The case for TeleHealth Medicare item numbers being made available for Inpatients

facilitating psychiatric care of people with mental health conditions whilst admitted to hospital

Psychiatry is the best positioned, out of all the medical specialities, to provide care that is delivered as much as possible via TeleHealth and telephone during the COVID-19 pandemic. It makes most sense to utilise this method for the sake of patient safety, psychiatrist safety and community safety.

Despite the RANZCP writing to Minister Hunt on 6 March 2020 requesting that TeleHealth should be urgently implemented for people living in the cities, as it has been for non-urban people for 10 years, the response by the Government since 13 April 2020 has been to drip-feed, partial, patchy capacity in a stepwise manner.

This has led to the outrageous discrimination against the most “vulnerable” groups who the Government had publicly argued it was looking out for in developing this policy (children under 16, pregnant women, women with infants under 1, those over 70, those immunocompromised or with chronic severe health conditions, people in isolation with suspected COVID-19), undermining the viability of many practices and causing unnecessary financial and mental distress across the entire medical and allied health mental health provider community, causing distraction from the real battle — World War C.

Constant appeals were made to Government to rectify the gaps by multiple stakeholders. Whilst they lifted billing restrictions for “vulnerable” groups on 20 April 2020 by specialist and consultant physicians, nurse practitioners, midwifes and allied health practitioners, they did not lift those restrictions from GPs.

And, believe it or not, as of some two months after the initial letter of appear that was made, there remains no capacity for conducting inpatient Telehealth under Medicare or supported by most health insurers. Here are some specific arguments showing that it has been a foolish mistake for the Federal Government to have ignored the advice of the RANZCP and front-line psychiatrists from NSW and Victoria (see references) to expand the Medicare item numbers to all patients including inpatients for psychiatric care:

  • Psychiatrists are reporting a daily increase in new patient referrals due to heightened anxiety and exacerbation of pre-existing anxiety and other mental health conditions.
  • Patients admitted a private hospital require regular review and some of these services would have been more safely undertaken by TeleHealth, based on clinician assessment.
  • Having comorbid mental and physical conditions is well known to be a frequent co-occurrence and many people in hospital with COVID-19 or for other reasons are at risk of developing a mental disorder or relapsing. Psychiatrists should have been able to assess these patients without putting themselves and broader society at risk by unnecessarily attending a highly contaminated hospital environment.
  • Many psychiatrists work across public and private inpatient settings, so are high risk vectors for taking virions from public more medical settings that are dealing with COVID positive admissions, into private inpatient settings, where it could spread rapidly in inpatient communities. Or vice versa. Because private hospitals are not obliged to stay open, some may close if they get a COVID-19 case. This has now happened with one of Victoria’s largest private psychiatric hospitals.
  • Inpatient treatment is qualitatively of high importance as it is treating the more acute, symptomatic and behaviourally disturbed patients, and hence of high importance to minimise community transmission of COVID-19. Hospitals are hot spots for COVID-19 so this is about preventing all community transmission.
  • Not having access to TeleHealth for inpatients has resulted in some clinicians doing less inpatient work, especially psychiatrists with risk factors to COVID19, and this has put extra pressure on those that are willing to provide inpatient care, which is not sustainable. This may also increase the risk of some hospital units closing due to lack of admitting psychiatrists available.
  • Seeing patients via video-conferencing requires no masks, which is much more personable and hence appropriate for psychiatric consultations and can save the use of masks enabling more to be available for F2F healthcare. As well as providing safer care for patients and their families, these proposed measures would contribute towards protecting staff of private hospitals, other mental health professionals and support workers, as well as psychiatrists themselves.

References RANZCP: