Auckland Physiotherapists Private Practitioners Association

  • Marie Hasler
Associate Accident Rehabilitation and Compensation Insurance

Remuera

Good evening everyone.

Thank you for giving me this opportunity to speak to you today.

As you all know Thursday, July 1 brings a sea of changes for people working in the health sector.

From this date, the ACC will no longer provide workplace accident insurance for employers.

Instead, registered commercial insurers will be able to market products to cover the work-related injuries of all working New Zealanders - as well as the non-work and non-vehicle injuries of the many thousands of people who are self-employed.

This is an opportunity on an unprecedented scale for New Zealand as a whole and for you as a group.

For too long New Zealanders have been paying too high a cost personally and financially for work-related injuries - injuries that cost us some $4.2 billion a year.

Year after year we have endured this huge waste in financial and productive terms and faced the prospect of it growing ever larger.

Worse still has been the tragic loss of lives and livelihoods.

Last year alone 173 New Zealanders were killed at work and some 88,000 people received ACC entitlements for work-related injuries.

Now, with the Accident Insurance Act 1998 New Zealand has a unique opportunity to manage and in the long term reduce, the cost of accidents in the workplace, on our society, and on the economy.

This is not cross your fingers and hope. We know we can make our workplaces safer than they are. We also know we can do much more than we have been doing to help people who are injured get back to work sooner.

These are proven facts, supported by two key points:

First, the appalling statistics concerning workplace accidents indicates how vast the actual scope for improvement is;
Second, the Accredited Employers' Programme (AEP) proves we can achieve the right results through the right incentives.
The AEP gave larger employers the opportunity to improve their accident record through better accident prevention practices and outcomes in return for a reduced premium. Injured people returned to work faster than under the wider scheme.

Following AEP's success, we thought about how we could extend AEP-style arrangements and advantages to all employers. Not just the large business, not just the pro-active employer, but every single employer - irrespective of size - in New Zealand.

And in effect this, of course, is what the Accident Insurance Act 1998 does.

About four months to go before the Act comes into effect, it is most encouraging to observe the reforms are already having a real impact on employers.

Interestingly, some small businesses are only now just starting to realise that they have been actually paying ACC premiums for workplace accident insurance for years.

It is hardly surprising really - until recently there was little reason for them to pay attention to it. The premium was charged automatically via their Inland Revenue return. Just another item of expenditure - probably taken care of by their accountant.

Now this is changing. Even employers with only a few employees are beginning to rethink the way they manage their workplace safety.

For the first time, others are showing an interest in their ACC claims history. Others are wondering how to go about committing their health and safety policy to paper. Or thinking hard about how to make their workplace safer and how to help injured employees back to work more quickly.

Throughout New Zealand, at all levels, the business community is busy and buzzing with developments and news - including the latest news of insurers deciding to enter the market, of acquiring ratings, of going through the registration process.

Meanwhile, the Government is focused on the final stages of implementation - drafting regulations needed to support the legislation, establishing the SOE insurer, restructuring the ACC, and establishing the Regulator within the Department of Labour.

The ACC proposes to form four new subsidiary companies providing claims management services, health contracting services, injury prevention and risk management services and claims review services.

These four new companies operate at arm's length from the parent ACC Board. They will serve ACC's customers and they will be able to contract with private insurers entering the workplace accident insurance market.

While that is the Government agency end of things, insurers and health providers such as yourself have been working together to develop smooth administrative systems for the purchase of treatment and the lodgement of claims with the appropriate insurer.

These systems must work efficiently and must appear seamless to the injured worker.

Physiotherapists are amongst the named treatment providers in the Act who are able to provide acute treatment to accident victims without prior referral to a medical practitioner. You will also be able to claim directly from the insurer. GPs will no longer be the gate-keepers.

The changes in the law are to make it easier for anyone who is injured at work to get the best treatment for them as fast as possible. They also ensure that those who provide the necessary treatment get paid for it.

The changes are designed to reduce any barriers to treatment; to reduce the unnecessary cost of injuries; and to get injured people back to independence and to work as soon as possible.

As you know, you have new opportunities to treat injured people sooner. You have new professional opportunities to develop treatment and rehabilitation programmes that will achieve specific goals for injured workers.

But with these opportunities come some changes in responsibility.

If a physiotherapist is not the appropriate treatment provider you now have a statutory obligation to refer the patient on to a provider who is. This requires a high level of professionalism on your part and a certain degree of diagnostic skill.

You also have a responsibility to refer a patient to a GP when they require compensation, or income replacement.

There is also an obligation under law to provide treatment that is timely and achieves the objectives specified in the legislation.

However, if an insurer believes the treatment is of excessive duration and not clinically necessary, the insurer has the right to refuse to pay for it. Insurers will be able to request clinical evidence to ensure patients are getting the correct treatment for their injury.

This means there is a powerful incentive for treatment to be both effective and well managed from the first contact with the patient. There is no incentive for over servicing which is counter to the best interests of the patient.

In the new environment health professionals hold the key to swift assessment, treatment and rehabilitation of claimants.

Currently, the second largest item of ACC expenditure at $483 million is medical treatment.

The bulk of ACC treatment services are provided in a non-hospital setting by GPs and physiotherapists. GPs are paid 40 percent of the medical provider expenditure totalling $198 million. Next are physiotherapists at almost 30 percent.

In the past vocational rehabilitation was receiving little funding from ACC. For example, in 1997, vocational rehabilitation spending was only three percent of the expenditure on medical treatment.

This will change with the introduction of competition. Private insurers see vocational rehabilitation as an important step in returning people to their jobs.

Through initiatives such as more active case management, insurers, employers and health care providers can ensure claimants receive the most appropriate and timely treatment which will help them return to work as soon as possible.

This is an exciting but critical time for all treatment providers.

However, because physiotherapy forms such an important part of treatment for common injuries at work, it is essential that you manage the new environment well.

This means making sure now that your businesses are ready. You need processes in place to communicate with insurers and to bill them for treatment. Most of all you need to be able to prove you can deliver good outcomes for your patients. And you need to be able to achieve these outcomes with genuine efficiency.

In the lead up to 1 July many providers are working with insurers, including ACC, to make competition work.

For example, ACC is endeavouring to develop a consensus amongst providers as to what is reasonable treatment. Once established these profiles will be used to monitor the outcomes of treatment.

With this in mind, the New Zealand Society of Physiotherapists has been working with ACC to develop treatment profiles.

Through seven ACC Treatment Profile Road Shows and direct mailouts many physiotherapists have had the opportunity to be involved in developing these treatment profiles.

This work has been very productive, with physiotherapists throughout New Zealand appreciating the opportunity to have a say in their own future.

I understand this is the first time in the physiotherapy world that this approach has been tried throughout the country to reach a consensus on accepted current practice.

The physiotherapy society and ACC will be working together to ensure that treatment numbers are not considered maximums, but complications and special conditions are taken into account.

This process will be reviewed in a year, with an agreed coding system.

Obviously the number of treatments will vary from case to case. And for serious injury, such as brain or spinal injuries, the focus of intervention will not be to return to pre-injury state, but to prevent deterioration and promote adjustment to daily living activities.

Packages of Care for health professionals, including general practitioners and physiotherapists is an international trend that we believe has value here.

Packages of Care requires the co-operation of treatment providers in that they will achieve measurable outcomes and manage some of the risks. However, fee for service will continue for about two years in recognition of the time required to develop and prepare for the implementation of Packages of Care.

Importantly, health professionals will also need to monitor present injury management and outcomes. Unfortunately people will always injure themselves and just like any other health professional physiotherapists have a responsibility to provide a good outcome at a competitive price.

We believe the Accident Insurance Act creates new opportunities for New Zealand as a whole - new opportunities that are designed first and foremost to be good for anyone injured at work.

I invite you - indeed, urge you - to take up your challenging role in the environment and thereby foster and share in the benefits of the changes.