Summary of Meeting 2 of the Rehabilitation Sub-Group 31 May 2018

This page contains the meeting summary for the Rehabilitation sub-group.

Page last updated: 04 July 2018

Summary of Meeting 2 of the Rehabilitation Sub-Group 31 May 2018 (PDF 139 KB)

Attendees

MembersSecretariat and other attendees
Dr Andrew Singer, ChairSusan Azmi, Secretariat
Jo Root, Consumers Health ForumMitch Docking, Secretariat
Ian Watts, Australian Physiotherapy AssociationVanessa Sheehan, Secretariat
Kendall Shearer, Occupational Therapy AustraliaTrevor Poole, Remedy Healthcare
Michelle Somlyay, Catholic Health AustraliaDavid Brajkovic, Australian Unity
Matthew Mackay, Royal RehabRebecca Windsor, Australian Unity
Lucy Cheetham, Australian Private Hospitals Association
Members – via teleconference
Rebecca Bell, Medibank Private (items 1-4)
Dr Stephen de Graaff, Australasian Faculty of Rehabilitation Medicine (items 5-6)

Apologies

John Biviano, Royal Australasian College of Surgeons
Dr Jui Tham, Australian Health Service Alliance
Associate Professor Graham Mercer, Australian Medical Association

1. Welcome, introductions, and conflicts of interest

  • The Chair opened the meeting and provided members not present at the first meeting an opportunity to introduce themselves to the Rehabilitation Sub-Group (the sub-group).
  • Members did not declare any new conflicts.

2. Rehabilitation data

  • Over the last 10 years, the data show average annual growth in private health insurance funded rehabilitation separations of over 15 per cent.
  • Members considered additional rehabilitation data aiming to determine underlying contributors to the growth in rehabilitation separations. Members agreed that the most common type of rehabilitation was following orthopaedic surgical interventions. However the growth in separations for orthopaedic surgeries, such as hip and knee replacements, does not reflect the growth observed in overall rehabilitation separations.
  • While members supported the data showing the growth in rehabilitation separations, some members suggested the growth trend is slowing and flattening.

3. Legislation overview and funding arrangements

  • A key component of work for the sub-group is identifying possible regulatory changes to private health insurance that support patient choice and access to clinically appropriate and efficient health care.
  • To facilitate the sub-group’s consideration, the Secretariat provided an overview of private health insurance legislation. This included a summary of the relevant parts of the Private Health Insurance Act (the Act) and Rules, and the inherent link with funding arrangements between private health insurers and private hospitals.
  • The overview focused on: types of treatment (hospital treatment and hospital-substitute treatment); pilot projects; recognition of allied health professionals under chronic disease management programs; contracting; and benefits arrangements.
  • Members provided advice on how the legislation is operationalised by private health insurers, private hospitals and other providers.
  • Members agreed that elements of the legislation are complex and can be difficult to interpret. Some members suggested that this complexity could potentially translate into variation in private health insurance product offerings and service delivery.

4. Alternative models

  • Remedy Healthcare delivered a presentation on its ‘Rehabilitation at Home’ program. The presentation focused on clinical appropriateness, factors for patient identification, patient outcomes, and economic benefits of the program.
  • A number of members presented on rehabilitation and possible alternative models to hospital treatment, which were discussed by the sub-group. The key themes were:
    • There are varying views of the recent data trends and what this may mean for future rehabilitation services funded by private health insurance;
    • Reconditioning is a growing area of rehabilitation;
    • Findings from recent and current rehabilitation pilot projects, such as rehabilitation in the home projects, suggest the projects deliver good clinical outcomes and positive patient satisfaction at a lower cost than admitted hospital-based rehabilitation;
    • Referral to admitted rehabilitation programs following hip and knee replacements vary significantly. It was suggested that some of this variation was unjustifiable and reducing this variation may reduce costs;
    • The definition of rehabilitation was raised in the context of private health insurance benefits, in particular recognising the ‘start and end point’ of a rehabilitation service for the purposes of payment;
    • Digitally supported models of rehabilitation care may have the potential to improve access and support for patients, while reducing costs. However, improving access may increase utilisation and it is unclear whether this would increase overall costs for the system; and
    • The concept of 'prehabilitation' was raised and its possible role in the context of private health insurance. It was recognised that while the evidence-base for prehabilitation is still being established, existing research suggests it may be promising in terms of reducing post-operation length of stay.

5. Incentives for admitted hospital-based care and barriers to alternative models

  • Members considered some of the incentives for admitted hospital-based rehabilitation and barriers to alternative models. Admitted patient care attracts guaranteed funding through private health insurance while funding for alternative models, such as hospital-substitute treatment, is not guaranteed and therefore may be more difficult to source.
  • A key barrier identified by members was legislative complexity. Some members suggested that in some instances, the difficulty with interpreting the existing legislation may discourage the development of innovative models that may actually be permissible under the Act.
  • Barriers identified by hospital representatives included: insurers are not required to agree programs or pay benefits for services that are alternative models for hospital treatment; and in some instances private hospitals participate in a market where their funder is also their service delivery competitor.
  • Barriers identified by private health insurers included: some elements of the legislation have not kept pace with contemporary practice for rehabilitation; and possible legislative barriers impacting the ability to transition successful pilot projects to ongoing programs.

6. Other business

  • The next sub-group meeting is scheduled for 27 June 2018.

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