The newly announced Australian Government Changes to Medicare Specialist Telehealth provisions, effective from 1 January 2022, will leave many patients unable to access necessary psychiatric assessment and treatment, including psychotherapy.
MASSIVE CUTS TO TELEHEALTH CONSULTATIONS FROM 1ST JANUARY 2022
- Removal of Telehealth loading effectively ceases bulk billed psychiatric consultations for rural and regional patients
- Removal of telephone access to initial consultation with a psychiatrist
- Removal of patient telephone access to psychiatric consultations > 45 minutes duration
This removes access to all psychiatrist-provided psychotherapy telephone consultations, which typically require a 50 minute session. By maintaining Medicare rebates for shorter duration psychiatric telephone consultations, the Government prioritises medication management of mental health needs, which for many presentations is not in keeping with contemporary best practice. Some patients will lose access to psychotherapy treatments as a result of these cuts, and may through deterioration, need to return into the public mental health system, negating cost savings.
- Removal of patient access to telephone consultations > 75 minutes duration; Reduction of long sessions will require patients with complex needs to attend more consultations, driving up out of pocket costs and further reducing access.
- Removal of telephone group and family psychotherapy consultations
- Removal of Medicare rebates for patients’ carer(s) and family member(s) to provide collateral information, which is often an essential part of a comprehensive initial assessment.
- Removal of access to comprehensive treatment and management plans for children with autism and developmental disorders, and for Psychiatrist preparation of eating disorder treatment and management plans.
THE MOST VULNERABLE PATIENTS WILL BE AFFECTED BY THESE CUTS:
- People in rural and regional locations or who are homeless.
- People unable to afford smartphones with video capabilities or who only have landline telephones.
- People unable to afford access to fast or reliable internet provisions or adequate data for mobile video consultations.
- People who have complex histories of trauma or mental health needs requiring or preferencing telephone consultation above video consultation; for example, patients who are house-bound, severely functionally impaired, or who find video contact distressing. Some people can find it easier to engage emotionally or feel safe on telephone telehealth than on video.
- People who wish to engage or who are engaged in individual, group or family psychotherapy. For many patients, including those with complex developmental trauma, depression, treatment-resistance and other presentations, access to telephone psychotherapy can be required to maintain mental health stability and reduce risks of self-harm and / or suicide.
- Patients who require telephone psychiatric consultations due to factors relating to the Covid-19 pandemic.
- People with executive, sensory or motor impairments that make computer and video mediated consultations difficult.
These telephone telehealth MBS consultations, which the Government is removing, have facilitated effective, trauma-informed care and practice, and psychiatric psychotherapy treatments not available within the public mental health system, despite their being a first line recommended treatment for many presentations.
With these cuts, psychotherapy provided by psychiatrists will become less accessible in the Australian private mental health system. Patient choice and clinical practice are being undermined.
These cuts to patients’ Medicare rebates will increase patients’ out of pocket costs, with only two weeks’ notice, and may force patients out of treatment.
These Government cuts to Medicare undermine the capacity of the psychiatric system to provide psychotherapy treatments and trauma-informed care in keeping with patients’ needs and the recommendations emerging from the Victorian Royal Commission into Mental Health.