Almost three-quarters of the APA membership works in private practice.

This means that the item numbers, descriptors and fees determined by third-party schemes are major topics of discussion for the APA’s Business group and the focus of frequent meetings and a broad range of other advocacy activity.

APA members may ask—where is the financial reward for private practices that are providing excellent, evidence-based, high-quality care for clients funded by third-party organisations?

This value is not always recognised in their fees.

Some of these third-party funders are state based, such as workers’ compensation schemes and motor accident schemes, while other schemes operate at a federal level, including the Department of Veterans’ Affairs, the National Disability Insurance Scheme and Medicare.

The APA has members from all the state branches working on maintaining and improving long-term relationships with key stakeholders in these schemes, negotiating new tables of costs and pricing structures and developing strategies to help improve access to treatment and outcomes for patients.

The APA also writes submissions to the schemes at regular intervals, providing education about the role and scope of physiotherapy and making suggestions for recognition of its value, such as rewarding high-value care and recognising titling and experience.

The majority of submissions have input from the branch council representatives and members of the business groups around the country.

Wherever possible, these submissions are made available to members on the advocacy websites.

In-depth knowledge of each third-party scheme’s aims, goals, financial constraints and compliance concerns is vital to this process.

Compliance with a third-party funder’s requirements is a major factor in its determination of remuneration for physiotherapy services.

In many of the meetings, discussions about value-based care is a central component.

The APA consistently receives feedback that physiotherapists are strong leaders and contributors to the clinical framework.

Significant effort is required to engage effectively with individual schemes.

For example, the New South Wales branch advocates strongly on behalf of members in its work with the State Insurance Regulatory Authority, which regulates workers’ compensation, and with worker insurer ICare.

In the first half of 2021 alone, the branch attended 10 meetings with the State Insurance Regulatory Authority and two with ICare.

A total of five submissions were made in that six months, along with a number of informal meetings and phone calls, as the branch continues to advocate for recognition of the important role that physiotherapists play.

The aim is to shift perspectives so that the cost of service is viewed as an essential value-add that contributes to patient recovery, not a negative component of the schemes’ actuarial models.

There is strong evidence of the important role that physiotherapists play in patient recovery, return to work and improvement in function and quality of life.

The role of physiotherapists in enhancing return to work has been recognised in NSW and Victoria, where physiotherapists are able to write updated certificates of capacity, improving the return-to-work journey.

However, there is currently no third-party scheme in Australia that recognises career pathways or titling in its table of costs.

There are also significant discrepancies from scheme to scheme.

For example, an initial Department of Veterans’ Affairs physiotherapy consultation is remunerated at $66.30.

In comparison, a WorkCover claim from Victoria where the physiotherapist has undertaken the Early Intervention Physiotherapy Framework training would attract a payment of $130.87.

When one can find and understand the fee schedule of the National Disability Insurance Scheme, it is a well-detailed and considered list of service descriptors.

The National Disability Insurance Scheme has been identified as one of the first schemes to remunerate health professionals for the skills they offer and the evidence-based services they provide.

With so much variation and so many discrepancies between these schemes in regard to items and service descriptors, what can be done?

The next article will cover in more depth the issues involved and the barriers to working with these schemes and effecting positive changes for the physiotherapy profession.