Telehealth

Practices that are already providing telehealth services should continue to do so as part of their normal practice. Those practices may wish to increase access to their telehealth services for patients that are high risk or are quarantined at home.

The APA is continuing to liaise with Government and other third party payers to identify any support for telehealth providers to enhance their current capacity to assist with the emergency response. Please see the next question for a list of third party payers funding telehealth as of 23 March 2020. As of this date, from a Commonwealth perspective, it is of note that:

• it is anticipated that the Department of Health will release funding for Medicare subsidised physiotherapy telehealth services in the coming days
• the Department of Veteran’s Affairs is yet to announce funding regarding telehealth, and
• the National Disability Insurance Scheme is funding of telehealth for allied health during this time.

For services provided under the NDIS, if telehealth is a part of your business as usual, it will be listed in your mode of service provision in the service agreement. If it is only a short term change in response to COVID-19, it will not be required to be listed in the service agreement. It is anticipated that the NDIS will release guidelines on telehealth in the coming days.

Please see below for a list of third party payers funding telehealth. It is noted that the APA is continuing its’ efforts in advocacy in this space.

The informaiton about PHI currently providing telehealth can be found here. This document is continuously being updated as new information becomes available.

Recommendation at this stage is for patient to pay upfront and then seek reimbursement from their health fund. The following recommendations have been made by the APA in regards to the delivery of Telehealth with Private Health Insurers. This has been provided to PHA:

• the physiotherapist should use their clinical reasoning to determine if the patient is clinically appropriate to receive the service via telehealth
• physiotherapists must continue to work within their scope of practice
• the service is undertaken in accordance with the Australian Physiotherapy Association Telehealth Guidelines
• a GP referral is not required as per usual practice

The fact sheet for the new temporary MBS Bulk Billing item can be accessed here. It is of particular note that providers can use their provider number from their primary location for this.

Telehealth is the provision of health services over an appropriate communication medium, rather than in person. The APA Professional Indemnity insurance policy will cover you to practice physiotherapy services online to Australian based clients, provided your advice is considered within your scope of practice.

Under the APA member policy, telehealth is covered as a normal activity and extends to any advice you give, such as at home exercises you can supervise or prescribe. You can also do demonstration videos of an exercise and share this with your clients to follow at home.

During the COVID-19 outbreak to lower the risk of catching or spreading COVID-19, or to assist clients who are quarantined or in self-isolation, you can make use of telehealth to continue to practice as much as possible as long as you are comfortable that the right processes and procedures are in place. Telehealth should fall within your individual scope of practice to be safely deployed.

BMS can provide further advice in relation to telehealth as needed. For any questions, please contact us at apa@bmsgroup.com or on 1800 931 068.

In light of COVID-19, the following video has been provided by Karen Finnin to assist physiotherapists in starting telehealth consultations within their clinics. Karen is the owner of Australia’s first entirely online physiotherapy clinic.

We will encourage members to take this free online survey to assess their individual practice readiness.

Yes, the following course provides guidance in setting up telehealth services. The course covers the following modules:

• Getting Started with Telehealth
• The Case for telehealth
• The legal and safety considerations
• Video platforms for digital practice
• Adapting in-person to online
• Pricing digital health services
• Marketing your telehealth practice.

University of Melbourne has also released a course for physiotherapists treating knee osteoarthritis via telehealth. Further information regarding this course is available here.

To assist in the uptake of telehealth during the COVID-19 outbreak, the APA will be providing two separate live Q&A webinars, giving members the opportunity to ask any questions they may have about the provision of this service. Joining us in responding to these questions will be digital health authority, speaker and author, Karen Finnin. Karen specialises in helping health business owners to take their services online and runs Australia’s first entirely online physiotherapy clinic.

Webinars details below:

• Session 1: Wednesday 18 March 2020 at 7.00 pm. Listen here to the webinar recording.
• Session 2: Friday 20 March 2020 at 4.00 pm. Listen here to the webinar recording.
• Session 3: Monday 23 March 2020 at 6.00 pm. Listen here to the webinar recording.
• Session 4: Wednesday 25 March 2020 at 5.30pm. Listen here to the webinar recording.

In light of COVID-19, the following video has also been provided by Karen Finnin to assist physiotherapists in starting telehealth consultations within their clinics.

For information on how to provide high quality and safe telehealth, please refer to this video.

Physiotherapists have extensive training in their degrees about risk management. They are taught how to evaluate risk in all clinical situations and use their clinical reasoning and clinical judgments on a daily basis to guide how they interact with patients to minimise risk. This is part of the DNA of a physiotherapist and is applicable regardless of the mode of interaction with the client (e.g. in-person or online).

There is no ‘one size fits all’ guide for which clinical conditions are appropriate for online consultations. Some conditions they may be thought to be high risk on the surface (such as balance issues or heart conditions) may be very appropriate to see via tele depending on the nature of supports available in the home (e.g. carer) and the type of interaction that is planned (e.g. education, supine muscle conditioning). Other conditions that may be considered low risk (such as knee OA) may be inappropriate in certain circumstances (e.g. lack of privacy, impulsiveness etc). Physiotherapists are adequately trained to evaluate risk and make decisions about which clients and conditions are indicated given the medium they are practicing in. This is the case for our medical specialists and GP colleagues.

It depends on where is considered to be the location of the consult and where you are registered. There are two different approaches taken by countries on the location of the consult. One being that the location of the consult, is where the practitioner is situated, the second being, the location of the consult is where the patient situated i.e. overseas. If it is considered to be located overseas, then, you would be bound whatever regulations apply in that country. One example of this regulation is as follows:

If a someone from the US is visiting Australia and walks into a physiotherapy private practice, that patient is able to be seen. They will be full fee paying as they are not eligible for any third party payments, but they can see that consultation and there are no regulatory issues with that. However, if a physiotherapist sees that person via telehealth whilst they are situated in the US, the health service is not only regulated by US law, but also US state law. This means there may be a requirement for me to register in the US to practice telehealth there.

Another aspect to consider is whether your insurance covers you to consult overseas. For further information specific to APA member insurance on this, please see the question “Is the telehealth covered by my APA member insurance?”

The APA in consultation with Karen Finnin, has developed the following guidelines for selecting a telehealth platform.

For further information, please see the following website for guidance in selecting a platform.

Please see the following website for guidance around how to set up Stripe.

As part of their response to the COVID-19 outbreak, COVIU, APA's endorsed product partner has a special offer for our members. For details of the offer, please visit APA Partner page and click on endorsed product partners tab to locate COVIU information.

The APA Telehealth Guidelines is a comprehensive document that clearly outlines how telehealth should be conducted by practitioners have just been released. For experienced providers and those who are transitioning towards delivering telehealth as part of their practice this resource will guide you through the process. They also capture essential considerations, such as security and privacy, when applying telehealth consultations into a private context.

The APA has also developed a few checklists to assist practitioners in adapting to telehealth. These checklists can be found here.

The APA, with Karen Finnin, has created the following video to help communicate the benefits of telehealth to consumers.

On April 1st, 2020, Cliniko founder Joel Friedlaender and Medipass (a digital health payment company) co-founder Pete Williams discussed the recent addition of telehealth bulk billing rebates for allied health practitioners in Australia. Pete is a wealth of knowledge on all things Medicare, and this webinar they recorded should answer everything you need to know to start doing Medicare rebates through telehealth.

The Australian Government funded Digital Health Cooperative Research Centre has recently launched the Telehealth Hub, which will help clinicians, health professionals and health consumers to access and deliver telehealth services in Australia more effectively.