Direct physiotherapy referrals are an obvious reform that’s long overdue, explains APA General Manager, Policy and Government Relations Simon Tatz.

The role of the APA Policy and Government Relations team is to advocate for change. 

We always strive for ‘better’—better access to care, a better patient journey, better health outcomes, better use of the physiotherapy workforce and better use of physiotherapists’ skills and scope of practice.

Australia’s health system is overly complex and weighed down by an overlapping and competing federal–state divide. 

The healthcare system requires constant reform—that is, evidence-based changes that are sustainable and built for purpose.

Reforms are dependent on the structure and responsibilities of the various governments and, of course, on the political will of those elected to make decisions.

Sometimes, reforms mean challenging the status quo, looking beyond existing models, rethinking the health system as we know it, looking at overseas models for inspiration and not taking anything for granted. 

Reforms should be sustainable, not the stop-start approach that we see currently.

Changes that the APA advocates for often fall into the category of what we could call ‘no-brainer’ reform. 

They are minor tweaks to existing systems; they don’t require complex legislative change or entail paradigm shifts. 

They are like loopholes waiting to be fixed, anomalies that make you wonder why they were there in the first place.

The direct physiotherapy referrals reform is one of the latter. It is very simple—we ask for an update of the Medicare Benefits Schedule (MBS) so that patients can have access to rebates when their physiotherapist refers them to an orthopaedic surgeon or
for some musculoskeletal-related diagnostic imaging. 

If an optometrist can refer to an ophthalmologist and a midwife to an obstetrician or a paediatrician, it is logical for a physiotherapist to be able to refer to an orthopaedic surgeon.

In Australia, GPs are rightly called the ‘gatekeepers’ of the Medicare system and regarded as the ‘primary source of referrals’ (Medicare Benefits Schedule n.d.). 

However, when it comes to straightforward musculoskeletal conditions, it is in the scope of practice of physiotherapists to diagnose and determine when further investigation is required or what the best management pathway is.

Currently, MBS rules limit the ability of physiotherapists to refer patients directly to the best practitioners or specialists.

Physiotherapists find themselves referring their patients to a GP, who then has to take on the tasks of writing referrals and requesting imaging that has already been deemed necessary.

This is a costly structural barrier that pushes an unnecessary workload onto an already stretched GP workforce while access to care is delayed for patients, with no prospect of better health outcomes. 

The Royal Australian College of General Practitioners’ 2023 report General Practice: Health of the Nation highlighted the need for urgent reforms to primary care to relieve pressure on GPs and benefit patients.

Changing the MBS rules makes sense, but simply saying that does not amount to effective advocacy for reform.

In support of our advocacy, we commissioned the Nous Group to undertake a cost modelling of the financial impact of direct
physiotherapy referrals on patients and the health system as a whole. 

Their conclusions are unequivocal. 

Such a reform would lead to millions in cost savings—an estimated $162 million of avoided costs for the health system and for patients in out-of-pocket and travel costs.

To model the financial impact analysis of the policy change, Nous surveyed APA members on their referral practices (volume and decision-making); performed cost assessments for MBS expenditure, patients’ out-of-pocket costs and travel costs; and broke down the data between major cities and areas outside of major cities.

The work built on previous modelling done by the Deeble Institute in 2015 and was informed by APA quick polls on referrals from late 2022. 

The quick polls indicated that over 60 per cent of respondents wanted the ability to refer their patients directly to orthopaedic surgeons. 

Collaboration with APA advisory groups led to the identification of a number of priority musculoskeletal diagnostic imaging items for reform.

We’re not the only ones who think it’s a good idea. 

Minister for Health and Aged Care Mark Butler has repeatedly indicated his support for improved patient pathways and for all health professionals to work at the top of their scope of practice in order to strengthen Medicare.

In the Grattan Institute’s report A new Medicare: Strengthening general practice, physiotherapists were identified as key contributors to improving Australia’s outdated healthcare system. 

The report outlined key system deficiencies, describing a ‘very significant gap’ between the contribution that physiotherapists are able to make and ‘what funding and policy let them do in Australia’, and recommended engaging an ‘independent commission to remove regulatory barriers that stop primary care workers from safely using all of their skills’ (Breadon et al 2022).

Doesn’t it sound like a no-brainer to you?

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