WorkCover Tender Panel Review - The Controversy Concerning Return to Work

Transcription

1 28 April 2015 Complaints Advisor WorkCover Queensland GPO Box 2459 Brisbane, QLD 4001 RETURN TO WORK SERVICES PANEL Dear Sir/Madam, On behalf of the membership of Occupational Therapy Australia - QLD Division (OTA QLD), we write to express our concern, dismay and disappointment with the recent WorkCover Return to Work (RTW) tender panel process and outcome. Before detailing our primary concerns, it is important to set the context by outlining the background leading to the appointment of the panel. Background In late 2014, WorkCover (WC) sought to make changes to the way rehabilitation and support was made available for injured workers. Up until then, more than 200 service providers were registered for RTW services. With the appropriate qualifications and experience, professionals could contact WC and, after demonstrating that they meet the requirements, be added to their referral system. This approach was considered by many professionals (not only Occupational Therapists), to be effective by enabling a locally accessible quality service to be provided to both employers and their injured workers. It is understood that WC s rationale for the appointment of the RTW panel was the perception that service standards and work volumes were variable between providers and not cost effective. WC had stated that to help achieve the best outcomes for their customers whilst managing the cost for employers, they want the best available providers delivering these services. They indicated the tender process was an important part of their commitment to working together with workers, employers and providers to achieve the best return to work outcomes at a reasonable cost to employers.

2 The process undertaken by WC commenced with a notification to service providers that they wished to review their 200+ service providers to ensure that providers met their minimum requirements and this was done by way of interested parties being required to respond to a tender addressing published criteria. WC had advised at that time they anticipated reducing the current number of providers from 200+ to ensure they were able to efficiently and effectively handle and monitor service delivery into the future. The tender process opened for a 4-week period and closed at the nominated closure date. Then WC reopened the tender process for a further 4-week period due to technical issues. When the tender process closed for the second time, WC received over 150 tender submissions from providers across QLD. From those, a total of 37 were selected to be on the panel. WC claimed a robust tender process was undertaken to assess providers against the published criteria and used their service and location requirements to select the final panel numbers and to ensure regional coverage, adding they were aiming for a more equitable distribution of work based on these factors WC maintain they have considered the number of services required and have selected the very best providers to meet these needs including regionally located customers. WC indicated they anticipated the number of appointed providers to reduce following this process. They said the applications were very competitive, however, because the volume of services offered far exceeded their expected customer needs, many very good providers who are highly experienced and capable were unsuccessful. The RTW panel exists now for referrals made regarding RTW services. This includes workplace evaluation and assessment, functional capacity evaluation, return to work facilitation, development and monitoring of suitable duties program, vocational assessment, preparation and placement services, and transferrable skills assessment. Successful providers have been appointed and will sign a contract for a period of 3 years with the arrangement effective 16 Feb 2015, with a two-year option to renew at WC s discretion.

3 Many employers nominate a preferred provider, however WC will only allocate and approve RTW services to appointed providers on the panel. They have advised that providers who were unsuccessful may still have their own arrangements to provide other services to employers that do not require WC approval or payment. Transitional arrangements are in place for providers who did not get on to the panel however are still currently acting on RTW service referrals. However once completed are no longer able to bill for their work through WC. What are the primary concerns of Occupational Therapy Australia - QLD Division? Lack of transparency and the haphazard manner with respect to the tender process: WC advised they would be calling for tenders, however there were ongoing delays until this finally happened. When it happened the tender was open for 4 weeks with a set date and time for submissions. Then after the tender period closed, WC announced an extension for a further 4 weeks due to apparent technical issues. What exactly were these technical issues and why did it require a further extension of 4 weeks? It is completely understandable that those who were unsuccessful might speculate that there were insufficient applicants or perhaps certain organisations or individuals who were expected to apply didn t hence an extension was provided. It would be interesting to note how many applicants made their submission during the extension period and, of those, who was selected on the panel. Criteria for assessing the tender is considered flawed and the statistical analysis undertaken invalid given the many variables: with respect to the Level of Service and Area of Service (Service Provision) Geographical Allocation of Work, the table that needed to be filled out by applicants denoting the areas where services would be provided was clunky and virtually impossible to fill in. WC built this into the assessment process however it was extremely difficult to quantify and make comparison between providers. The decision to select providers should not be based on the proximity between where service providers live or are located in an effort to reduce travel costs. A good quality provider, irrespective of where they live or are located, will provide the best outcomes. Similarly to assess providers based on performance for the past 12 months and corresponding claims costs does not always result in the best outcome there are too many variables to make comparisons. High quality providers may understandably attract more complex cases with higher claims costs. Looking at past performance in terms of the cost is simplistic and does not always take into account the cost savings often realized in the longer term for employers.

4 Lack of fundamental quality review: one applicant/member of OTA - QLD was told by WC that all of the information they submitted would be taken into account with any review process, for example, associated referral relations with value add services from medical teams through to specialty advisors. However this was not taken into account as the applicant s contacts were not even consulted nor was a review undertaken of outcome studies or a review of report samples. Also the lack of confirmation by WC that some of the successful applicants who indicated in their tender submissions that they could adequately service areas clearly have not been able to in their current situation. One only has to review SEEK to see the number of advertisements posted following the panel announcement in a bid to scramble to find staff. Testimonials/References: many OTs provided fantastic testimonials (some up to 20 per tender) along with references. WC advised that referees would be contacted in the review/selection process however this did not happen for many applicants. WorkCover website: the statement on the WC website that they have considered the number of services required and have selected the VERY BEST PROVIDERS is quite frankly defamatory and almost restrictive of trade for those providers who were unsuccessful. In fact WC contradicts their own statement by acknowledging that many very good providers who are highly experienced and capable were unsuccessful. So how can it be that the panel consists of only the very best providers? The language used on the website is offensive, potentially damaging to others who were not selected for the panel. The phrase best providers were selected may indeed have implications for other work opportunities for the unsuccessful providers as industry and doctors are directed to that panel by WC QLD who has the monopoly on the QLD compensation system. Provision of quality outcome guidelines to the successful panelists: following the appointment of the successful panelists, WC have provided them with quality outcome guidelines which would appear to be firming up a monopoly of providers who are now given coaching regarding outcome reporting. This will potentially create greater barriers for other providers when the panel tender opens again in 3 yrs time, notwithstanding WC s offer to the successful panelists of a 2-year option to renew at their discretion. If someone new moves to an area with great experience and expertise, they will be restricted from service provision until (eventually) another tender process reopens Queenslanders will miss out! Creation of a monopoly: the appointment of this panel has created a monopoly without concern for employers, injured workers or providers. WC has referred to equitable distribution as a component of their decision making - how is this the case with 37 providers selected on the panel from over 200 service providers previously?

5 The lack of savings to the public purse: for the effort required to undertake this process, perhaps WC would have been better placed to review general practitioners who certify RTW certificates rather than the providers who have been shown to be successful in their support of the RTW process. Inappropriateness of WC response to unsuccessful applicants: statements have been made that providers who were unsuccessful in their appointment to the panel could simply market new services and ask employers to pay privately! To suggest that an occupational rehabilitation provider can still receive referrals from an employer, just not for rehabilitation and RTW services seems to dispel the great specialisation developed among these providers who have honed their skills over the years to provide a quality clinical service. They cannot easily jump ship and convince an employer to start paying privately for a newly imagined service. It is extremely disheartening to see many sole trader/small business owners now faced with losing what has been up to 25% of their workload and potential income and for some their entire revenue stream. Risks: by reducing the number of providers in the RTW space, there is a significant risk of losing clinical niche specialty practice and maintenance of clinical competence. There will be a negative effect of losing many highly experienced OTs from the QLD WC system and the likelihood that work will be performed by less experienced therapists. This is a particular risk in the regional areas of QLD where few local providers were successful. Customer Advisors (Care Managers) at WC are being given a limited pool of professionals from which to choose rehabilitation support. Workers and individuals with claims will miss out. No longer can employers select a provider of choice their choices have been limited by WC s truncated list of providers. Lack of consultation with industry: WC advised that there was extensive consultation with industry, however many OTs have spoken to dozens of employers customers of WC QLD, none of whom knew of this panel. Also some OTs have spoken to multiple safety committees and Work, Health and Safety representatives, many of whom also didn t know about the panel? So how did this industry consultation take place and with whom? It is important to recognize that many providers operating in the RTW space establish long term relationships with employers and this is crucial for good quality RTW outcomes. Potential Impact on New Graduates: many OTs are concerned that in this particular area of work, the majority of the most experienced providers are not there and have been replaced with other larger organisations who often employ new graduates who are not established and have limited experience and expertise particularly to support complex cases. Has WC considered this as a potential negative effect by not affording adequate protection of the professional standing of the students in this situation?

6 To conclude, for the reasons outlined in this correspondence, Occupational Therapy Australia QLD Division, is extremely disappointed with the RTW tender panel process and outcome and many OT s who are members of the Division have been significantly impacted by this decision of WC. The outcome has had, and will continue to have, a detrimental effect on those who work in this sector, with the loss of many highly experienced OT s from the QLD WorkCover system. At the national level, Occupational Therapy Australia is in the process of developing an advanced practice framework for Occupational Therapists. This is likely to provide a robust process for identifying occupational therapists who are leaders in particular fields, such as work rehabilitation. This structure may be more suitable than the current RTW Services Panel in identifying health practitioners who are likely to provide high quality outcomes and service. This may meet the needs of WC, as well as providing a transparent, fair and equitable process for providers. WC has clearly committed to moving forward with the RTW Services Panel in its current form, however we respectfully request that the decision makers give serious consideration to rethinking the RTW Services Panel for the reasons outlined in this letter. There are many highly experienced and capable providers who have now been terribly disadvantaged through no fault of their own, which presents an untenable situation for not only the provider, but also the employer and the employee receiving RTW services. Thank you for your time and attention to this issue. Kieran Broome Chair, OTA QLD Division Council Sharon Oxenbridge Division Manager, OTA QLD