The APA has been closely involved in the latest National Disability Insurance Scheme (NDIS) pricing review.

We have contributed a written submission and members and representatives participated in workshops organised by the National Disability Insurance Agency.

While the review was ongoing, we saw the suitability of NDIS pricing for providers, including physiotherapists, questioned.

So while we are waiting for the outcomes of the review, let’s talk about price, cost and value.

Physiotherapy and the NDIS

The APA’s ambition is to have a strong and sustainable NDIS that delivers on its promise, where participants can meet their goals while providers receive fair remuneration for the services they provide.

We also advocate for strong safeguarding systems that protect participants and don’t hinder the provision of physiotherapy services.

Therefore, the APA is not questioning the current price point but we wish to see ongoing increases in line with the Consumer Price Index in recognition of the highly regulated environment physiotherapy already operates within, a reduction in unnecessary red tape and any additional compliance burden taken into consideration to avoid the ongoing ‘admin creep’ currently experienced.

NDIS pricing

In compliance with the NDIS pricing guide, physiotherapists can charge up to $193.99 for one hour of service, pro rata, to an NDIS participant.

It has been reported that this is higher than what is usually seen as the fee of a single physiotherapy session for private patients or for participants in other care schemes.

It is implied that the services are comparable; however, the comparison is erroneous.

Providing supports and services in a social model of care differs from the often ‘hands on’ and medicalised provision of services in a health context.

NDIS participants have complex needs and require specifically tailored services.

Physiotherapists take a capacity-building approach and focus on functional outcomes in the participant’s environment, working with participants, families and carers.

Many NDIS services require specific training, different working spaces, more intense and longer sessions and better and more expensive equipment.

Some of this equipment is not used by physiotherapists for other patients.

Furthermore, the NDIS’s requirements for accreditation, registration and administration for claiming, reporting and compliance come at a cost, both in time (non-billable hours of work) and in actual money (eg, the cost of registration and auditing and investment in software for compliance and reporting).

Standard appointments in the physiotherapy sector are charged per session, whereas NDIS services are provided on a time-dependent basis.

Comparing NDIS pricing with other schemes misses the point that many of these schemes remain underfunded; it is not the NDIS pricing that is too high, but the pricing of other schemes that is too low.

APA members report difficulties in accepting participants in those other schemes because the fee is unsustainable for their practices.

So the question shouldn’t be ‘Why are fees in the NDIS so high?’ but ‘Why are fees in other schemes so low?’

Systemic underfunding of some schemes has resulted in challenges to the provision of high-value quality care to participants and the APA has been advocating for appropriate fees across all sectors for many years.

Of course, the fiscal pressure of the funding of the NDIS on government expenditure shouldn’t be understated, so it’s important to understand that the Australian economy as a whole benefits from proper funding to the NDIS.

The Per Capita report False Economy: the economic benefits of the National Disability Insurance Scheme and the consequences of government cost-cutting shows that NDIS funding has a positive impact on employment, both directly and indirectly, and has a multiplier effect of about 2.25.

The report estimates that the economic contribution of the NDIS in 2020–2021 was about $52.4 billion.

Participants’ outcomes

Now let’s talk about what matters: outcomes for participants.

Overwhelmingly, the NDIS works for participants—not in its administrative and planning aspect, but in the care they receive.

This can be seen in a detailed way in the National Disability Insurance Agency’s own NDIS participant outcomes summary report to 30 June 2021.

Timely physiotherapy improves functional outcomes for participants, which in turn reduces costs for all of government by facilitating the return to work of participants and carers and enhancing participation in society.

It is also worth remembering that the NDIS is a very recent scheme.

If we want to look at long-term benefits for participants, consider that the rollout started in 2016 and was only completed in 2020.

It is still very early days when looking at the care of people with significant and permanent disabilities (the eligibility criteria to participate in the NDIS).

Healthcare has a cost, and this cost is high, but it’s the value provided that we should be focusing on.