Occupational Therapy Working Group: Service Delivery review and Fee Review

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1 Occupatinal Therapy Australia Victria Divisin Terms f Reference submissin Occupatinal Therapy Wrking Grup: Service Delivery review and Fee Review HDSG (TAC and VWA) July 2014 Occupatinal Therapy Australia Limited ABN ACN VIC Divisin 5/340 Gre Street Fitzry VIC 3065 P F E W

2 Occupatinal Therapy Wrking Grup: Service delivery review and fee review. Terms f reference submissin t HDSG - TAC/VWA Occupatinal Therapy Australia welcmes the pprtunity t cntribute t the develpment f TAC/VWA s terms f reference fr the Occupatinal Therapy Wrking Grup t review the ccupatinal therapy services and fee schedule. INTRODUCTION In May 2014 it was annunced that the Transprt Accident Cmmissin (TAC) and WrkSafe Victria (nw VWA), thrugh the Health and Disability Strategy Grup (HDSG) wuld undertake a review f the delivery f ccupatinal therapy services t TAC clients and injured wrkers. This review was t include key internal and external stakehlders wh have expertise in the delivery f ccupatinal therapy services t TAC clients and injured wrkers, and wh perate within the systems that supprt the delivery f these services. The ability f TAC clients and injured wrkers t access high quality, effective health and disability services in a timely manner is a critical factr in supprting them t achieve meaningful life utcmes (including health, wrk and independence). Restructuring the framewrk under which these services are delivered and funded will help imprve functinal utcmes and future service delivery. Occupatinal Therapy Australia (OTA) has been invited t participate in this review. OTA is the prfessinal assciatin and peak representative bdy fr ccupatinal therapists in Australia. As f December 2013 there were nearly 4,000 registered ccupatinal therapists wrking acrss Victria in the public, private and cmmunity sectrs. CONTEXT: This review f ccupatinal therapy services and assciated fees is in line with the Victrian gvernment s bjectives, as utlined in TAC 2015 strategy and WrkSafe 2017 strategy; t reach imprvement targets in the key areas f client utcmes, client experience and scheme viability, and t imprve targets acrss three key areas f; return t wrk, service and sustainability. Occupatinal therapists play a key rle in assisting TAC and VWA in achieving these strategic bjectives. Occupatinal therapists are key service prviders wh perate within ccupatin and engagement fcused framewrks t facilitate injured wrkers and TAC clients return t wrk and/r achieve independence gals. REVIEW PURPOSE: The review will invlve a range f stakehlders with subject matter expertise. OTA anticipates that the review will: evaluate the capacity f the current mdels f ccupatinal therapies service prvisin t achieve the stated TAC and VWA bjectives explre pprtunities t further develp services delivered explre a fee structure cmmensurate with service delivery csts cnsider nging and emerging wrkfrce initiatives t ensure best practice service delivery Cnsider required implementatin strategy 1

3 OTA believes that key TAC and VWA bjectives f imprved client utcmes and client experience, imprved scheme viability and the prmtin f a client- centered service apprach will be enhanced by implementing recmmendatins arund the delivery f ccupatinal therapy services the structure f fees fr ccupatinal therapy services the develpment f the prvider wrkfrce f ccupatinal therapy services Other related matters f significance r further matters f significance related t service delivery, fee and prvider wrkfrce may becme evident during the prcess f the review. 2

4 PROPOSED REVIEW PROCESS: Review wrk area: Operatinal Expected utcme July 2014 Preliminary August 2014 Preliminary wrking grup review discussins and stakehlder submissins. Initial Occupatinal Therapy Wrking Grup meeting 1. First meeting f Occupatinal Therapy Wrking Grup: Adpt meeting prtcl, functins and expectatins as utlined in HDSG s Occupatinal Therapy Wrking Grup Terms f Reference. Clarify legislative framewrk and parameters fr review. Review stakehlder submissins and pririty review areas Cnfirm wrk plan & meeting schedule Finalize Occupatinal Therapy Wrking Grup membership arrangements Cnfirm HDSG Occupatinal Therapy Wrking Grup secretariat arrangements Establish intended utcmes f review HDSG circulate draft wrking grup terms f reference and call fr feedback. Stakehlder submissins and expressins f interest Prir t August meeting: TAC and VWA representatives t cnsult relevant parliamentary Acts, and reprt n/clarify specific parameters fr the wrking grup At August meeting: All stakehlders agree t wrking plan. Determine prcesses fr meetings, including prir ntificatin f meeting business in time fr preparatin/cnsultatin fr all meetings at each stage f the review. Backgrund scping; terms f reference finalized. Occupatinal Therapy Wrking Grup cmmences review with clear bjectives, staged plan, and time frames. Belw is OTA s suggested cntent and time frame fr the service and fee review prcess. Sept Oct 2014 Review f ccupatinal therapy service delivery 3

5 1. Review existing scpe f ccupatinal therapy services available t current TAC clients & injured wrkers. Include: Review f ccupatinal services prvided under ther gvernment arrangements Identificatin f gaps relevant t client grup Re-alignment fr cnsistency with ther gvernment departments. 2. Timely access t services fr TAC clients and injured wrkers via a streamlining f apprvals prcesses. 3. Develp imprved multidisciplinary cmmunicatin/crdinated client care apprach with ther prviders within TAC and VWA. 4. Review client infrmatin sharing prcesses including, but nt limited t, reprts & case cnferences. 5. Review f efficiency f service delivery. Identify ways t minimize the number f therapists wh becme invlved fr an individual client. Enable individual therapists t prvide a variety f services when client gals determine that this is indicated. 6. Review f all task cmpnents invlved in client assessment and treatments, as well as prcesses and prcedures required t interact with the TAC and VWA administrative systems. 7. Review the rles and invlvement f case managers and OT advisers in administering and facilitating the delivery f ccupatinal therapy services. Cmpare ccupatinal therapy services available under ther gvernment schemes/systems such as Medicare, DVA, NDIS. Align TAC and VWA services t enable clients access t a cmprehensive range f ccupatinal therapy services. List individual task cmpnents f each service and cnsider variables fr hme/wrk/cmmunity-based and cnsulting rm based assessment and interventins. Track prcess frm referral t apprval, initial assessment and interventin, reprting and discharge. - Identify pprtunities fr increased system efficiencies. - Identify and create pprtunities fr therapists t undertake a mre hlistic, client centered apprach, e.g. streamlined prcesses fr therapists t undertake a variety f assessment and/r treatments fr the same client when indicated, accrding t client need and therapist skills. Cmpare cntracted and nn-cntracted service mdels, including: - different prcesses t recruit prviders - different KPIs, quality and reprting requirements fr each - patterns f referral surces fr each - marketing f services fr each - patterns f apprvals fr services fr each - client utcme measures fr each - efficiencies f service delivery Explre new mdels fr prvider wrkfrce structure - adpt ne cnsistent, unified mdel OT wrking grup develp and agree t cmprehensive, best practice ccupatinal therapy service fr TAC clients and injured wrkers 4

6 8. Review cntracted and nn-cntracted service delivery mdels; evaluate prs and cns fr bth, and alternatives. 9. Identify and investigate any barriers t best practice early referral prcesses and t clients access t OT services. Review incnsistencies and inefficiencies in referral and apprval prcesses, identifying impact upn service access and delivery 10. Review eligibility criteria and apprvals prcesses fr prescriptin f assistive technlgies t identify and eliminate any barriers t timely cnsumer access. f service delivery. Cmpare and align apprvals systems when like services are als delivered by anther, alternative allied health prfessinal. Nv Jan 2015 Review f ccupatinal therapy fee structure and billing prcesses: 1. Stakehlder discussin arund actual csts incurred in the prvisin f service delivery; time, cnsumables, travel, verheads, and ther expenses assciated with ccupatinal therapy service activities. 2. Cmpare actual csts with existing TAC and VWA fee schedules. 3. Review existing TAC/VWA internal methds/frmulas fr determining therapy fee schedules. 4. Cmpare current fee schedules and rates with existing ccupatinal therapy service fees in crrespnding schemes in ther jurisdictins (bth cmmnwealth and state) and fees ffered in ther gvernment-funded services, such as; NDIS, CmCare, DVA, WrkCver SA. Full audit f csts assciated with actual time required fr service delivery, and including all identified task cmpnents such as preparatin time; adequate assessment/ assessment reprt time; case cnferences/liaisn with relevant thers, treatment times. (Cmpnents previusly listed in service delivery phase abve.) TAC and VWA prvide a breakdwn f frmula used t determine current fees fr each scheme. Cmpare actual csts with existing TAC and VWA fee schedules and ther gvernment funded schemes. Determine apprpriate fees based upn revised agreed mdel/frmula fr each scheme which Occupatinal Therapy wrking grup develp and agree t restructured fees and fee structures that better reflect the csts f ccupatinal therapy service delivery. Occupatinal therapy wrking grup develp and agree t a timely, transparent and efficient billing prcess that reduces administrative burden 5

7 5. Restructure TAC and VWA fee frmulas t better reflect actual csts f delivering therapy services. reflects service csts and which aligns with ther like gvernment-funded services. n prviders, TAC, VWA and clients. 6. Explre a variety f external fee structure mdels, including thse adpted by ther gvernment agencies and services. 7. Implement a regular review f fee schedule, including key stakehlders, at least every tw years Invlve stakehlders in discussins n efficient and transparent billing prcesses with reduced administrative burden than existing arrangements. 8. Review current billing prcesses 9. Review existing assistive technlgy apprval prcesses. 10. Cmpare assistive technlgy apprval prcesses with existing prcesses fr ther allied health prfessinals within the TAC and VWA 11. Review assistive technlgy apprval prcesses fr ther cmmnwealth and state gvernment departments and agencies, including DVA, NDIS, CmCare, WrkCver SA. 12. Address any prblem areas and identify aspects f billing prcesses that are negatively affecting service delivery (such as delayed agent apprvals, lss f paperwrk, delayed payment). 13. Develp mre efficient, timely and transparent billing systems with reduced administrative burden that benefit TAC/VWA prviders and the cnsumer. 6

8 Feb March 2015 Review f ccupatinal therapy prvider wrkfrce 1. Review existing prcesses, structures and strategies fr bth cntracted and nn-cntracted: prvider emplyment and recruitment prvider retentin prvider develpment 2. Review arrangements fr cntracted and nn-cntracted ccupatinal therapy services Detail existing prvider emplyment retentin and develpment strategies. Review arrangements and functins fr cntracted and nn-cntracted ccupatinal therapy services Occupatinal therapy wrking grup agree t mechanisms which supprt and develp existing and future ccupatinal therapy prvider wrkfrce. 3. Review existing quality assurance structures 4. Review the rle f OT advisrs with respect t any cnflict in their capacity t prvide bth therapy services and assess eligibility f ccupatinal therapists t prvide services. Develp independent eligibility assessment prtcls cnducted by ccupatinal therapists wh are nt als service prviders. 5. Develp prcess fr supprting/mentring less experienced service prviders, therefre incentivizing and develping graduate prvider wrkfrce. 6. Cnsider initiatives t recgnize and cmpensate experience and advanced practitiner skills. Benchmark with existing systems perating in ther prgrams such as the SWEP prgram fr credentialing therapists with skills in assistive technlgy prescriptin. 7. Prvide fr the develpment f the future ccupatinal Review existing supervisin and mentring prgrams within ther gvernment departments r agencies Explre pprtunities t implement an ccupatinal therapy prvider mentring r supervisin prgram within existing TAC/VWA structure r externally if mre viable. Review existing mdels f prvider cmpetencies within ther prgrams, such as SWEP. Cnsider develping similar mdels fr each f the services prvided by ccupatinal therapists. These criteria 7

9 therapy wrkfrce thrugh a system which ffers ccupatinal therapy students clinical placement pprtunities. recgnize that supprt is required fr less experienced therapists wh may nt yet pssess required cmpetencies. Prvisins are made fr supprt t develp skills fr these prfessinals. 8. Develp mechanisms fr regular and clear cmmunicatin with prviders and representative bdies regarding any internal plicy r prcess changes which impact upn ccupatinal therapy service delivery 9. Imprve and streamline equipment apprvals prcesses, aligning with ther allied health prfessinals where apprpriate, and cnsidering mst lgical prcess accrding t prfessinal decisin-making expertise. 10. Explre pprtunities t incentivize experienced and expert therapists t remain as a prvider in system while encuraging junir therapists t develp skills. April 2015 Outstanding matters & draft reprt May 2015 Final reprt July 2015 Implement and adpt new service delivery and fee framewrk. 8

10 RECOMMENDED MEMBERSHIP FOR OCCUPATIONAL THERAPY WORKING GROUP: T effectively address the needs f all stakehlders invlved in ensuring high quality, best practice, cst effective service delivery frm ccupatinal therapy service prviders, OTA recmmends the fllwing individuals/rganizatins shuld be represented n the Occupatinal Therapy Wrking Grup: HDSG representatives Trevr Clark and ther/s TAC and VWA representatives TAC and VWA prcurement representatives HDSG stakehlder engagement representative Elaine Wilcck OTA representatives business and clinical - Kim Mestrni - Nathan Clarke - Vicki Abraham (clinician) - 2x further clinician representatives TBC OTA t prvide (include cntracted and nn-cntracted) AHTA representatives Everyday Independence representatives TAC and VWA cnsumer advcates Assistive Technlgy/Equipment supplier Hme mdificatins services Prgram Manager and Technical Advisr. TAC and VWA case management representatives OT advisr representative e.g. Julie Warren Occupatinal therapy mental health expert OTA t prvide Rural and remte ccupatinal therapy service prvider TBC OTA t prvide Occupatinal therapy schl university representative Representative frm ther state r cmmnwealth gvernment funded scheme which prvide ccupatinal therapy services OUTCOME SUMMARY: As utlined in ur prpsed wrk plan, OTA is dedicated t an immediate start t the review after all relevant stakehlder submissins are received. As part f this prcess, OTA anticipates reviewing all aspects f: the delivery f ccupatinal therapy services, structure f ccupatinal therapy fees develpment f ccupatinal therapy prvider wrkfrce Given the extensive nature f this prcess, OTA believes that the review shuld aim t cnclude April 2015 with a draft reprt, fr implementatin at the start f the 2015/16 financial year. OTA is dedicated t ensuring that, thrugh this prcess, TAC clients and injured wrkers will cntinue t receive best practice, cst effective ccupatinal therapy services. 9

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