The Federal government may have decided against introducing a Medicare item for optometrists engaging directly with patients via telehealth without an ophthalmologist’s participation, but that should not stop optometrists from offering the service, according to platform developers.
Ongoing consumer fear of visiting healthcare practices due to the COVID-19 pandemic, an ageing, less mobile population, and Australia’s vast geography, are all arguments being put forward. Additionally, according to Klaus Bartosch, CEO of 1st Group which owns MyHealth1st, consumers who have experienced the convenience of telehealth simply don’t want to return to the old days of attending unnecessary physical appointments.
with the right funding models and systems in place, a lot of pressure could be taken off the public system by using the huge number of highly skilled optometrists and ophthalmologists in cities and communities
SYNCHRONOUS AND ASYNCHRONOUS
There are essentially two forms of telehealth: synchronous and asynchronous consultations. Synchronous telehealth is when a patient directly connects with a doctor or specialist via teleconferencing, video chat or over the phone. Asynchronous telehealth refers to ‘store and forward’ – the health practitioner captures images or video of a patient to send to a specialist for further analysis.
MyHealth1st recently launched its end-to-end encrypted, browser-based telehealth service (Easy Telehealth) which enables up to four participants to engage in a phone or video consultation at one time, and securely share and notate information then save it to an external file. Most recently, the service has been added to with an online billing system (MyHealth payments), enabling practitioners to charge at the time of the consultation.
One of the reasons the Federal Government cited for refusing a Medicare number for tele-optometry was the expectation that online consultations would lead to physical consultations, both of which would be billed to Medicare, significantly raising costs. However Mr Bartosch says optometrists should not necessarily assume that every teleoptometry consultation should be billed. He said free teleoptometry consults, during which patients are welcome to ask questions about their eye condition/ issues with spectacles etc. will, in many cases, result in better care, greater patient loyalty, and become the precursor to a billable consultation.
“We’re heading into a very difficult economic time. Post the national COVID-19 lockdown, optometrists experienced a spike in consultations and business due to pent up demand, but that’s going to flatten. With high unemployment and low spending, we’re going to need to look for a new way to do business.
“So we need to put ourselves in the patients’ shoes and ask ourselves what is it that they want? Anecdotal evidence tells us they want to feel more looked after by their healthcare practitioners but they do not want to return to the old days of coming into practices unnecessarily – practices are seen as hotspots for infection.”
Mr Bartosch said 500 of the 1,200 optometry practices using MyHealth1st’s booking platform are now offering its teleoptometry service – second only to psychologists in terms of adoption across the organisation’s client base.
“The corporates and smaller innovative practices were quick to take it up and equally quickly, they’ve realised that teleoptometry is here to stay – even if they’re only currently booking one teleoptometry consultation a week, it needs to be part of their mix.
“Those who have reached out to patients that need support to manage their health conditions have found the platform particularly beneficial for all parties,” he said. “Nine out of ten teleoptometry consults have led to a billable consultation”.
According to Optometry Australia (OA), in 2019 just 630 of the 10 million optometry services provided by Australian optometrists were telehealth consultations. The majority of these were delivered in Western Australia where the service is necessitated by geographic distance between health care and remote communities. While telehealth consultation figures are unavailable for 2020, of those optometrists who provided the service during the COVID-19 pandemic, an OA survey found 40% intended to continue telehealth for at least some appointments after the pandemic was over, 49% were unsure, and just 11% did not intend to continue with telehealth.
OCULO AND OPTOMETRY AUSTRALIA
Oculo recently launched a teleoptometry service, and in partnership with OA, offered OA members free access to the technology for the remainder of 2020.
CEO Dr Kate Taylor said the service is both synchronous and asynchronous. “While Oculo is often known for its referrals, our vision of ‘eye care connected’ has always been to securely share clinical data. The platform enables the remote capture of images and other eye health diagnostic information, which is stored and transferred to another eye health professional in another location for their review. This is asynchronous or ‘store and forward’ telehealth.
“What’s new and was accelerated by COVID-19, is video consultations – also known as synchronous telehealth. This became a priority for our customers and their patients as things were being locked down as a result of COVID-19. “While patients are terrified of losing sight, we could see how worried everyone was by COVID-19 and the likelihood that patients would defer critical care. We accelerated our video feature in response so eye care professionals could continue to provide patient care and maintain their relationships with patients.”
Dr Taylor said the take-up of telehealth is hardly surprising and we can expect it to grow. “I’m going to use the word that may seem tired-out given the last months – this situation was so unprecedented, that we really did not know what to expect. Over the course of April and May, when the situation was most acute, we saw steady usage from both optometrists and ophthalmologists as people initially became accustomed to video consultations.
“As restrictions started to be lifted in late May and June, we saw a fairly rapid reduction in the number of tele-consultations in Australia. In other geographies, like the US and UK, where recovery from COVID-19 has not been as rapid, we see an ongoing and in some instances, a growing need for video consultations and telehealth more broadly.”
She believes Australia can do much more to leverage telehealth. “We have been a part of numerous conversations with different stakeholder groups in eye care in Australia about using telehealth to facilitate better co-management between optometrists and ophthalmologists. Oculo can support in a number of ways. One is our core store and forward capability, enabling the exchange of clinical information, including images, between practitioners. A second is by allowing practitioners and patients to be present on video consultations together to collaborate on care.
“We also think that with the right funding models and systems in place, a lot of pressure could be taken off the public system by using the huge number of highly skilled optometrists and ophthalmologists in cities and communities around Australia, in collaboration with doctors in the public system.
“We think this will be helped as tools come to market to give robust clinical information to inform virtual care. This should help make the case for changes to funding models. It may not happen overnight, but progress is already trending in this direction.”
Lyn Brodie, CEO of OA, said the Association will continue to explore the potential for teleoptometry to enhance deliver of optometry services. “Optometry Australia offered members the Oculo telehealth service free for the remainder of the year well before it was clear the Commonwealth wouldn’t provide MBS support for optometry provided via telehealth. This was because we recognised that teleoptometry was likely to be necessary to meet patients’ needs during the pandemic period. While we know many optometry practices offered telehealth during the pandemic period, we believe it is likely teleoptometry may have been more extensively offered and used if it was supported by a MBS rebate.”
“We are carefully considering the potential role teleoptometry may be able to play in helping ensure patients have access to timely care, particularly in rural and remote areas, and will plan any further advocacy accordingly. We believe that across the health system we are likely to see greater usage of telehealth, following the pandemic.”
Given a Medicare rebate is not currently available, OA has published recommended fees for private billing of telehealth services. Visit optometry.org.au.