Summary of Meeting 1 of the Rehabilitation Sub-Group 1 May 2018

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

Page last updated: 25 May 2018

PDF version: Summary of Meeting 1 of the Rehabilitation Sub-Group 1 May 2018 (PDF 134 KB)

Attendees

Members Secretariat
Dr Andrew Singer, Chair Julianne Quaine, Secretariat
Ian Watts, Australian Physiotherapy Association Susan Azmi, Secretariat
Dr Jui Tham, Australian Health Service Alliance Mitch Docking, Secretariat
Dr Stephen de Graafe, Australasian Faculty of Rehabilitation Medicine Alison Harriden, Secretariat
Kendall Shearer, Occupational Therapy Australia
Michelle Somlyay, Mater Hospitals and Health Services
Jo Root, Consumers Health Forum
Members – via teleconference
Lucy Cheetham, Australian Private Hospitals Association

Apologies

Rebecca Bell, Medibank Private
John Biviano, Royal Australasian College of Surgeons
Matthew Mackay, Royal Rehab

1. Welcome and Introductions

  • The Chair opened the meeting and provided members an opportunity to introduce themselves to the Rehabilitation sub-group (the sub-group).

2. Opening Statement/Operation of the Working Group

  • The Chair delivered his opening statement, advising members that the purpose of the sub-group is to provide advice to the Improved Models of Care Working Group (the Working Group) on options to improve the regulation of private health insurance funded rehabilitation services.
  • The Chair advised that a key consideration for this work is to identify regulatory changes to private health insurance that support access to clinically effective and efficient care.
  • The Chair noted that members may be required to discuss particular issues with their organisation, and asked that members be mindful of the balance between appropriate consultation and respecting confidentiality.

3. Declarations of Conflicts of Interest

  • The Chair noted that he had considered members’ declarations of their interests and did not consider there were any declared conflicts that would prevent participation.
  • The Chair reiterated members’ obligations to advise of new conflicts should they arise during the existence of the sub-group.

4. Improved Models of Care – Issues Paper and Presentation

  • The Secretariat delivered a presentation, also given to the Improved Models of Care Working Group, providing an overview of issues to be considered by the Working Group and sub-group.
  • The presentation covered current government regulation, including relevant parts of the Private Health Insurance Act and Rules.
  • Members were also provided information and data on the common types of rehabilitation services funded by private health insurance.

5. Member perspectives

  • Members summarised their views and identified a range of issues including:
      • the importance of maintaining independent clinical decision-making in determining appropriate clinical pathways and care settings;
      • rehabilitation delivered in alternative settings must be high quality and safe, and should achieve equivalent outcomes compared with admitted hospital based care;
      • consumers need to be empowered and more informed. Consumers are likely to support alternative models if timely access to quality health care in not impacted;
      • there are issues with the collection, reporting, and quality of rehabilitation data, which impacts the ability to robustly measure patient outcomes in alternative settings. This may make it difficult to quantify the ‘value proposition’ of allowing insurers to fund alternative settings of care;
      • some members suggested the definition of ‘rehabilitation’ requires refinement to recognise better the interdisciplinary approach to rehabilitation care;
      • rehabilitation has potential to capture efficiencies, such as reducing unjustifiable variation in referral to admitted patient rehabilitation, which may help insurers invest in new models and address affordability;
      • there has been a shift in the delivery of private rehabilitation services from admitted overnight care to day rehabilitation programs. This shift may reflect improvements in technology and service delivery, and the private sector should continue to evolve to deliver rehabilitation in alternative settings, such as home and community; and
      • digitally supported models, such as digital health records and telehealth are particularly relevant for regional and rural patients.

6. Work plan

  • The work plan was agreed in-principle by the sub-group.

7. Establishing the evidence base

  • Members agreed to provide the Secretariat with resources and evidence to support advice on the delivery of rehabilitation in alternative settings. These resources will be captured by the Secretariat on an evidence register.
  • Members agreed that the evidence would require examination for publication bias, robust clinical outcomes and acknowledgement of different health systems.
  • Rehabilitation data was provided to members for consideration, including the number of rehabilitation separations, growth in services, costs, and underlying principal diagnoses.

8. Types of rehabilitation and clinically appropriate settings of care – Issues Paper

  • The Secretariat introduced an Issues Paper, outlining the various types of rehabilitation treatment and settings of care which may be clinically appropriate.
  • The paper identified cost-efficiency and the affordability of private health insurance as key considerations of this work. The risk of new non-admitted services delivered in addition to the existing admitted services would add costs and contribute to premium growth.
  • The Secretariat sought members’ expertise to refine the definitions of the various types of rehabilitation, including identifying additional categories or sub-categories of rehabilitation.
  • Considering these categories, members discussed the clinical appropriateness of delivering rehabilitation in alternative settings, such as home and community. Members noted that for any individual, the appropriate setting would be influenced by the full range of clinical and social factors.
  • Members considered current industry guidelines, definitions and criteria for private rehabilitation services, noting that these focused on hospital-based care.
  • Members discussed the integration of other models of care with the hospital setting and the allocation of resources required across the spectrum of patient rehabilitation.

9. Other business

  • The next sub-group meeting is scheduled for 31 May 2018.

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