Summary of Meeting 3 of the Rehabilitation Sub-Group 27 June 2018

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

Page last updated: 27 July 2018

Summary of Meeting 3 of the Rehabilitation Sub-Group 27 June 2018 (PDF 140 KB)

Attendees

MembersSecretariat and invited guests
Dr Andrew Singer, ChairSusan Azmi, Secretariat
Jo Root, Consumers Health ForumPauline Dusink, Secretariat
Ian Watts, Australian Physiotherapy AssociationMitch Docking, Secretariat
Kendall Shearer, Occupational Therapy AustraliaVanessa Sheehan, Secretariat
Dr Stephen de Graaff, Australasian Faculty of Rehabilitation Medicine Sarah Kennedy, Department of Veterans’ Affairs
Dr Jui Tham, Australian Health Services AllianceFrances Simmonds, Australasian Rehabilitation Outcomes Centre
Dr Sarah Barras, Australian Health Service Alliance
Members – via teleconference
Rebecca Bell, Medibank Private
Michelle Somlyay, Catholic Health Australia
Assoc Prof Graham Mercer, Australian Medical Association

Apologies

John Biviano, Royal Australasian College of Surgeons
Lucy Cheetham, Australian Private Hospitals Association
Matthew Mackay, Royal Rehab

1. Welcome, introductions, and conflicts of interest

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

2. Presentations

  • Sarah Kennedy, Department of Veterans’ Affairs (DVA), delivered a presentation on DVA’s model of delivering rehabilitation services to its members. DVA applies a broad definition of rehabilitation compared with the current operation of private health insurance funded rehabilitation services, which involves a tailored whole-of-person approach and includes support for: medical management; psychosocial assistance; and vocational assistance.
  • Frances Simmonds, Australasian Rehabilitation Outcomes Centre (AROC), delivered a presentation on AROC’s role in the collection and reporting of rehabilitation data. AROC is the national data bureau that receives and manages data on rehabilitation services in Australia and New Zealand, and is the national certification body for the Functional Independence Measure (FIM).
  • AROC’s presentation showed that orthopaedic replacements are the most common reason for overnight rehabilitation. Reconditioning is the second most common reason for overnight rehabilitation, and has been identified as a growth area for overnight rehabilitation.
  • AROC reported that over the past five years, there have been observable improvements in FIM at discharge and reduced length of stay for orthopaedic replacements and reconditioning rehabilitation in private facilities.
  • It was recognised that the AROC data collection for ambulatory rehabilitation is incomplete, which limits the quality and accuracy of reporting of rehabilitation delivered in these settings.

3. Definitions: Rehabilitation

  • Members considered whether there were rehabilitation definitional issues within the private sector influencing funding arrangements and the consideration of alternative models of care.
  • Members generally agreed that how rehabilitation services are defined in the admitted setting was well understood by industry. However, some members also raised that the lack of minimum triage requirements for admission to rehabilitation services was an issue.
  • Members agreed that the scope of what was a rehabilitation service was less clear for services provided outside the hospital. Members noted that current industry guidelines link to hospital admission, rather than to a patient (wherever that patient may be receiving services). Members discussed whether a framework or guidelines around the types of services that could substitute for admitted hospital-based rehabilitation might be useful for industry.
  • Members generally agreed that differences in how parties define rehabilitation was a product of insurer contracting arrangements and was not driven by regulation.
  • Members considered several rehabilitation definitions already used by industry, and whether these could be used to describe services provided outside the hospital.

4. Principles

  • The Chair introduced a paper of draft principles and invited member comments.
  • Members generally agreed a set of principles, which will be used to assess possible reform options.
  • The principles broadly included the following themes: maintaining independent clinical decision-making; support for informed patient choice and best practice care; support for system sustainability and best clinical outcomes regardless of setting; appropriate use of workforce; and no unreasonable shifting of costs or responsibilities onto patients or carers.

5. Options for change

  • The sub-group considered a range of possible options for change to improve the delivery of rehabilitation funded by private health insurance.
  • Many of the options considered by members would require legislative change.
  • Options were generally identified through previous group discussions, aiming to either address existing barriers or to provide a greater incentive for clinically appropriate alternative models of care.
  • Key options under consideration are:
    • simplify the legislation to make clearer what is permitted regarding alternative models;
    • improve the ability to transition successful pilot projects to ongoing programs; and
    • enhance rehabilitation data collection and reporting requirements.

6. Implementation issues

  • Members considered the implementation issues associated with improving the regulation of private health insurance funded rehabilitation.
  • Implementation issues included the following:
    • appropriate implementation timeframe to allow for passage of legislation if necessary and market responses from private health insurers and providers under a new regulatory environment;
    • ensuring appropriate independent clinical decision-making is retained;
    • rehabilitation services delivered in alternative settings are clinically appropriate;
    • ensure costs and responsibilities are not inappropriately shifted to patients, carers and families;
    • capacity of alternative settings to deliver additional services; and
    • ensure efficiencies are captured and support sustainability of the sector.

7. Other business

  • The next sub-group meeting is scheduled for 26 July 2018.

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