The challenge for the APA
National APA Business group Chair Jackie Robertson continues her exploration of advocacy to third-party schemes.
In a previous article (October 2021 InMotion, page 22), I covered the state of play with what we call third-party funders—that is to say, when the funding for a physiotherapy service doesn’t come from private health insurance, the patient’s own money or a Medicare rebate, but due to the participation of the patient in a publicly funded scheme relevant to their personal circumstances (eg, age, disability, veteran status or if they are the victim of an accident).
These schemes exist at federal level—for example, the National Disability Insurance Scheme (NDIS), veterans’ care and aged care—and at state level—work and transport accidents, for example.
With almost three-quarters of the APA membership working in private practice, descriptors and fees determined by third-party schemes are a significant component of advocacy for the APA Business group and the APA Policy and Government Relations division.
All health professionals want their value and skills recognised for the excellent quality care that they provide to their patients.
For private practice physiotherapists, the financial rewards provided by third-party organisations, including government schemes, private health insurance and others, are not in step with the skills value physiotherapists deliver.
There are significant barriers to fee parity, fee changes and innovation of care models that the policy team and Business group come up against in our work with third-party funders.
Physiotherapy is not properly understood by those who fund services or plan for the delivery of those services and therefore the value of physiotherapy can be underestimated.
The 2020 Value of Physiotherapy in Australia report demonstrates clearly what the actual economic value of physiotherapy is, which is why it has been lauded nationally and internationally as a landmark economic study.
However, this report and others highlight the critical need for skilled workforce planning, for building awareness of the value of physiotherapy and for this to be reflected in fee structures.
National Disability Insurance Scheme
The National Disability Insurance Agency (NDIA) is the independent statutory agency that manages and implements the NDIS to ensure that people with disability continue to get the support they need.
The NDIA is currently undergoing its annual pricing review and the APA is discussing advocacy priorities related to pricing.
There are concerns being raised in public forums and the media that the government is seeking to rein in NDIS costs because of the long-term sustainability of the scheme.
Those following this matter will note that the NDIS has become a political issue and no doubt future appropriations and sustainability will feature during the federal election.
Trying to achieve efficacy and innovation in the market and to ensure that the NDIS is efficient and sustainable are universally supported goals, but if these are done at the expense of participants and a reduction in high-value care, then the NDIS will be a failure.
Engagement with the NDIA is not just about maintaining or increasing the fees paid.
It means helping the NDIA understand the role and value of high-value physiotherapy care within the scheme, reducing administrative burdens on providers, understanding the value of non-face-to-face care and assisting with outcome-based tools that can be utilised in valuing care models.
An issue we confront is how to negotiate with third-party funders who make potentially flawed comparisons between schemes, where they compare fees for different services and even for services that operate under different administrative burdens and complexities.
Physiotherapists, as healthcare professionals, ‘compete’ on excellence; they don’t use pricing as a competitive differentiator.
The future of market regulation may lie in using accreditation to assure quality services in the industry.
This will drive price regulation based on quality, sidestep overservicing and overpricing and avoid monopolies in the market.
The APA’s strategic approach with the NDIA pricing review is to not just concentrate on fees, but to examine the bigger picture to improve outcomes for NDIS participants.
Department of Veterans’ Affairs
Following a meeting between APA National President Scott Willis and Tasmanian Senator Jacqui Lambie, questions were asked at the June 2021 Senate estimates hearing into veterans’ affairs.
Jackie Robertson continues to explore advocacy to third-party schemes.
Senator Lambie questioned the Budget allocation of an additional $61.9 million over four years to increase the fees payable by the Department of Veterans’ Affairs (DVA) to occupational therapists and podiatrists with no additional funding for physiotherapists.
The senator also asked whether DVA considered the fees payable by DVA to physiotherapists to be in line with market rates.
The senator further asked (on our behalf): ‘Did DVA consult with the Australian Physiotherapy Association or other relevant industry bodies/experts in order to reach this conclusion?’
DVA’s response indicates the barriers and challenges we encounter with funders.
DVA stated: ‘Direct market rate comparisons between funders are not straightforward.
'While the Department of Veterans’ Affairs’ fees per service for physiotherapy are lower than some other funders, the administrative burden on providers to participate in DVA-funded arrangements is comparatively low.’
DVA confirmed that their funding ‘decision was subject to Cabinet confidentiality until it was announced’, although ‘concerns were raised to the Department by the two relevant allied health provider associations and several individual allied health providers’.
It is appropriate to question the fee parity and how DVA values physiotherapy services to the veteran community.
The APA has continued to make strong representations to the government and the Opposition.
It is possible—likely, even—that these funding decisions are not based on value and skills, but on a lack of understanding of physiotherapy.
Decisions are often made by those who do not necessarily understand scope of practice and the competitive analysis between allied health practitioners.
This is our biggest challenge—building awareness and understanding of the value of physiotherapy.
At stake is the sustainability and viability of physiotherapy clinics and ensuring equity of access to healthcare for participants in those schemes.
If DVA support prices are too low to cover operating costs and travel, we may well see more physiotherapy clinics exiting the DVA care space.
For business owners, and indeed the entire APA, the challenge is in building and maintaining a sustainable workforce, having robust business models and increasing understanding within the market of high-quality physiotherapy services.
Demonstrating valued care and veterans’ outcomes, rather than focusing on the treatment cycle initiative, can be achieved by:
- assisting with understanding service delivery inside the Australian Defence Force, through the transition phases to discharge, and DVA service delivery models and how they can work better and more efficiently
- working more closely with the Australian Defence Force physiotherapy workforce and understanding their role in support of serving members
- being part of the Royal Commission into Defence and Veteran Suicide by highlighting the essential role of physiotherapy in a veteran’s health journey, both physical and mental
- presenting new models of care, such as complex case management, that supersede the treatment cycle initiative to improve medical outcomes and costs to DVA.
The APA understands that without longer term service planning and a pricing framework that encourages earlier intervention and a holistic lifestyle approach to care, the achievement of outcomes for veterans is at risk.
Lack of workforce, a reduction in the number of physiotherapy clinics willing to take on veterans’ care, low-value care issues and lack of support in the transition phases through poor communication and handover from the Australian Defence Force all contribute to long-term physical and mental health issues.
>> Jackie Robertson APAM is the national chair of the APA Business group and a regular adviser in the advocacy and policy arenas. Jackie is also active in the education and development of businesses and practice principals.
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