Budget 2024: Private hospitals are used to provide psychiatric telecare during a crisis
Australia’s mental health system has reached a crisis point where psychiatrists and other mental health professionals are leaving the sector en masse due to burnout and inadequate support, leaving patients waiting long periods of time for care or delaying treatment, risking further deterioration.
a news report Recently, it has been found that in some states one in four psychiatric positions in public health care facilities are vacant. The National Association of Practicing Psychiatrists confirmed this, adding that the “The staffing crisis is negatively impacting patient carewhere psychiatrists feel pressured to discharge patients prematurely, leading to rapid readmissions and a revolving door situation on psychiatric wards.” This is also what nine out of ten psychiatrists recently surveyed by the Royal Australian and New Zealand College of Psychiatrists, the ongoing mental health workforce shortage was reflected on.
The impact is greater in rural and regional areas, where there are only one to five psychiatrists per 100,000 inhabitants.
The Australian Government maintains that it is committed to addressing the supply and demand crisis in the sector by implementing reforms and making significant investments in both workforce training and retention, as well as filling gaps and increasing of access to mental health care.
For example, in its latest budget for 2024-2025, the Ministry of Health and Aged Care announced funding of $588 million over eight years to set up a new national digital service to provide support to those in temporary need. Based on the Talking Therapies model in the UK, the mobile application-based ‘low intensity’ mental health service aims to serve approximately 150,000 Australians annually, some of whom had sought support from their GP or were enrolled in programs designed to for diagnosed diseases. clinical cases.
The government also appears keen to use telehealth to address accessibility issues in mental health care. The Australian Private Hospitals Association (APHA) recently announced that the 2024-2025 Budget also introduced temporary Medicare Benefit Schedule (MBS) items for the admission and some subsequent teleconsultations of admitted patients to private hospitals. It will initially be implemented over the next two years, starting in November.
The organization has been campaigning for this addition to the MBS for about a year. APHA CEO Michael Roff further discussed this upcoming telehealth trial with Healthcare IT news. He also shed light on issues hindering technological innovation among private hospitals and what he hopes the government could do more for the sector amid the ongoing crisis in the country’s mental health system.
Q. I have noted your organization’s enthusiasm about the upcoming government pilot funding of psychiatric teleconsultations. Can you describe private practice/practitioners’ use of telehealth – do they seem to prefer this to in-person consultations and does it somehow help alleviate their burnout and increase the likelihood of them staying in the business?
a. A temporary telehealth item for inpatient services was offered during COVID-19, where psychiatrists could not go to a hospital in person due to concerns about infection control or lockdowns. They found that this system worked well as hospitals generally had professional standard videoconferencing equipment and a trained psychiatric nurse was present with the patient. This is in contrast to outpatient telehealth consultations where the patient is in a shopping center via a mobile phone, i.e. an environment not conducive to the best clinical care.
This particular trial is for inpatient consultations, so it will alleviate some of the pressure on psychiatrists, especially when an out-of-hours consultation is required. We hear from our members that, while we wait for more details, the response from many psychiatrists has been positive.
Q. Besides telehealth, what other technologies are being tested/implemented in private hospitals to supplement their services, amid staff shortages and growing demand for healthcare? Can you identify which technologies (e.g. AI, chatbots, cloud workflows) are proving useful for the industry? And how does your organization promote the introduction and use of these technologies?
a. Private hospitals are always exploring innovative approaches to care that benefit patients. However, the main barrier to innovation in the private hospital sector is the payment model, and many large private health insurers are entering the provider space. This means that they do not fund private hospital innovation, but create their own programs in which only their members can participate. Hospitals also need to be aware of patient privacy and cybersecurity issues.
Q: Can you describe the private hospital system’s relationship with the broader mental health system over the years?
a. Private psychiatric hospitals care for people with moderate to severe and complex mental illnesses. They treat Australians suffering from the full range of mental health disorders, including major depression, severe anxiety, eating disorders, addiction and post-traumatic stress. In Australia, 45% of adult psychiatric beds are in private hospitals.
Private hospitals are often contracted to treat public patients when public hospitals are full or a patient needs a service for which the public hospital is not set up. Private hospitals also provide care through intensive day programs and outreach care. Private psychiatric hospitals care for more than 40,000 Australians with mental health problems every year.
Q. How is Australia’s private hospital sector positioning itself in the midst of the ongoing mental health crisis? In addition to the campaign for the addition of psychiatric MBS items (i.e. admission and teleconsultation of patients in private hospitals), what other initiatives is the sector taking to help address the crisis?
a. There have been four mental health hospital closures in the last six months, so we know this is a challenging time in the sector. APHA has long advocated for a minimum standard private health insurance benefit for private hospitals to provide outpatient care programs that would provide better access to patients regardless of who their insurer is. This would give private hospitals the flexibility to create programs tailored to their own benefit own patient cohort.
We also want the rules for foreign-trained psychiatrists to be relaxed so that they can work in any private hospital and have access to the MBS. Currently, for the first ten years of practice in Australia, they can only claim the MBS when treating patients in hospitals in areas designated as a ‘workforce shortage district’. Currently, all private psychiatric hospitals are experiencing staff shortages.
Q. How is the industry being supported by the Australian Government in pursuing these initiatives? What improvements do you want to see in the government’s cooperation with the sector?
A. APHA has and will continue to work closely with state and federal governments and departments. We have argued for a reduction in costly regulatory burdens, especially when this is caused by duplication of effort between different levels of government. There is now more government attention on the super-profits made by health insurers while they fail to compensate hospitals for the true costs of delivering high-quality care.
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Interview responses have been edited for brevity.