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Review of physiotherapy services funding

Review of physiotherapy services funding

ACC Minister Ruth Dyson and New Zealand First Deputy Leader Peter Brown today announced details of a review of the way physiotherapy services are funded and accredited.

"The confidence and supply agreement between the Labour-led government and New Zealand First includes a review of the way in which physiotherapy services are funded and accredited. This announcement progresses that commitment," said Ruth Dyson.

"The review will also consider the rehabilitation outcomes of ACC claimants receiving necessary and appropriate physiotherapy services."

Peter Brown said he and Ruth Dyson were pleased to announce the appointment of Bill Wilson, QC as the Independent Reviewer.

"Mr Wilson has extensive experience as a lawyer and has undertaken the other reviews including ACC Regulations (1994) and Tranz Rail Safety (2000).

"The progress of the Review will be monitored through regular reporting to the Minister for ACC, in consultation with myself. A final report is expected by September 2007," said Mr Brown.

In summary the review will look at: a. ACC payments to physiotherapists. The level of payment under regulations specifically, and the effect of payment relativities between regulation and contract generally, on the sustainability of physiotherapy services; b. The endorsed provider network (EPN). Concern about certification and associated compliance costs with EPN; c. Culture of ACC/audits. Perceived inappropriate culture and attitude by ACC towards physiotherapists; and d. The Physiotherapy profession generally. The general sustainability of the physiotherapy profession within New Zealand and ACC's role in maintaining a sustainable physiotherapy sector.

Draft terms of reference for the review (see background information attached) will be given to physiotherapy groups for their input and feedback before being finalised.

Proposed Terms of Reference for Review of the way in which Physiotherapy Services are Funded and Accredited by ACC

The Confidence and Supply Agreement between the Government and New Zealand First includes a review of the way in which physiotherapy services are funded and accredited. Accordingly, the Government has decided to undertake a Ministerial Review to assess the adequacy of the current regulatory and purchasing arrangement for physiotherapists within the ACC regime having regard to the context of the existing regulatory regime governing competency standards of health practitioners.

The Review will also have regard to the rehabilitation outcomes of ACC claimants including the provision of necessary and appropriate physiotherapy services to achieve improved claimant outcomes. The Review will look at the ACC regime only. The regulatory arrangements for health practitioners competency standards are outside the scope of the Review and will not be the subject of recommendations (though they may be looked at in order to provide context).

Content of the Review

The Commission of Inquiry or Independent Reviewer will inquire into and make recommendations to government on the following questions.

ACC Payments to Physiotherapists

1. The Government wishes to ensure public access to high quality physiotherapy services by reducing co-payments, whilst ensuring the sustainability of physiotherapy service delivery: 1.1. Are the levels of current payments for service delivery made by ACC to physiotherapists under:

1.1.1. Cost of Treatment regulations; 1.1.2. the Endorsed Provider Network (EPN) contracts; and 1.1.3. other contractual arrangements,

adequate to cover the cost of services whilst ensuring the retention of an appropriately sized, skilled and financially viable physiotherapy profession to meet the needs of ACC claimants?

1.2. Bearing in mind the history of adjustments to physiotherapy charges under ACC “Cost of Treatment” regulations, are the above payments likely to continue at an appropriate level in the foreseeable future?

1.3. In the long term interests of ACC claimants and the profession, are compulsory restrictions on co-payment (claimant part charges) appropriate?

1.4. What changes (if any) are necessary to pricing frameworks, annual adjustment indices, restrictions on ACC claimant co-payments and other relevant factors to ensure that the financial viability and integrity of the profession is maintained now and in the future?


2. The Endorsed Provider Network has been piloted and implemented nationwide since 2004.

2.1. Are initial and ongoing compliance costs for accreditation standards appropriately built into ACC payments when accreditation is a contractual requirement for EPN providers?

2.2. Are the differences between pricing frameworks and fee structures paid under cost of Treatment Regulations, as opposed to the EPN and other contract pricing frameworks, valid and justifiable in the interests of patients, and in maintaining a healthy and suitably qualified profession?

Culture of ACC/Audits

3. Physiotherapists have raised concerns about the culture of ACC and its attitudes towards physiotherapists.

3.1. Is there evidence of any inappropriate culture or attitude from within ACC towards physiotherapists which is detrimental to the funder / provider relationship between the parties

3.2. Are audits and investigations being carried out only for proper purposes, in appropriate circumstances, and within appropriate guidelines for programmed and selected audits?

3.3. What changes, if any, are necessary to addresses any inappropriate culture, attitudes or activities found within ACC towards physiotherapists?

Physiotherapy Profession Generally

4. There are challenges facing the profession as primary health care practitioners in ensuring that it continues to plays its vital public health role in rehabilitating and maintaining the quality of life New Zealanders, including ACC claimants.

4.1. In regard to the needs of New Zealanders, is the physiotherapy profession:

4.1.1. retaining adequate numbers of senior physiotherapists within the profession?

4.1.2. adequately remunerated for post-graduate qualifications and expertise

4.2 What, if anything, can ACC or the Government do to assist with any deficiencies found regarding seniority and post-graduate training in the profession?

4.3 Are there any other matters arising out of this review that impact upon the way in which physiotherapists are accredited and funded by ACC which ought to be addressed by the Government to encourage provision of sustainable and high-quality physiotherapy service to the public of New Zealand?

Process Issues Governance The progress of the Review will be monitored through regular reporting to the Minister for ACC, in consultation with Peter Brown, MP, NZ First. Manner of conducting the Review The conduct of the Review shall be carried out according to the following principles:

the Review is to be an investigative review that is not overly legalistic or adversarial; the principles of natural justice are to be complied with; the Review is to be consultative; officials will cooperate with the Reviewer; the process for conducting the Review will be flexible in order to accommodate any changes in the Terms of Reference that may be required at the discretion of the Reviewer with the agreement of the Minister;

the Review will focus on finding practical solutions that can work to any issues that are identified; and given the investigative nature of the Review, it will be up to the Reviewer to determine what, if any, part of the Review should be held in public; and to the extent that the conduct of the Review would require ACC or any other agency to disclose to the Reviewer the content of legal advice, the Reviewer is to treat that legal advice as covered by legal professional privilege and natural justice will not require disclosure to any other party.

Context for making recommendations The Review will focus on whether current regulatory and contracting arrangements lead to adequate rehabilitation and compensation outcomes for claimants and what, if any, changes are required. The recommendations will be guided by the Government’s objectives and goals, including: ACC scheme focus on rehabilitation with the goal of achieving appropriate quality of life; the proposed rehabilitation framework, which aims to provide a set of principles and/or definition on which to base all future rehabilitation policy, purchasing and service delivery;

ACC scheme principle of fair compensation, including compliance with ILO 17; Woodhouse vision that health practitioners should not bear burden of costs of the ACC scheme; the Government goal of effective and efficient sector regulation, and principles underpinning health sector regulation; and the Government goal of building the capability of the health sector workforce. Information provision ACC and the Department of Labour will discuss issues surrounding the Review with the Reviewer and will make available relevant material and information as requested.
The Reviewer may use any other sources of information and advice considered to be useful in conducting the Review. Consultation The Reviewer will consult as required in order to contribute to the Review. It is expected that the following will be consulted: ACC, the Department of Labour, the Ministry of Health, the New Zealand Society of Physiotherapists Inc., the New Zealand Physiotherapy Trust, Auckland Physiotherapy Practice Association, individual members of the physiotherapy profession, physiotherapy accreditation providers, claimants or consumers of physiotherapy services, and other interested parties.

Timeframes and reporting The Review will commence in October 2006 and is expected to report to the Minister for ACC by no later than September 2007. Interim reports will be supplied to the Minister for ACC quarterly. The final report will provide recommendations to the Minister for consideration.


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