Exploring the role of Medicare-funded private practice telepsychiatry, during and after the COVID-19 pandemic

Abstract

Background: Limited telepsychiatry, in the form of synchronous ICT-based consultations, was available through Medicare Benefits Schedule (MBS) since 2000s. Limited Medicare Benefits Schedule (MBS) video telepsychiatry commenced in the early 2000s. During the COVID-19 pandemic, it was expanded nationwide in March 2020 and consolidated in January 2022. However, a synthesis of current evidence and research on its impact on access, cost, and implementation in pragmatic settings was still lacking. Objectives: (1) Synthesise the evidence of Australian telepsychiatry, (2) Examine telehealth policies' impact on the usage trends of general MBS psychiatric consultations and telepsychiatry, (3) Investigate the out-of-pocket (OOP) costs of MBS telepsychiatry, and (4) Explore the implementation of telepsychiatry in private practices. Methods: (a) A scoping review of the literature on Australian telepsychiatry (1990-2022). Using aggregate MBS usage data: (b) Comparison of MBS telepsychiatry and consultant physician telehealth (2017-22); Regression analyses on the: (c) Seasonality of telepsychiatry (2016-23); (d) Impact on total and face-to-face (F2F) psychiatric consultations (2012-23); (e) Impact on telepsychiatry consultations (2016-23); (f) Effects on per capita psychiatric consultations (2005-23); (g) Ratio of one-off to follow-up consultations (2016-23); and (h) Single-year (2021-22) telepsychiatry OOP costs. Person-level data from the Australian Bureau of Statistics: (i) Determinants of video telepsychiatry provision (2017-23); (j) Telepsychiatry and ADHD drug prescriptions (2017-23); and (k) multiple-year (2017-23) telepsychiatry OOP costs. (l) A mixed-methods study (a survey and interviews of psychiatrists) on the normalisation of telepsychiatry. Results: (a) Few existing longitudinal or economic telepsychiatry studies existed. Telepsychiatry perceptions involved patient benefits, clinical care, sustainability, and technological impact. Research gaps were patient perspectives, outcomes, clinical practice, health economics, usage trends, and technical issues. (b) MBS psychiatrist services shifted more substantially to telehealth than physician services, especially since early 2022. (c) Total psychiatric consultations were seasonal before and after telehealth expansion, but telepsychiatry was not. (d) & (e) Total consultations increased significantly alongside telepsychiatry after adjusting for lockdown severity, but F2F consultations decreased. More telepsychiatry services were used in psychiatrist-density regions. Males and those >65y showed greater relative usage growth. (i) Video consultations became as widespread as F2F consultations, more prominently among metropolitan providers and varied by patient characteristics. (f) Telepsychiatry reduced per capita consultation variability and contributed to more equitable service utilisation by complementing F2F consultations, with a larger effect for items targeting rural populations. (g) One-off video consultations surged after consolidation, notably among youths (15-24y) and young adults (25-44y), and trended upward among young females. (j) Concurrently, linked-ADHD prescriptions soared, particularly for female patients and through one-off sessions. (h) & (k) Compared with F2F consultations, video consultations were increasingly more costly, especially for rural patients and ADHD prescriptions. (l) Solo or non-metropolitan practices, and higher cognitive participation and collective action, were associated with greater adoption of telepsychiatry. A conducive environment, perceived benefits, and individual initiatives also contributed. Conclusions: Telehealth-enabling policies have reduced access barriers and integrated telepsychiatry into standard care. However, rising costs and shifting clinical focus (e.g., one-off ADHD sessions) may exacerbate inequity, necessitating policy refinement to clarify its purposes, maximise benefits, and mitigate unintended effects. Show more