Vulnerable Australians ‘filled with dread’ over telehealth cuts

Living through Covid-19 with inflammatory arthritis, telehealth has been the only way for Eliza Sorensen to safely access her routine medical appointments.

Sorensen is considered severely immunocompromised due to the medication she takes to control her chronic disease. She also lives with asthma.

Sorensen says the government's decision not to extend pandemic-related telehealth services will be "devastating" for her and people in similar situations.

"I can't drive due to the medication I'm on, and without mask mandates being in place it's incredibly risky for me to leave the house, let alone catch public transport to my appointments," she said.

"I've experienced being kicked out of an Uber for wanting to leave the window down because the driver refused to wear a mask. It's not without risk or issues."

The federal health minister, Mark Butler, announced on Thursday he would go ahead with a decision of the former government to end a range of telehealth services on 30 June - despite acknowledging the challenges arising from the current wave of the Covid pandemic.

The decision means more than 70 different telehealth-related consultations have been cut, including 33 initial and complex specialist items, 40 specialist inpatient items, and GP consultations that last longer than 20 minutes.

Short telehealth consultations with GPs are still available.

Medical practitioners fear the winding back of telehealth services will cause vulnerable patients to decline while the health system remains under serious strain.

Mental health nurse Grahame Gee said patients with complex mental health needs, who often require longer consultations, would suffer the most.

"These patients are also at high risk of developing serious chronic physical health problems such as cardiovascular disease and diabetes," he said.

"Untreated, these conditions will lead to avoidable suffering, distress and impairment, in addition to the distress caused by their mental health condition."

Gee said telehealth had been successful in decreasing barriers to access throughout the pandemic.

"The decision to dramatically reduce the MBS funding for these services is of great concern to me with respect to the physical and mental wellbeing of patients, in particular to those in rural and remote areas where access to medical services is already a serious issue," he said.

The windback comes months after the former government imposed "devastating" changes to the telehealth system, removing a 50% loading for some rural psychiatric services, meaning a string of consultations could no longer be bulk-billed.

128 telehealth items ended on 1 January on the recommendation of the MBS Review Taskforce, restricting phone consultations for a long list of specialist items in favour of video conferencing or face-to-face appointments.

The federal government has committed to reinstating a 50% regional loading for telehealth psychiatric appointments when the federal budget is handed down in October.

But Butler has doubled down on the government's suspension of pandemic-related services.

"With a trillion dollars of debt, extending the temporary Medicare rebate for longer telephone consults which were not clinically optimal would have meant cuts in other areas of the health budget," he told Guardian Australia.

The Australian Association of Psychologists executive director, Tegan Carrison, said telehealth had been a "literal lifesaver" during the pandemic.

"We can't go backwards in accessible healthcare delivery," she said.

"Telehealth is not suitable for all situations or all clients [but] the decision on the best delivery method for a particular client should be left to the treating health professional and the client, not the government."

Carrison said limiting time allowance for telehealth services was a "terrible decision" which would have "serious consequences".

"For some clients a telephone call is the best option for them," she said. "Not all clients who need to utilise telehealth can access this via a video link. Equally, not all clients who need a psychology appointment can access one in their area - with telehealth providing a bridge to them accessing needed support."

Peter-Anderson Stewart was "filled with dread" when he saw 33 specialist items would be cut. He was diagnosed with oesophagogastric junction carcinoma, a form of cancer, in late 2019.

"I'm on the south coast of NSW, but if I'm forced to have to drive to Sydney, pay for accommodation overnight, then drive back the following day it is unlikely I'll continue [specialist appointments]," he said.

"The cost alone would cripple me."

InstantScripts, one of Australia's largest telehealth services, found 68% of telehealth patients use services when they can't get to a doctor quickly, feel too unwell or can't enter a medical centre.

Chief operating officer Richard Skimin said the need for telehealth was greater in remote and regional areas, where doctor shortages were continuing to bite.

"InstantScripts' regional patient base has grown 114% this year," he said.

As well as requiring vulnerable patients to attend longer consultations, the suspension also prevents doctors from treating Covid-positive patients with complex needs at home.

The deputy AMA president, Chris Moy, told Guardian Australia the decision would compromise the ability of GPs to care for and provide Covid-19 antiviral treatment to vulnerable patients - "critical in protecting individuals from getting severe disease". Individuals like Sorensen, who caught Covid a fortnight ago.

"The only reason I got care and a prescription for an antiviral was because I paid out of pocket for a telehealth appointment with a GP," she said.

"The Covid hotline couldn't say with certainty whether or not I'd be contacted by a practitioner within 48 hours. As a high-risk individual, I had to start antivirals as soon as possible to prevent hospitalisation."