The AACP made a submission in relation to the Department of Health and Ageing's (DoHA) discussion paper "Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations".  Thank you to the many members that provided details on how prepared your practice is for the introduction of e-consultations. 

The AACP's submission included recommendations that:

• there be Medicare rebates for both phone and "asynchronous" consultations as part of the e-consultation initiative.
• resources are made available to CPPs to support wider implementation of e-health and e-consultations.
• existing Medicare fee relativities between CPP, specialist and GP items be maintained in relation to e-consultation.
• that appropriate documentation, along the lines of a "discharge summary" generated in relation to an e-consultation, case conference or telephone enquiry be considered appropriate for the purposes of eligibility for Medicare rebates under the e-consultation initiative.
• Medicare fees for e-consultation reflect the clinical requirements of the service provided, acknowledge the complexities associated with undertaking a consultation when the patient is not physically present and reflect the costs of installing and maintaining appropriate technology for undertaking e-consultations.

The AACP does not support the view that e-consultations are a replacement for normal face-to-face consultations between a CPP and the patient, but rather that e-consultations offer a valuable additional consultation option when the patient may otherwise have difficulty getting to see a CPP (e.g. because of the patient's location or ability to travel) or for a follow up consultation that avoids a day of travel for the patient, or to confirm (or avoid) the need for urgent transfer of a patient.  The Government has indicated that e-health (including e-consultations) will be implemented from 1 July 2011.  

The AACP is involved in the ongoing discussions on both e-consultations and the PCEHR (see later item) to ensure that the views of CPPs are represented.  The AACP has ensured that our CPP attendance items are included in the e-health arrangements.

We wish to reassure all our members that the AACP continues to push for a number of MBS items to support quality CPP practice and provide appropriate rebates to patients for these services; this includes an item for seeing patients with very complex conditions and support for practice nurses in CPP practices.  E-consultations are but one such option that may be of assistance to some of our members and their patients.

For those members who are or will be involved in telemedicine, from 1 July 2011 there is expected to be: 

• Resources to assist CPPs in establishing themselves for e-consultations; and
• Medicare fees that acknowledge the ongoing cost of the technology that is required to effectively participate in e-consultations. 

Guidelines relating to the technological side will not be available from the DoHA until close to the implementation date; as soon as further information is available, the AACP will pass it on.  

A Medicare item for phone consultations is not included in the program to be implemented from 1 July 2011.  The inclusion of phone consultations in this program has not been ruled out and the AACP has also sought further discussions with the DoHA after 1 July on this matter.  

Similarly, it is recognised that there are valid reasons for participation of a CPP in an asynchronous consultation - that is, where a CPP may not be able to participate in a three-way consultation due to scheduling, it is possible to review a range of documentation and test results, and conclude the consultation at a later stage.  There is no provision at present for a Medicare item for asynchronous consultation, but there are situations where such an approach would be appropriate and the AACP will continue discussion on this matter as well.  

Scheduling of appointments for e-consultations is recognised as one of the difficult aspects for all participants, but particularly for CPPs and specialists, whose appointments are usually filled weeks, and sometimes, months ahead.  Government needs to expand the options available for patients to see CPPs, without adversely affecting existing attendance arrangements.  

View our submission here.

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From 1 July 2012, patients can ask for a PCEHR to be created for them.  This is another initiative of the Government, which has committed significant funds to the development of PCEHR for Australian patients. 

Unless Government changes its position on this mater in the next 12 months, the PCEHR will be an "opt in" arrangement so initial take up is not expected to be more than about 10 per cent of patients.  It is unlikely that patients will request a CPP to take prime responsibility for creating a PCEHR; GPs are being promoted as having prime responsibility for this.  However, over time, when a CPP sees a patient who has a PCEHR, they will need to be able to both have access to that record and to enter information so it will be necessary to have a suitable level of information technology capacity within the practice to do this.