Summary of Meeting 4 of the Rehabilitation Sub-Group 26 July 2018

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

Page last updated: 06 August 2018

Summary of Meeting 4 of the Rehabilitation Sub-Group 26 July 2018 (PDF 134 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 AustraliaAndrew McLaren, Medibank Private
Dr Stephen de Graaff, Australasian Faculty of Rehabilitation Medicine Amanda Kennedy, Department of Health
Dr Jui Tham, Australian Health Services AllianceRansome Mclean, Department of Health
Michelle Somlyay, Catholic Health Australia
John Biviano, Royal Australasian College of Surgeons
Matthew Mackay, Royal Rehab
Dr Sarah Barras, Australian Health Service Alliance (via teleconference)

Apologies

Rebecca Bell, Medibank Private
Lucy Cheetham, Australian Private Hospitals Association
Associate Professor Graham Mercer, Australian Medical Association

1. Welcome, introductions, and conflicts of interest

  • The Chair opened the meeting and provided members a brief overview of the issues to be considered at the meeting.
  • Members did not declare any new conflicts.

2. Options for change

  • The sub-group considered additional possible options for change to improve the delivery of rehabilitation funded by private health insurance.
  • Members considered an option to support the delivery of ‘prehabilitation’ funded by private health insurance, particularly relevant for orthopaedic services. This possible option could support an episodic based or bundled payment funding model, where insurers could cover an episode of care that may include prehabilitation, acute surgical intervention, and post-acute rehabilitation.
  • Members discussed what it means (or could mean) to be covered for rehabilitation under hospital treatment products. Private health insurers currently provide cover for rehabilitation and consumers would expect to access clinically appropriate rehabilitation services. Some members were of the view that hospital treatment should fund services delivered under a rehabilitation plan irrespective of setting, and improved models of care should better support the longer tail of rehabilitation (back at the home setting) which may contribute to improvements in the durability of clinical outcomes.

3. Implementation issues

  • Members reconsidered the implementation issues associated with changing the regulation of private health insurance funded rehabilitation.
  • Cost-efficiency was raised as an issue for further discussion. While it has been suggested that alternatives to hospital-based rehabilitation may be more cost efficient, members were of the view that a viable model would require an appropriate volume to achieve economies of scale.
  • An additional consideration identified by members was the value proposition of private health insurance. There are two aspects of value: affordability (private health insurance premiums) and coverage of services. While enhancing rehabilitation services funded by private health insurance is desirable, it was acknowledged that premium affordability is currently the main concerns for consumers.

4. Transition arrangements

  • The Chair introduced an item for members to consider the possible arrangements for transitioning to a new regulatory environment to support improved models of rehabilitation care funded by private health insurance.
  • Members considered the following transition issues:
    • the capacity of alternative settings to meeting increasing demand, including possible transition of new or existing capital stock and workforce;
    • a clear communication strategy to accompany any reforms to educate and inform clinicians, providers and consumers;
    • industry guidelines for rehabilitation that include guidance on alternatives to hospital-based rehabilitation;
    • research and monitoring the effect of changes to service delivery, safety and quality, and clinical outcomes resulting from reforms; and
    • development and application of an effective change management framework to successfully transition to a new regulatory environment.

5. Application to other clinical areas

  • Members considered the issues and options developed for rehabilitation and the possible application of these to other clinical areas.
  • Andrew McLaren, Medibank Private, provided a brief overview of the ‘Medibank at home’ initiative, focusing on at home trials for chemotherapy, dialysis, and palliative care. The presentation outlined the evidence base supporting Medibank’s at home care, criteria for identifying new pilot projects, key learnings from the rehabilitation at home program, and other key learnings including barriers and enablers for at home services.
  • Key considerations for Medibank for pilot projects were: consumer experience, clinical outcomes, and affordability of private health insurance.
  • Members generally agreed that the application of options developed for rehabilitation to other clinical areas might be possible for less complex and more predictable elective procedures.

6. Presentation: Medicare Benefits Schedule (MBS) Review

  • Amanda Kennedy and Ransome Mclean presented on the MBS Review, providing the sub-group with an update on the progress and outcomes to date. The MBS Review is considering how the 5,700 MBS items can be aligned with contemporary clinical evidence, best practice, and high value care. The sub-group considered possible linkages of rehabilitation services funded by private health insurance and the MBS Review.
  • The presentation focused on two key aspects of the MBS Review:
    • the Specialist and Consultant Physician Consultation Clinical Committee, which includes reviewing specialist and consultant physician attendance items; and
    • the Primary Care Reference Groups, which includes consideration of allied health, nurse practitioner, mental health, midwife, and Indigenous health item numbers.
  • Members were particularly interested in the MBS Review’s consideration of telehealth, case conferencing, and chronic disease management plans.

Other business

  • The next sub-group meeting is scheduled for 28 August 2018.

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