Operations Manual Current as at 01/07/2012
TABLE OF CONTENTS Section One: Purpose of Document 1.1 Introduction......................................... 03 1.2 Background.......................................... 04 1.3 Definitions........................................... 05 Section Two: Preparing for a video consultation 2.1 Technical requirements.................................. 06 2.2 Environmental requirements............................... 08 2.3 Process requirements.................................... 10 2.4 Registering........................................... 11 Section Three: Testing readiness for video consultations 3.1 First-time login........................................ 12 3.2 Pre-testing........................................... 14 3.3 Toolbar summary....................................... 16 Section Four: Joining a video consultation 4.1 Enter my virtual consulting room (Specialist-end)............... 17 4.2 Enter a virtual consulting room (Patient-end)................... 18 Section Five: Medicare telehealth services items 5.1 Overview............................................ 19 5.2 Telehealth Incentives Program............................. 20 5.3 Specialist items........................................ 21 5.4 Support items 5.4.1 GP/Specialist patient-end fees......................... 22 5.4.2 Practice Nurse and Aboriginal Health Worker patient-end fees... 23 5.4.3 Midwifery patient-end fees........................... 23 5.4.4 Nurse Practitioner patient-end fees..................... 24 Section Six: Forms 6.1 Registration form....................................... 25 6.2 Patient evaluation form................................... 26 Section Seven: References Version 5.4 Lower Murray Medicare Local Page 2
Section One: Purpose of Document 1.1 INTRODUCTION In 2010 the Australian Government announced the Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations initiative. This initiative commenced on 1 July 2011 with the release of Medicare rebates and financial incentives to encourage the uptake of online video consultations. Telehealth video consultations provide opportunities for care to be provided utilising additional technologies. However, without a coordinated approach and informed decision-making, general practices may purchase or use solutions that are not fit-for-purpose, and which provide inadequate video and/or audio quality for video consultations. This operations manual is intended to provide health professionals with understandable and easy to interpret instructions on the Medicare Local Telehealth Service. It will be updated regularly as new information becomes available and as the technology evolves. We have taken into account recommendations found on the Royal Australian College of General Practitioners (RACGP) website: www.racgp.org.au/telehealth and the Department of Health and Ageing website: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/content/mbsonlinetelehealth-landing.htm. Lower Murray Medicare Local recommends that health professionals read the Standards for general practices offering video consultations, an addendum to the RACGP Standards for general practices (4 th edition) before deciding to offer video consultations This operations manual will include recommendations on hardware, environment and practice processes needed to conduct video consultations. Version 5.4 Lower Murray Medicare Local Page 3
1.2 BACKGROUND With a shortage of health care workers in many regional and rural towns, the decreasing cost of technology and the introduction of Medicare rebates for online consultations there has been an increased interest in telehealth services. Telehealth offers a potential solution to the challenges of distance, time and institutional structures. The critical role that telehealth can play in expanding the reach of health professionals, and access of patients to them, is becoming more evident. Increased specialist access for populations that experience isolation, such as those living in Broken Hill, Balranald, Mount Gambier and Sea Lake are now possible through the use of video consultations. Video consultations not only reduce the need to travel 100+ kilometers to see a specialist at a regional centre or capital city but also reduces waiting times allowing for improved continuity of care. Often regional and rural areas have a higher concentration of Aboriginal and Torres Strait Islander patients as well as other High Risk groups making it even more critical that we improve access to specialist services. By providing a regionally based solution we are able to guarantee a high Quality of Service that is also secure, reliable and easy to use. The solution involved the purchase of a video routing appliance which is maintained by LMML and hosted at a Data Centre to maximize bandwidth. We are now able to leverage this service to improve access to follow up consultations with visiting specialist services, create links between local health professional and education providers and facilitate multidisciplinary team meetings. Below is a diagram illustrating the service. Version 5.4 Lower Murray Medicare Local Page 4
1.3 DEFINITIONS Telehealth: Healing at a distance. It is the electronic transmission and storage of health information/images in the delivery of both clinical and nonclinical health related services utilising a range of telecommunications technologies VC ready: The necessary hardware, environment and process requirements have been considered and implemented to allow for a successful video consultation Host: A person who initiates a video consultation, a username and password are required to login Invitee: A person who accepts an invitation to join a video consultation, no password is required Invitee email address: The email address assigned to receive invitations from Host s to join a video consultation Room Link: An internet address (URL) generated by a host to allow the assigned invitee access to the Host s private room without requiring a password Private room: A virtual consulting room assigned to each host allowing them to video consult with invitees Meeting room: A virtual consulting/conferencing room created to allow multiple hosts to meet, these rooms require a security PIN code to access Eligible Telehealth Practitioner: For the purposes of receiving financial incentives under the telehealth incentives program and eligible telehealth practitioner is any medical practitioner who is eligible to claim telehealth MBS items. Eligible telehealth practitioners who hold more than one provider number are considered a single eligible telehealth partitioner and are eligible for a single telehealth on-board incentive payment only. Telehealth On-Board Incentive: A one-off Telehealth incentive payment to an eligible Telehealth practitioner which is upon the first occasion that a Medicare benefit is paid for a Telehealth MBS item billed against that practitioners provider number. Eligible Residential Aged Care Facility An eligible residential Aged Care Facility is a facility where care and accommodation are provided to residents under the Aged Care Act 1997 (including Residential Aged Care Services) and which meets the following eligibility requirements: i. possess sufficient equipment and facilities to host a Telehealth consultation; ii. is registered with Medicare Australia; and iii. has been assessed by Medicare Australia as meeting the above eligibility requirements. Eligible Specialist Service Specialist services are eligible telehealth services provided by specialists and consultant physicians to patients: i. in an eligible geographical area; ii. in an Aboriginal Medical Service; or iii. who are care recipients at an eligible residential Aged Care Facility by video conferencing. Patient-end Service Patient-end services are eligible telehealth services provided by a GP, other medical practitioner/ midwife/ nurse practitioner/ practice nurse or Aboriginal Health Worker co-located with a patient who is receiving a specialist service. Eligible Geographical Area An area (outside inner metropolitan) defined as telehealth eligible by the Department of Health and Ageing on the website: www.mbsonline.gov.au/telehealth, and updated from time to time. Version 5.4 Lower Murray Medicare Local Page 5
Section Two: Preparing for a video consultation 2.1 TECHNICAL REQUIREMENTS There are 4 hardware requirements necessary to use the LMML s video consulting service: adequate computer, internet speed, webcam and speakers, once you have completed an assessment on these items we recommend a test video consult to make sure the audio and visual experience is appropriate to your needs. Computer Your computer should be able to provide the additional processing requirement necessary to allow for an adequate video consultation, we recommend as a minimum the following: Core 2 Duo 2.0 GHz processor or above; 1GB of RAM or above; Digital High Definition (HD) Sound Card; Windows XP SP3 or above, Macintosh OS X 10.5 or above. Internet Speed The internet connection should be able to provide an adequate quality patient/healthcare provider video consultation experience without affecting or being affected by the core clinical and administrative functions of the practice IT systems. The size of the practice and its internet usage will impact on the speed and quality of the internet connection needed to provide adequate quality for video consultations. If the connection is shared with multiple internet-enabled devices the amount of traffic on the network will always be a consideration until there is sufficient bandwidth. As a last resort you may need to consider installing a separate, dedicated internet connection to conduct video consultations to avoid a poor Quality of Service. LMML can assist you with choosing an internet plan that will give the best possible video consulting experience. We recommended as a minimum that your internet plan be ADSL2+ Another factor is your distance from the telephone exchange, ADSL speeds fall off rapidly as the distance from the exchange to your modem increases. It is therefore important to complete an assessment of the baseline capacity of your internet connection before deciding to start video consultations. You can test the speed of your current internet connection by going to the following web site: http://www.speedtest.net example of Cable internet speed test example of ADSL2+ speed test To maintain an acceptable Quality of Service we recommend: Download speed > 6.00 Mb/s Upload speed > 0.70Mb/s Version 5.4 Lower Murray Medicare Local Page 6
Webcam / Microphone There are a large range of webcams available in the market place, some of which are unsuitable for use with LMML s video consultations. LMML recommends that you invest in a high definition webcam as it will dramatically improve your video consulting experience. Most webcams built into notebook computers do not meet the minimum requirements set by LMML, therefore we recommend you purchase a separate high definition webcam for your notebook computer. Do not allow a retail sales person to talk you into purchasing an inferior quality webcam. Our minimum requirements are: High definition (HD) 720p video calling; 8 Mega Pixel (MP) photo quality; Autofocus; Built-in mic with echo cancelling properties; Auto light correction; Widescreen video. LMML recommends the following high definition webcam which can be sourced from good retail stores or online: Logitech HD Pro Webcam C920 Recommended retail price $150.00 Speakers / Speakerphone Your speakers should be able to provide the quality and volume of sound required to allow for an adequate video consultation. You can start by trying your existing speakers, however if they are inadequate we recommend stereo speakers with their own power supply and a TRS connection (shown below). The positioning of the speakers in relation to the webcam is crucial to avoid echoing or feedback of sound. Place the speakers parallel to the webcam pointing in the same direction. Do not position the speakers in front of the webcam or point them towards the webcam, this will cause the sound coming through the speakers to be picked up by the webcam microphone and sent back to the source. LMML recommends the ClearOne CHAT 60 speakerphone to give the best possible audio experience. The speakerphone has noise cancellation, a USB connection and can be positioned close to the patient and Doctor ClearOne CHAT 60 Version 5.4 Lower Murray Medicare Local Page 7
2.2 ENVIRONMENTAL REQUIREMENTS A video consultation needs to occur in an appropriate video consulting facility that has the minimum technical requirements (see section 2.1). If the Medical Practitioner considers it clinically appropriate and the patient consents a video consultation can occur. Facilities are encourages to use evaluation forms to collect feedback on the patients experience to help improve their video consultation service, an example of an evaluation form can be found in section 6.3. Appropriate Consulting facilities There are some special factors that need to be considered when setting up a room for video consultations. The following features are suggested: A quiet room where the raised sound associated with video consultations will not be overheard by others or disturb others; Plain décor that will not distract from visual images on the screen or cause the webcam to lose focus; Avoid high intensity light behind the patient, reduce that amount of natural light entering the room while maintaining adequate light for the webcam; Provide a comfortable position for the patient and minimise unnecessary movement; Ensure there is adequate privacy if the patient is required to remove clothing such as a screen or separate area for changing; Ready access to medical equipment that may be needed during a video consultation; Ready access to resources for managing adverse events during a video consultation. Below is a diagram illustrating layouts for patient-end consulting rooms Version 5.4 Lower Murray Medicare Local Page 8
Patient consent LMML encourages practices to give patients information about the purpose, importance, benefits, risks and possible costs associated with a proposed video consultation to enable the patient to make a properly informed decision regarding consent. All parties in the video consultation whether present on or off camera should formally introduce themselves at the commencement of a video consultation. Most patients will feel uncomfortable with seeing themselves on the screen, the patientend supervision needs to make the patient feel relaxed and able to talk. Participants should speak clearly at a normal voice level and allow others to finish before they start speaking. Facilities are encourages to use evaluation forms to collect feedback on the patients experience to help improve their video consultation service. Appropriate supervision Medical practitioners are encouraged to provide appropriate clinical supervision at the patient-end of the video consultation. Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated. Only clinical details recorded at the time of the attendance count towards the time of the consultation. It does not include information added at a later time, such as reports of investigations Below is a diagram illustrating possible scenarios used with video consultations Version 5.4 Lower Murray Medicare Local Page 9
2.3 PROCESS REQUIREMENTS There are many technical factors involved in achieving a successful high quality online video consultation. What should not be overlooked are the human and organisational factors involved including user training, clinical operations, checklists and guidelines, reporting and monitoring. Regular communication is essential to coordinate each parties readiness for the video consultation. LMML recommends that staff who currently control the clinics appointment booking system also coordinate the booking of video consultations. The following needs to occur: 1. The patient-end site contacts the specialist site by phone and requests/ enquires regarding the possibility/readiness of a video consultation; 2. Both sites negotiate appointment day/time allowing for possible delays from either site. The appointment is entered into both sites appointment systems and clearly labelled as a VC (video consultation); 3. When the appointment time arrives the patient-end site enters the specialist s virtual consulting room then contacts the specialist site to confirm readiness. The specialist also enters his virtual room to start the video consult. Both sites communicate any changes or delays that may cause the appointment to be altered or cancelled. Coordination should occur between staff trained on the video consulting system as the time between making the appointment and starting the video consultation can be minutes or months. Parties in a video consultation including the GP (or designated support clinician) and the specialist should introduce themselves at the commencement of the video consultation to confirm their professional identity and speciality, and establish empathetic communication with the patient. Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated. The diagrams below illustrate the processes required: Booking appointment Joining video consultation Version 5.4 Lower Murray Medicare Local Page 10
2.4 REGISTERING To host a video consultation using LMML s video consulting service you are requires to complete our registration form, once approved you will be allocated a login account and added to the LMML s video consulting directory. For a copy of the registration form see section 6.1. The registration form allows us to: Ensure the service is used appropriately to the maximum benefit of patients living in our region; Ensure that the quality, reliability and security of the service is of the highest possible standard; Create a video consulting directory of sites and practitioners that are able to communicate via audio visual technologies; Clearly define the roles and responsibilities of each participant in a video consultation. Once registered you will be able to: Login, enter your own virtual consulting room (Specialist-end); Login, enter another virtual consulting room (Patient-end). The diagram below illustrates the processes: Version 5.4 Lower Murray Medicare Local Page 11
Section Three: Testing readiness for video consultations 3.1 FIRST-TIME LOGIN 1. Navigate to the following website: http://video.malleehcn.com.au 2. Enter your login details. 3. Click the Log In button. The installation web page appears. 4. Click the Install VidyoDesktop button to install the VidyoDesktop software. You first see the following Security Warning Version 5.4 Lower Murray Medicare Local Page 12
5. Click the Run button. You then see the following progress screen The installer guides you through the installation process screen by screen, which takes just a few minutes. Since this is the first time you re installing VidyoDesktop (You may have to install it again if the system is updated with a later version) you will first be prompted to read and accept the licensing agreement. 6. If asked, click the I Agree button and complete the remaining installation steps. Version 5.4 Lower Murray Medicare Local Page 13
7. Click the Finish button. 3.2 PRE-TESTING If you have just completed section 3.1 First-time login skip to step 5. 1. Make sure the VidyoDesktop software is running on your taskbar, you should see the following icon. If not click VidyoDesktop from your Programs menu, if you do not have VidyoDesktop installed see section 3.1 first-time login 2. Navigate to the following website: http://video.malleehcn.com.au 3. Enter your login details. 4. Click the Log In button. Enter your virtual consulting room Version 5.4 Lower Murray Medicare Local Page 14
5. Click the My Room button. 6. Click the Join Room button. You will be prompted to select the webcam, microphone and speakers you want to use for your video consultation. Make sure that Echo Cancellation and Auto Adjust Microphone Level are ticked 7. Click the Save button. You should now see yourself in your virtual consulting room. If not contact Troy Bailey at LMML for assistance 8. Check the direction of the webcam and visual aesthetics of your room to ensure optimum viewing, see section 2.2 for environmental requirements. The audio settings will adjust automatically to suite the room. Version 5.4 Lower Murray Medicare Local Page 15
3.3 TOOLBAR SUMMARY This summary describes the VidyoDesktop toolbar icons that appear once you have entered your virtual consulting room (as they appear from left to right): Layout Full Screen Share Toggle Self View Speaker Microphone Privacy Dialpad FECC Configuration Disconnect Change screen layout (Only functions with 3+ participants). Allows you to fill your whole screen with the webcam image. Clicking on the Full Screen button toggles the screen between sizing the window to utilise the entire screen real estate and restoring the window to the previous size. Share any application window running on your computer with those in your virtual consulting room, including your patients medical record. Toggle among shared applications windows. Turn On/Off Self-view (the ability to see yourself), including Picture-in- Picture (PiP). Speaker volume up/down and muted. Microphone volume up/down and muted. Toggles your camera On and Off. Feature is unavailable. Feature is unavailable. Allows you to change some of the technical specifications of your VidyoDesktop software, we recommend you leave the default settings unless advised by LMML. Exit the video consultation and close the VidyoDesktop program Version 5.4 Lower Murray Medicare Local Page 16
Section Four: Joining a video consultation 4.1 ENTER MY VIRTUAL CONSULTING ROOM (SPECIALIST-END) 1. Make sure the VidyoDesktop software is running on your taskbar, you should see the following icon. If not click VidyoDesktop from your Programs menu, if you do not have VidyoDesktop installed see section 3.1 first-time login 2. Navigate to the following website: http://video.malleehcn.com.au 3. Enter your login details. 4. Click the Log In button. 5. Click the My Room button. 6. Click the Join Room button. You should now see yourself in your virtual consulting room, if not contact Troy Bailey at LMML for assistance. When others join your virtual consulting room you will hear an audible tone followed by their image on the main window, see section 3.3 for a summary of the toolbars. LMML produces a video consulting directory listing those health professionals who have registered for this service and are VC ready. Version 5.4 Lower Murray Medicare Local Page 17
4.2 ENTER A VIRTUAL CONSULTING ROOM (PATIENT-END) 1. Make sure the VidyoDesktop software is running on your taskbar, you should see the following icon. If not click VidyoDesktop from your Programs menu, if you do not have VidyoDesktop installed see section 3.1 first-time login 2. Navigate to the following website: http://video.malleehcn.com.au 3. Enter your login details. 4. Click the Log In button. Type the first name of the clinician you wish to video consult with, their full name should then appear under Suggestions: 5. Click the Clinician s name 6. Click the Join Room button You should now see yourself in the virtual consulting room, if not contact Troy Bailey at LMML for assistance. When others join then virtual consulting room you will hear an audible tone followed by their image on the main window, see section 3.3 for a summary of the toolbars LMML produces a video consulting directory listing those health professionals who have registered for this service and are VC ready. Version 5.4 Lower Murray Medicare Local Page 18
Section Five: Medicare telehealth services items 5.1 OVERVIEW The Australian Government has committed to providing Medicare rebates and financial incentives for online consultations across a range of medical specialties under the Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations initiative. The initiative will address some of the barriers to accessing medical services, and specialist services in particular, for Australians in remote, regional and outer metropolitan areas. The initiative includes: Telehealth MBS Items; Financial Incentives; and Training and supervision for health professionals using online technologies. Telehealth MBS Items Specialist items From 1 July 2011, 11 new MBS items will be available for telehealth consultations provided by specialists, consultant physicians and consultant psychiatrists with a patient. Telehealth MBS Items Support items From 1 July 2011, 23 new MBS support items will be introduced for Patient-end Services. These will enable GPs, specialists, nurse practitioners, midwives, aboriginal health workers and practice nurses to provide face to face clinical services to the patient during the video consultation with a specialist. Incentive Program A range of financial incentives will be introduced from 1 July 2011 to encourage and support the provision of telehealth services to Australians in Eligible Geographical Areas and in Residential Aged Care Facilities (RACFs) and Aboriginal Medical Services throughout Australia. Specifically, the incentives encourage: Eligible telehealth practitioners to provide eligible telehealth services to their patients; and RACFs to provide Hosting Services to their residents. Five types of incentives are available for practitioners and RACFs: telehealth On-Board Incentive; telehealth Service Incentive; telehealth Bulk Billing Incentive; RACF On-Board Incentive; and telehealth Hosting Service Incentive. Each of these incentives will be expanding on within the context of each health professional in the following sections. For a detailed explanatory of the relevant telehealth MBS Items visit MBS online at http://www.mbsonline.gov.au/telehealth. Version 5.4 Lower Murray Medicare Local Page 19
5.2 TELEHEALTH INCENTIVES PROGRAM The following service incentives do not require submission of an application or claim form. Medicare Australia will automatically determine eligibility based on Medicare claiming information, and make incentive payments to the bank account listed for the relevant provider number. On-Board Incentive A telehealth on-board incentive is a time limited, two installment payment which is made to an eligible telehealth practitioner. The first telehealth on-board incentive installment will be paid to an eligible practitioner after the first valid telehealth MBS claim is processed against a practitioner s provider number. The second installment will be paid after the tenth valid telehealth MBS claim is processed. Telehealth on-board incentive payments will be calculated using the amounts outlined below Incentive 2011-12 2012-13 2013-14 First Telehealth On-Board installment $6,000 $1,600 $1,300 Second Telehealth On-Board installment $3,200 $2,600 Service Incentive A telehealth service incentive is a time-limited, per service payment to encourage eligible practitioners to continue to provide eligible telehealth services. A telehealth service incentive will accrue to a practitioner each time a Medicare benefit is paid for telehealth MBS item billed against a practitioner s provider number, a single payment will be made once per payment quarter. Telehealth service incentive payments will be calculated using the amounts outlined below Incentive 2011-12 2012-13 2013-14 Telehealth Service Incentive (specialist) $60 $48 $39 Telehealth Service Incentive (Patient-end) $40 $32 $26 Bulk Billing Incentive A telehealth bulk billing incentive is a time-limited, per service payment to encourage eligible practitioners to bulk bill telehealth consultations. A telehealth bulk billing incentive will accrue to a practitioner each time a telehealth MBS item is bulk billed against a practitioner s provider number. Telehealth bulk billing incentives accrue to a practitioner each time a telehealth MBS item is bulk billed by a practitioner; a single payment will be made once per payment quarter. Telehealth bulk billing incentive payments will be calculated using the amounts outlined below Incentive 2011-12 2012-13 2013-14 Telehealth Bulk Billing Incentive $20 $16 $13 RACF On-Board Incentive A RACF on-board incentive is a one-off payment which is made to an Eligible RACF to encourage the provision of appropriate facilities and resources to host telehealth consultations. RACFs applying for this incentive will need to have provided at least one hosting service and then submit the RACF Application for On Board Incentive Payment. RACF On-Board Incentive payments will be calculated using the amounts outlined below Incentive 2011-12 2012-13 2013-14 RACF On-Board Incentive $6,000 $4,800 $3,900 Hosting Service Incentive A telehealth hosting service incentive is a time-limited, per service payment to encourage eligible RACFs to provide ongoing hosting services. RACFs will need to provide evidence of having provided hosting services through a claim form submitted to Medicare Australia. Telehealth hosting service incentive payments will be calculated using the amounts outlined below Incentive 2011-12 2012-13 2013-14 Telehealth Hosting Service Incentive $60 $48 $39 Version 5.4 Lower Murray Medicare Local Page 20
5.3 SPECIALIST ITEMS Telehealth MBS Items The 11 new specialist telehealth items specified in the MBS will enable eligible telehealth services to be provided in conjunction with 55 existing Medicare specialist consultation items. These new items must be billed in association with one of the existing Medicare items as stipulated in the new telehealth item descriptor outlined below. The fee for the new specialist items are derived by reference to the fee for the associated existing item that the item is rendered with, being 50% of the associated item. The augmented fee recognises that the provision of a professional attendance via video conferencing involves increased administrative and professional complexity. Specialty Associated Existing Item Telehealth Item = %50 Specialist 104, 105 99 Consultant physician 110, 116, 119, 132, 133 112 Geriatric medicine 141, 143 149 Psychiatry 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350, 352 288 Occupational medicine 385, 386 389 Pain medicine 2801, 2806, 2814 2820 Palliative medicine 3005, 3010, 3014 3015 Neurosurgery 6007, 6009, 6011, 6013, 6015 6016 Assisted reproductive 13209 13210 services Obstetrics 16401, 16404, 16406, 16500, 16590, 16591 16399 Anaesthesia 17610, 17615, 17620, 17625, 17640, 17645, 17650, 17655, 17690 17609 Example of fees reimbursed for a single professional attendance by video consultation Telehealth Item Medicare Fee 105 Subsequent professional attendance where the patient is $42.20 referred 99 Professional attendance via video conference $21.10 Auto Telehealth service incentive, paid quarterly $48.00 Auto Telehealth bulk billing incentive, paid quarterly $16.00 Total $127.30 WARNING Medicare Australia requires a patient signature when claims are lodged manually paper, if you send in claims without a patient signature they will be rejected even though you are claiming a telehealth item number. How do I manually bulk bill my patient when they are not present? Step one: Advise the patient that they need to verbally agree to assign the benefit and reply to an email detailing the service. Step two: Send an email to the patient confirming the details of the service and seeking agreement to assign the benefit, which they must reply to. Step three: Complete a bulk bill assignment form noting email agreement in the signature block, send a copy to the patient and keep the email containing the patients consent for a period of two years Minimum distance requirement From the 1st November 2012, the MBS telehealth items will require that the patient and remote specialist be at least 15kms apart. This minimum distance requirement does not apply to residents of Aged Care Facilities or patients of an Aboriginal Medical Service. Version 5.4 Lower Murray Medicare Local Page 21
5.4 SUPPORT ITEMS 5.4.1 GP patient-end fees Telehealth MBS Items The 12 new telehealth support items specified in the MBS will enable eligible patient-end support services to be provided by GP or specialist during a video consultation with a specialist or consultant physician. These new items are time-tiered consultations with a fee provided recognising the added complexities involved in providing a supporting attendance for a specialist video consultation. The patient MUST be physically with the GP to be eligible to claim the telehealth MBS items listed below Telehealth Item Medicare Fee Time Based General Attendance Item Descriptors 2100 Level A $22.05 2126 Level B $48.05 Telehealth attendance at consulting rooms 2143 Level C $93.20 2195 Level D $137.10 2122 Level A Derived 2137 Level B fee % Telehealth attendance other than at consulting rooms 2147 Level C patients 2199 Level D seen 2125 Level A 2138 Level B 2179 Level C 2220 Level D Telehealth attendance at a Residential Aged Care Facility Derived fee % patients seen Example of fees reimbursed for each 15 minute video consultation with a specialist when the patient is present in the room Telehealth Item Medicare Fee 2126 Telehealth attendance at consulting rooms < 20mins $48.05 Auto Telehealth service incentive, paid quarterly $32.00 Auto Telehealth bulk billing incentive, paid quarterly $16.00 Total $96.05 Version 5.4 Lower Murray Medicare Local Page 22
5.4.2 Practice Nurse and Aboriginal Health Worker patient-end fees Telehealth MBS Items The 2 new telehealth support items specified in the MBS will enable eligible patient-end support services to be provided by a practice nurse or aboriginal health worker on behalf of a GP/specialist during a video consultation with a specialist or consultant physician. These new items recognise the added complexities involved in providing a supporting attendance for a specialist video consultation. The patient MUST be physically with the practice nurse or aboriginal health worker to be eligible to claim the telehealth MBS items listed below Telehealth Item Medicare Fee General Attendance Item Descriptors 10983 Telehealth support service on behalf of a medical practitioner $31.80 10984 Telehealth support service on behalf of a medical practitioner at $31.80 a Residential Aged Care Facility Example of fees reimbursed for each 15 minute video consultation with a specialist when the patient is present in the room Telehealth Item Medicare Fee 10983 Telehealth support service on behalf of a medical practitioner $31.80 Auto Telehealth service incentive, paid quarterly $32.00 Auto Telehealth bulk billing incentive, paid quarterly $16.00 Total $79.80 5.4.3 Midwifery patient-end fees Telehealth MBS Items The 3 new telehealth support items specified in the MBS will enable eligible patient-end support services to be provided by a midwife during a video consultation with an Obstetrician or Paediatrician. These new items are time-tiered consultations with a fee provided recognising the added complexities involved in providing a supporting attendance for a specialist video consultation. The patient MUST be physically with the midwife to be eligible to claim the telehealth MBS items listed below Telehealth Item Time Based General Attendance Item Descriptors Medicare Fee 82150 Telehealth attendance lasting < 20 minutes $27.75 82151 Telehealth attendance lasting < 40 minutes $52.70 82152 Telehealth attendance lasting > 40 minutes $77.50 Example of fees reimbursed for each 15 minute video consultation with a specialist when the patient is present in the room Telehealth Item Medicare Fee 82150 Telehealth attendance lasting < 20mins $27.75 Auto Telehealth service incentive, paid quarterly $32.00 Auto Telehealth bulk billing incentive, paid quarterly $16.00 Total $75.75 Version 5.4 Lower Murray Medicare Local Page 23
5.4.4 Nurse Practitioner patient-end fees Telehealth MBS Items The 6 new telehealth support items specified in the MBS will enable eligible patient-end support services to be provided by a nurse practitioner during a video consultation with a specialist or consultant physician. These new items are time-tiered consultations with a fee provided recognising the added complexities involved in providing a supporting attendance for a specialist video consultation. The patient MUST be physically with the nurse practitioner to be eligible to claim the telehealth MBS items listed below Telehealth Item Medicare Fee Time Based General Attendance Item Descriptors 82220 < 20 minutes $27.75 82221 Telehealth attendance < 40 minutes $52.70 82222 > 40 minutes $77.50 82223 < 20 minutes $27.75 Telehealth attendance at a Residential Aged 82224 < 40 minutes $52.70 Care Facility 82225 > 40 minutes $77.50 Example of fees reimbursed for each 15 minute video consultation with a specialist when the patient is present in the room Telehealth Item Medicare Fee 82220 Telehealth attendance lasting < 20mins $27.75 Auto Telehealth service incentive, paid quarterly $32.00 Auto Telehealth bulk billing incentive, paid quarterly $16.00 Total $75.75 Version 5.4 Lower Murray Medicare Local Page 24
Section Six: Forms 6.1 Registration form To use the Medicare Local Telehealth Service complete this form and return to Lower Murray Medicare Local (LMML) by email or fax. LMML will contact you to ensure you are telehealth ready and provide you with a login account. LMML recommends that health professionals read the RACGP Standards for general practices offering video consultations before deciding to offer video consultations. (http://www.lowermurrayml.com.au/e-health.html) Organisation Name Address Phone Fax Email Provider Title First name Last name Profession Email Equipment Internet type (eg. ISDN, ADSL, Cable) Speed test using http://www.speedtest.net Webcam (make, model) Download Mb/s Upload Mb/s Ping ms Purpose of Service Due to potential bandwidth limitations at each endpoint of the video consultation we prefer to allocate one login account per organisation, this means that only one video consultation may be active at any time from your organisation. More login accounts may be allocated if your internet speed test is above average or you operate from multiple sites. If accepted we will provide you with login details to the service and assist with the technical, environmental and process requirements. After completing a successful test video consult you will be added to our telehealth directory. We recommend you read through the LMML s Operations Manual before using the service. (http://www.lowermurrayml.com.au/e-health.html) It is the responsibility of each health professional to determine if a video consultation is appropriate and to obtain the patients consent. Each health professional is responsible for their own risk management protocols, privacy and security of the consultation and data. Signature Version 5.4 Lower Murray Medicare Local Page 25
Patient Evaluation Form Section 6.2 Date Please rate your level of agreement with the following statements. There is no right or wrong answer. We are interested in feedback that will help us improve our video consultation systems. Thank you for taking a few minutes to complete this evaluation form. No. Statement Strongly disagree Disagree Neutral Agree Strongly agree 1 I received the same standard of care from my video consultation as I would have from a face-to-face consultation. 2 The video consultation was convenient for me (eg. saved me travel costs, saved me taking a day off work, was easier to manage because I have limited mobility). 3 I felt well prepared for the video consultation. 4 I would be willing to participate in another video consultation if my doctor considered it appropriate. 5 How could we improve our video consultation service? Thank you for taking the time to complete our questionnaire we value your feedback. Current as at 01/07/2012
SECTION SEVEN: REFERENCES 1. RACGP. Telehealth standards for general practices on the use of video consultation, background paper, July 2011 2. RACGP. The RACGP implementation guidelines for video consultations in general practice, A Telehealth initiative, August 2011 3. RACGP. Standards for general practices offering video consultations, An addendum to the RACGP Standards for general practices (4 th edition), October 2011 4. MBS online, Medicare Benefits Schedule, Telehealth Program Guidelines: MBS Items and Financial Incentives for Telehealth 5. VidyoConferencing Administrator s Guide, Document Version 2.1-C Current as at 01/07/2012