A Consultation on the Recommendations from the Report from the Allied Health Reference Group

The full Report from the Allied Health Reference Group

The aim of this consultation is to seek feedback on the recommendations that have been made on the MBS review by the Allied Health Reference Group. The key recommendations have been summarised in the survey for your input - your feedback is critical to informing our report back to the taskforce.

Requests for amendments to the MBS not addressed by the recommendations are not in the remit of this survey, however we would welcome your input on any anything your consider relevant.

Any comments you wish to make in addition to this survey can be directed to Shelley.Crowther@australian.physio

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* 1. Recommendation 1 - Introduce initial assessment appointments (of more than 40 minutes) for allied health professionals. 

This recommendation aims to encourage comprehensive initial assessments by allied health professional. It includes the creation of new item (109AA) for an allied health appointment of at least 40 mins. This would be restricted to a unique presentation, claimed per patient, per provider, per year. It would only be able to be claimed once per practice, unless the provider was from a different discipline.

We believe we should support this recommendation as it provides more appropriate funding for initial consultations. We support the definition of a unique presentation being “a primary complaint for which the allied health professional has seen the patient before but where a significant change in the quality or severity of the complaint necessitates reassessment” but request addition of the words “as defined by the eligible allied health professional e.g. physiotherapist”

More information: Report from Allied Health Reference Group pg 22

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* 2. Recommendation 2: Increase the number of allied health appointments under team care arrangements (TCA's) item 721 and 723, by stratifying patients to identify those with more complex care requirements. A follow-on piece of work will be conducted to test and identify the most appropriate stratification approach

We are broadly in support and believe this is a step forward to achieving improved access, however, we are still concerned that there may not be adequate access to physiotherapy services through the stratification process. We would prefer to see an envelope of designated physiotherapy services, assessed according to the patients condition. We also support development of a patient-centred model that ensures the physiotherapist is involved in the identification of eligibility and in determining the process for renewal

More information Report from the Allied Health Reference Group pg 27

Do you think this recommendation adequately addresses access to physiotherapy appointments? If not, why?

If you would like to provide a detailed response please email shelley.crowther@australian.physio

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* 3. Recommendation 4 - Introduce a practice incentive payment for allied health professionals who provide group therapy under items 81105, 81115 and 81125.

Physiotherapy is not an eligible provider of these group services under the MBS. Data shows that claims for exercise physiology group services are growing at 15 per cent per year, while claims for group diabetes education and dietetics services are decreasing at 13 per cent and 12 per cent annually, respectively. The Reference Group agreed that group therapy items are underused because allied health professionals face barriers in organising and running group sessions and efforts are being made to improve utilisation.

We believe that physiotherapy practices are well-equipped to manage these barriers and could enhance utilisation. We believe that there is sufficient supporting evidence to add physiotherapists to the list of eligible providers.

More information Report from the Allied Health Reference Group pg 31

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* 4. Recommendation 13 – Support the codifying of allied health research and evidence

The aim of this recommendation is to build an allied health research base which would potentially be funded by the Medical Research Future Fund (MRFF)

We support any investments made into the building the physiotherapy research base, particularly in areas where evidence is currently lacking.

Are there priority areas that you would like to identify or any particular gaps in evidence that you think need to be urgently addressed?

More information Report from the Allied Health Reference Group pg 43

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* 5. Recommendation 14 - Expand the role of telehealth in allied health care. 

This recommendation is to create an interim new MBS item for the provision of telehealth services for patients consulting with an allied health professional via teleconference.

Whilst we support enhanced access to telehealth, the following restrictions have been applied around which we have concerns.
1. The patient must be located both within a telehealth-eligible area and at least 35 kilometres by road from the allied health professional.
2. The patient must reside in a rural or remote region (defined as Modified Monash Regions 4 to 7).
3. The allied health professional must be a primary health care provider for the patient, defined as having had at least two face-to-face consultations with the patient.

Do you support this recommendation?

More information Report from the Allied Health Reference Group pg 45

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* 6. Recommendation 15 - Pilot non-fee-for-service allied health payment models.

This recommendation aims to undertake a piece of work to understand how bundled and other non-fee-for-service remuneration models could help to better integrate allied health into the Australian primary health care system, to include the following:

Do you agree that a pilot on non-fee-for-service payment models for physiotherapy should be undertaken? Please explain why.

More information Report from the Allied Health Reference Group pg 47

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* 7. Recommendation 16 - Enhance communication between patients, allied health professionals and general practitioners (GPs).

This recommendation seeks to invest in an education campaign for allied health professionals and GPs to promote shared decision-making. It also aims to improve communication between allied health professionals and GPs by providing financial support for GPs and private allied health professionals to set up secure messaging systems. In addition, it aims to promote more formal referrals between GPs and allied health professionals. 

Do you support this recommendation?

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* 8. Recommendation 17 - Add non-dispensing pharmacists to the list of eligible allied health professionals under the MBS.

The Reference Group recommends adding an item to allow pharmacists to provide medication management services to patients with complex care requirements outside of usual retail pharmacy operations as part of TCAs under M3 MBS items (up to twice a year).

Whilst we support the inclusion of non-dispensing pharmacists in team-based care, this should not be done by reducing access to other allied health services. Given that there are already an insufficient number of appointments available, we recommend that no new eligible practitioners be added to TCAs, but rather a rationalisation to evidence-based practitioners. We suggest that a separate numbers specifically for the purpose of medicines management by non-dispensing pharmacists be added instead.

Do you have any concerns with the addition of non-dispensing pharmacists to the list of eligible allied health providers?

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* 9. Recommendation 6-11 relate to allied health services for autism, pervasive developmental disorder and disability. These recommendations broadly aim to to increase access to high quality allied health care for these patients. We are in support of these recommendations in principle, however would like to understand if there could be any issues with implementation that we may not be aware of. 
The recommendations are to:
Improve access to paediatric health assessments, complex paediatric health assessments for children with a potential ASD, CND or eligible disability diagnosis,  M10 treatment items as group therapy, ASD and eligible disability assessments to people under 25
Encourage multidisciplinary planning for children with a potential ASD or eligible disability diagnosis and improve allied health collaboration during assessments

This information is detailed in the Report from the Allied Health Reference Group on pages 33-42. 

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* 10. Additional recommendations

APA provided a written submission to the Taskforce in June 2018. While most of our requests were addressed in this report (or in reports from other committees) the following recommendations were not taken up. Please tick any areas in which that you would like to see APA provide continued advocacy.

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