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Private Health Insurance (PHI) Reforms for Natural Therapy

Private Health Insurance (PHI) Reforms for Natural Therapy

By Emily Shiel, APAM (Masters Clinical Physiotherapy), acknowledgement to APA

While we were all a bit distracted by Christmas the government and PHI released reforms for natural therapy claims that will take effect on 1 April 2019. Private health insurance rebates will no longer be available for a number of natural therapies including Pilates. As physiotherapists we know that there are changes that we will need to make to help our customers navigate this system.

The Department of Health’s initial position was to remove all rebates for Pilates-informed exercises regardless of who delivered them or where. The outcome the Australian Physiotherapy Association has negotiated means physiotherapists can continue to prescribe treatments informed by a range of relevant techniques. It also clearly differentiates physiotherapy from other treatment practices—and recognises our training and expertise in clinical settings. Physiotherapists are eligible to deliver exercises drawn from Pilates as part of a treatment program.

How will Pilates change at Shiel Family Physiotherapy as a result of the reforms?

Physiotherapists who are already meeting their obligations as clinicians—such as suitable screening, assessment and record keeping—will continue to be compliant with PHI rules as long as their sessions do not solely consist of Pilates exercises and are not scheduled as Pilates. Physiotherapists deliver exercise within an evidenced-based and therapeutic framework, rather than simply for fitness.

We will not need to change the way we work in our clinic because the way we run our programs is physio focused. It's based on a clinical diagnosis, patient goals, what people are aiming to achieve and it’s tailored for each individual. Our classes are not just limited to using Pilates exercises. Pilates is a way of branding for us — to get our patients exercising so they can achieve their goals. It doesn't mean clients just do Pilates. Our small groups and also machine based sessions include Pilates exercises but also other strengthening, stretching and balance work etc.

However, we are reviewing our internal processes to make sure that we're all practicing as physios and not as Pilates instructors. This includes our assessment procedure, our note taking and ensuring we have regular reviews and better outcome measures.

Session Names

Under the new reforms physiotherapy exercise sessions—whether individual, group or class—cannot be promoted or advertised as Pilates or clinical Pilates. In our practice they will now be called ‘Physiotherapy Small Group Floor Classes’ rather than Pilates floor classes. Clinical Pilates sessions using machines will now be called ‘Physiotherapy Studio Rehab Sessions’.We have removed Pilates from all of our forms, removed them from appointment times and over the next couple of months the name of them will be changing on our online booking system and our timetables.

Advertising & Marketing

Physiotherapy exercise sessions will no longer be advertised as Pilates via social media, website or printed material. The name changes above will be fully introduced by April 1st 2019.

Treatment Codes for Health Fund Claiming
Service descriptors have not been impacted by the PHI reforms. You can continue to claim item code 560 and 561 where the private health insurance fund allows it. You can continue to claim on 593, 595, 596 for pelvic, post and ante natal sessions if treatment is clinically justified and does not reference Pilates.

Clinical Notes & Monitoring

We've changed the way we document what people do in their classes. Like many practices, we did use a standard class format to document the exercises that people completed at each visit. We will change our forms to now be based around the impairments/focus/goals for each individual attending. As a result of physiotherapy assessments and reviews we will make sure that every patient has at least one well defined outcome measure to track their progress. Patients will be re-assessed when it is clinically indicated. This will vary individually and may be every six weeks or six months.

Patient Communication
We are communicating about these changes through Facebook, newsletters and there will also be emails coming out as well as printed flyers available at our front desk in March and April explaining the changes and how they may be affected. The main thing that we have communicated is that the way we run our classes will not change because they are run as group physiotherapy with individualised assessments and an individualised program that we progress appropriately.

We have encouraged all our Pilates patients to attend a new year assessment to ensure their assessment and goals are current. This should ensure they meet all the criteria to continue to claim for their group physiotherapy classes.

How do you think patients will react to the changes?

I don't think patients will be as worried about it as physiotherapists and clinic owners are. Patients will benefit from having the chance to set some new goals for the year.

Positive Outcomes from the PHI reforms

We need to look at the changes as a positive. A chance to continue to progress. Having a stronger focus on goals will make us better physios because every time we're seeing a patient we're being reminded of why they're here.

As health professionals we can use Pilates as a valuable treatment tool. When a physio is delivering a rehab session to a patient – it’s physio, not personal training. When a physio shows a patient a stretch – it’s physio. Not Yoga. When a physio uses Pilates exercises as part of their overall treatment – it’s physio. There will be several months of some painful administration but we will get there. We are yet to figure out how to market to new patients wanting to do Pilates – but change is a good opportunity to improve what we do and how we work!