Australia’s Department of Health fails to manage risks in telehealth expansion: state auditor

The Australian National Audit Office has conducted a review of the Department of Health and Aged Care’s nationwide expansion of telehealth services in response to the COVID-19 pandemic.


Based on State audits, the department has lacked governance, risk management and assessment of telehealth expansion.

Although it made “significant” changes to the Medicare Benefits Schedule (MBS), expanded telehealth services are “only partially supported by contractual implementation agreements.” physical.”

The audit showed that it did not require significant decisions and implementation plans to be documented.

Also note that the department has not managed the implementation risks associated with temporary or permanent telehealth changes in accordance with the department’s risk management policy. It also does not conduct risk assessments for integrity risks, such as provider fraud and non-compliance, prior to implementing MBS’s temporary and permanent telehealth items.

Therefore, according to ANAO, itgovernance arrangements to expand telehealth are not “fit for purpose”.

Meanwhile, the state audit also found that the department had not planned to monitor or evaluate the performance of temporary or permanent telehealth.

“Health has not coherently assessed the effectiveness of telehealth as a response to a pandemic, although several analyzes of billing data and independent research have been performed,” the report said.

It used MBS billing data to monitor telehealth usage patterns on the assumption that telehealth usage and billing behavior are adequate indicators of telehealth implementation. Successful telehealth declaration. It also has no performance goals.

However, the audit highlighted that both the temporary and permanent expansion of MBS’s telehealth offerings was informed primarily by “robust” policy planning and advice.

During the initial pandemic response, the department was quick to advise the Health Secretary about the costs, as well as some of the benefits and risks of establishing a temporary telehealth policy. It has also consulted and absorbed input from the highest authorities into its policy advice on temporary and long-term telehealth.

Following these findings, ANAO made several recommendations, which were agreed upon by the department. This includes strengthening the control system for implementing changes to the MBS, integrating governance elements such as documentation of issues and implementation decisions, and monitoring and evaluation planning. It also agreed to develop procedures to ensure changes in MBS are subject to a structured and documented risk assessment, and to finalize a long-term telehealth assessment plan.

It only agreed in principle with the recommendation that it consider lessons learned from the introduction of temporary telehealth items as a pandemic response measure to prepare for future pandemics. future.

In response, the department said that it “acknowledges the findings of ANAO while also recognizing the unique scenario of the COVID-19 emergency health response.”

“The department has fulfilled its goals of maintaining patients’ access to essential health services throughout the lockdown as well as reducing [the] risk of transmission to patients and providers,” it added.

Furthermore, it says it still has to refine and evaluate the alignment of MBS telehealth items with modern clinical practice through post-implementation assessment. It will be carried out by the MBS Review Advisory Committee, which will report back to the government later this year.


ANAO conducted the audit to provide “assurance” about the swift implementation of health policy changes and the transition from an emergency to a permanent facility. “The rapid implementation of policy changes may increase the risk to [the] efficient and effective delivery of public services,” it explains.


To provide greater access to health services amid the ongoing global pandemic, the Australian government has introduced 281 new telehealth categories on MBS. At the end of 2021, the Ministry of Health announced that the government had set aside funds for the production of subsidized telehealth items. long-term. However, a few weeks after this announcement, the government revealed a move to end support for 128 telehealth categories on Medicare as recommended by the MBS Review Task Force. In late November, the government revoked the subsidy for mass billed video telemedicine consultations by providing additional funding in the October budget.

As of year-end, more than 130 million services were provided through subsidized telehealth in Australia, based on current Department of Health figures.


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