Telehealth - Medicare
Please note the same telehealth item codes cover all allied health professions and are not exclusive to exercise physiology.
Videoconference services are the preferred approach for substituting a face-to-face consultation. However, in response to the COVID-19 pandemic, providers are able to offer audio-only services via telephone only if video is not available. There are separate items available for the audio-only services.
The bulk billing benefit is $53.80 (85% of the fee of $63.25).
The new telehealth item numbers 93000 and 93408 must be provided by videoconferencing.
The new item numbers 93013 and 93061 can only be provided by telephone if videoconferencing is not available.
Q. How can you obtain a signature from a patient when undertaking services covered under the new temporary MBS telehealth items?
• Where practicable, each individual provider should make efforts to obtain patients’ signatures in whichever way is appropriate to their needs. There are several options available to providers performing these services:
o Provider to post the completed assignment of benefit form to the patient to obtain his/her signature and return.
o Request assistance from a supporting practitioner (when there is one and possible).
o Email agreement between the provider and patient.
• The Department of Health’s position is that, under these exceptional and temporary circumstances, for the new temporary MBS telehealth items only, the practitioner’s documentation in the clinical notes of the patient’s agreement to assign their benefit as full payment for the service would be sufficient.
• This means that agreement can be obtained through one of three options being in writing, by email, or verbally through the technology with which the attendance is conducted. This agreement can be provided by a patient, or another person, such as the person’s carer or family member. Practitioners should keep their own records that patients agreed or acknowledged that the service was provided, and that the Medicare benefit could be paid directly to the practitioner.
• The Department of Health may investigate potentially fraudulent claims by seeking to verify that the service was provided to a patient. However, the Department is not intending to undertake compliance activity directly focused on whether the assignment of benefit process aligned with the usual requirements.
ESSA strongly recommends that at a minimum, members email patients to seek their agreement to assign their benefit as full payment for the service.
Telehealth - National Disability Scheme (NDIS)
The NDIS recognises ‘telepractice’ as an alternative method of delivering therapy supports, which can be used to assist participants to receive support that may otherwise not be available to them in their surrounding areas (for example participants living in more remote locations). This not only allows more choice and control for participants but may also provide value for money in instances where telepractice can be used to compliment and/or supplement face-to-face delivery of support. Providers wishing to use telepractice services should ensure they have met the appropriate quality and safeguard requirements.
The NDIA do not have an item number for telepractice. They consider telepractice to be a mode of delivering a service, not a separate service.
Please refer to the Support Catalogue for exercise physiology support items.
Click here for FAQs.
Telehealth - New – Private Health Funds
Australian Unity, Teachers Health Fund and TUH have announced telehealth items for exercise physiology. ESSA provided a submission to Private Health Australia last month evidencing the efficacy of AEP telehealth services. We expect more private health funds to announce telehealth items for exercise physiology over the coming weeks and will keep you updated as these occur.
Notes from Department of Health (DoH) webinar:
COVID-19 response update for allied health practitioners – Thursday 2 April
1) Flu vaccines:
i. Influenza expected to arrive June to September. Vaccinations are available in GP practices and pharmacies. Ring ahead to check if supplies are available first and make an appointment. DO NOT just go to your GP or pharmacist expecting he/she will have it.
ii. Australian Government is recommending everyone get the Influenze vaccine this year.
iii. Anyone in an at-risk category will receive the vaccine for free. This includes pregnant women, 65+, those over 6months with chronic condition, and children aged between 6months and 5 years.
iv. There is an anticipated shortage of the vaccine for obvious reasons. The DoH is working on this.
2) Telehealth
i. Bulk billing via MBS is still the only available option.
ii. The DoH is putting in place the regulations which are required to allow people to do private billing, and then to have patients to claim a rebate. If you privately bill patients, the claim will be knocked back.
iii. Make sure services are affordable once private billing is allowed.
iv. The DoH is expecting this change to implemented shortly. Please be patient.
3) Workforce incl private health
a. Private health service:
i. Private hospitals are being supported with a guarantee package to remain open and still offer some of their private health services.
ii. State and Territory governments are talking to private hospitals about using their facilities for public patients.
b. Pandemic clinical registration
i. Australian Health Practitioner Regulation Agency (APHRA) has announced a pandemic register for those with relapsed registrations who can apply through a new pathway to return to work.
ii. New opportunities to train as a critical care nurses. The Government has announced $4.1 million in funding to train 20,000 nurses in critical care. The online course, which will be free of charge, will inject thousands more registered nurses into the national response to the coronavirus pandemic.
iii. There was an overwhelming response to the Australian Government scholarships for the Refresher Program for Registered Nurses. The 3,000 scholarships places have now been filled.
c. Employment opportunities
i. Many new employment opportunities will be created in health and they will have different requirements than we are used to seeing for certain jobs. This is to cater for the current climate and increased demand for workforce.
Please see state government websites for job opportunities which will be increasing though the crisis. (ESSA published a list of where to apply for surge positions with state governments yesterday Wednesday, 1 April.)
4) Intensive care unit beds (ICU)/ Personal Protective Equipment (PPE)
i. The Government is ramping up the number of intensive care unit beds including the use of wards and theatres in the private hospital sector to respond to to anticipated demand.
ii. Australian and New Zealand Intensive Care Society released on Monday 30 March a paper which indicated an expansion capacity of 2,200 to 4,800 ICU beds up to a scenario of 6,000 beds under certain circumstances.
iii. Looking to procure ventilators and local production is occurring to increase supply.
iv. There is a global shortage of Personal Protective Equipment (PPE). The Government is bringing in PPE from overseas and ramping up Australian production.
v. Priorities for PPE are people working with patients with or suspected of having the virus. Primary Health Networks are distributing PPE to primary practices. Please call your local PHN first if you have issues getting supplies of PPN.
5) Mental health
i. The Australian Government has released a package to help support people’s mental health, both workers and the general population.
ii. The mental health package includes $10 million for a dedicated coronavirus wellbeing support line, delivered by Beyond Blue, to help people experiencing concern due to a coronavirus diagnosis, or experiencing stress or anxiety due to employment changes, business closure, financial difficulties, family pressures or other challenges.
iii. $14 million will bolster the capacity of mental health support providers who have experienced an unprecedented surge in call volumes with funding increasing their capacity, including $5 million for Lifeline and $2 million for Kids Helpline. The funding will also bolster other existing services, including digital peer-support to people with urgent, severe and complex mental illness who may be experiencing additional distress at this time.
iv. Encourage people to use existing resources e.g. Beyond Blue where relevant.
6) Questions
a. What is essential care?
i. All allied health services are currently being labelled as essential.
ii. Some procedures may not need to take place at this time. All urgent and continuing procedures need to happen. Treatments should continue especially for those with chronic conditions.
iii. Peak bodies are working with the Dept. of Health on recommendations on how allied health professionals can be supported.
b. Should allied health professionals (AHPs) still be seeing people face to face or moving to telehealth?
i. It is essential that face to face consultations are available when required.
c. Any guidance on telehealth platforms?
i. Guidance on telehealth platforms is being developed by DoH in conjunction with peak bodies. The Australian College of Rural and Remote Medicine (ACRRM) has resources for using TeleHealth to improve access to care for rural, Aboriginal and aged care patients.
ii. Consider issues about privacy – who else is in the room? The Royal Australian College of General Practitioners (RACGP) has developed the ‘Using email in general practice fact sheet’ to provide information for general practices about using email to communicate health information with patients, health organisations, and third parties, and to support practices to make an informed decision whether to use email at their practice.
iii. Getting advice from the Australian Information Commissioner and Privacy Commissioner re telehealth consults. More information to come.
iv. DoH will share updates as they come in.
d. What restrictions are there for allied health providers on home visits?
i. No restrictions. Essential home visits still take place for those who need them i.e. elderly/disability services BUT
1. Emphasis on PPE
2. Hygiene and infection control
3. DO not put yourself or clients at risk. If in doubt, do not attend a patient’s home.
4. A note that home visits may even become MORE necessary as the isolation continues for those who do not have social supports e.g. elderly.
e. What are recommendations re student placements?
i. The DoH is in talks with university Allied Health Depts. and faculties re student placements. Any statements will be posted on the webinar website. Deans of Medical Colleges have put out statements allowing placements to continue.
ii. Currently the DoH is trying to encourage placements to still take place
BUT need to ensure students are protected, not put at high risk or high stress and that social distancing and PPE is enforced.
iii. DoH is aware that delay to graduations will have a significant impact health service capacity so is doing its best to ensure that any delays are minimal, especially for nurses and midwives.
f. Are allied health services essential services in residential aged care?
i. Will be answered next week’s DOH webinar. May come to teams of AHPs just working in aged care to reduce risk of infection.
g. Should 30 minutes be the time limit for face-to-face sessions?
i. No limit for sessions but try to keep direct contact with patient to a minimum.
h. What support is available for allied health businesses?
i. Number of measures available. (ESSA has published links to business support available to business owners on the COVID-19 home page.)
j. How do I tell if someone has the virus?
The Communicable Diseases Network Australia (CDNA) has published Coronavirus Disease 2019 (COVID-19) CDNA National guidelines for public health units. Page 3 outlines the criteria for a suspected case.
DoH has released two new resource kits for your use:
1. Video and audio communication materials on mental wellbeing
2. Radio, digital banner, and video for Aboriginal & Torres Strait Islander people and remote communities.
Hand Sanitisers
Many Australian distillers (who would normally make gin) have converted part of their production facilities over to producing hospital grade hand sanitisers. Google what’s available you to locally and support other small businesses that have had to pivot at this time. Check that sanitisers have at least 75% of isopropanol content to meet the World Health Organization’s Alcohol-based Handrub Formulation & Production standards.
News from the National Broadband Network (NBN) Co
1) Collaboration softwares (Zoom, skype for business) are now unmetered through the NBN. Please be aware that connecting through WIFI is not NBN so there will be data charges.
2) The NBN is aware that there is now an increased demand on telehealth services as of Monday when the MBS item numbers were announced. They will keep us abreast of issues that come up and potential solutions as they create them.
3) The NBN has been increased to 40% more than its original capacity. This capacity is currently able to service more than the traffic being experienced at peak hours. As per point 2, this may change.
4) For anyone in rural and remote areas, the Sky Muster download allowance has been doubled.
Please send any member feedback on any NBN issues impacting you or a client/patient to [email protected] so Caroline can raise these issues next Monday 6 April with the NBN.
Business Development
Article “Retool and reboot: How to keep afloat during times of economic crisis” published 1 April, 2020. RESEARCHER Dr Troy Sarina WRITER Michael Yiannakis, Macquarie Business School.
Acts of Kindness
Looking for some positive news? Then check out the Kindness Pandemic, a Facebook forum to share your acts of kindness with the world. It was launched in response to the need for people to see acts of kindness right now by Dr Catherine Barratt, Australian Association of Gerontology (AAG)’s 2019 Glenda Powell Travelling Fellow. The group has grown to over 550,000 members across the world and growing daily.
In response to the virus, the Kindness Pandemic will be focusing on a number of vulnerable groups including older people, who are particularly at risk of COVID-19.