Changes to practitioner indemnity cover for the telehealth services offered by many GP practices have been announced by the insurance industry.
Ms Georgie Haysom, General Manager of Advocacy Education and Research at Avant, said that from 1 January 2023, there was no indemnity for civil claims where telehealth services were provided based on the electronic transmission of medical images and/or patient data (including online questionnaires and/or text-based chat) involve the provision of a prescription, a medical certificate, a pathology or radiology request, or a referral to a health practitioner.
“Avant’s claims experience and identification of risks associated with these types of services has prompted these policy changes,” she said.
While recognising that telehealth has become an essential part of healthcare delivery, Ms Haysom said that Avant was committed to supporting the provision of telehealth that met ‘the same standards of care as the provision of in person healthcare.’
Avant will continue to provide cover for telehealth services where a medical practitioner has previously undertaken an in-person medical consultation, telephone, or videoconference call with the patient.
“We will also provide cover where an in-person medical consultation has been performed by another medical practitioner and there is a written agreement with the medical practitioner and/or the medical practice where the in-person medical consultation took place and there is access to all patient medical records,” Ms Haysom said.
“Cover is subject to the terms, conditions and exclusions in the policy.”
Ms Haysom also highlighted that MDOs such as Avant have welcomed the Medical Board of Australia’s recent public consultation on draft revised guidelines for telehealth consultations.
The draft guidelines emphasise that doctors should continuously assess the appropriateness of the telehealth consultation and whether a direct physical examination of the patient is necessary and provide new guidance on prescribing for patients with whom the doctor has not previously consulted.
Avant has made a submission to the consultation supporting the update to the guidelines which stressed that that convenience should not be given a higher priority than quality of care.
“Our submission supports the broad concept that, ‘The standard of care provided in a telehealth consultation must be safe and as far as possible meet the same standards of care provided in a face-to-face consultation,’” Ms Haysom said.
“The submission voiced our support for doctors to convert from telehealth to face-to-face consultations if clinically indicated. We also called for enhanced guidance around the requirements for doctors when an in-person examination is needed.”
Avant surveyed its members in September 2020, seeking experiences with telehealth, including the challenges they faced. The survey was open to members across all specialties and career stages, including trainees. More than 1,300 responses were received.
Avant’s submission noted that a significant number of doctors were unaware of the current guidelines for technology-based patient consultations and their obligations contained in the code of conduct, Good medical practice: A code of conduct for doctors in Australia.
“Over the past two years, one of the most-asked telehealth-related was what to do when they believed patients would benefit from a physical examination,” Ms Haysom said.
“[We believe] it would be useful to include guidance, principles and examples related to this issue.
“Avant is also concerned that where telehealth services that do not attract a Medicare rebate are provided, there is a risk that these will be provided by doctors who are not experienced, qualified or appropriately supervised in that scope of practice.”
Avant’s submission also raised concerns about the provision of some services where consultations are not performed and there is no contact with a patient, whether face-to-face, or via video or telephone.
“In particular, the completion of online questionnaires by patients as essentially the sole basis to determine clinical management (including provision of prescriptions, investigation requests and medical certificates) presents a greater risk of harm compared to consultations conducted verbally and generally visually,” Ms Haysom explained.
“A pre-determined questionnaire consisting of questions relating to a patient’s request for a specific medication or test is unlikely to be a substitute for an appropriate history taking and examination, and this is exacerbated in circumstances where a patient does not have an existing relationship with their doctor.
“We are also concerned that this mode of healthcare delivery may lead to fragmentation of the patient’s care.
“In unforeseen situations where a patient requires a doctor other than their regular doctor to write a prescription, it is arguably more important that the new doctor should have a real-time conversation with the patient to determine if the prescription is appropriate and that safe care is being provided.”