COVID-19 and telehealth: Department of Health implementation questioned in audit

In March 2020 the Australian government, led by then-prime minister Scott Morrison, expanded Medicare rebates for telehealth services for vulnerable Australians.

The implementation occurred less than two months after COVID-19 was declared an emergency on January 21.

This was then extended to all Australians in April of that year.

The introduction of permanent rebated telehealth services in January 2022 was described as the "most significant structural reform to Medicare since it began" in the 2022-23 budget.

The Department of Health and Aged Care called the change "10 years of reform in only 10 days".

The value of benefits paid for telehealth services skyrocketed by nearly 800 million dollars after the expansion was put into force.

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Despite this, an Auditor-General report found "there were shortfalls in the governance, risk management and evaluation of the expansion".

The report said advice given about the expansion did not adequately assess risks, such as Medicare fraud.

It did not prepare for the permanent implementation of telehealth or provide mechanisms for monitoring the success of the expansion.

State and territory governments "were largely not consulted on the details of changes to MBS items".

However, the Auditor-General also said "the temporary and permanent expansion of [Medicare Benefit Schedule] MBS telehealth items was informed by largely robust policy advice and planning".

While the cost of telehealth services to Medicare has dropped since COVID-19 lockdowns have ended, they remain popular.

The value of benefits was ten times higher in the last three months of 2021-22 compared to the quarter pre-pandemic.

The proportion of MBS services claimed through Medicare from April to June 2020 was 16.5 per cent, compared to only 0.06 per cent the previous year.

This was even higher for general practice at 31 per cent, compared to 0.04 per cent in the same months of 2019.

Midwifery services were added in March 2020, followed by specialist items in April.

The permanent funding of telehealth services through Medicare began on January 17, 2022.

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Australian Medical Association president Dr Omar Khorshid said at the time: "Expanding access to telehealth is an overdue reform, which brings Medicare into the 21st century."

Medical professionals who can provide at least some services via telehealth from July 2022 include general practitioners, psychologists, midwives, allied health professionals, paediatricians, neurosurgeons, and nurse and dental practitioners among others.

Three out of four recommendations made by the auditor-general have been accepted by the health and aged care department.

They have agreed to strengthen systems of control for the implementation, including planning for performance evaluation; develop procedures to ensure changes to the MBS are subject to risk assessments; and finalise plans to evaluate permanent telehealth.

The department has also agreed in principle to consider lessons learned for future pandemics as part of a broader review into the COVID-19 response.