By John Meckiff, Healthcare Management Consultant; former GM Pathology Collections & CPO at Healius; Founder of Remedy Healthcare.
While demand for community based allied health services is increasing, the APA reports that profitability and revenue per employee in private practice is actually falling. This has been in part driven by:
- Raising wage inflation (structural shortages in therapists leading to higher wages to both retain and attract staff)
- Rising overhead costs (rent, utilities)
- Under-indexation of funding mechanisms across both compensable schemes and insurance rebates.
Rising competition in urban hubs within the private allied health sector, as well as growth in non-traditional treatment models – including pilates practices and gym franchises that often promote unvalidated claims they treat spinal and joint arthritic conditions – is also impacting revenue for clinics.
The industry is adapting with new service models
Many private practices now include clinical pilates or resistance training equipment, while other clinics are employing Exercise Physiologists to manage their patients through prescribed programs.
While there is evidence these programs can reduce pain and anxiety and improve function and balance, there is limited statistically significant evidence of a resulting drop in future insurance claims or hospital episodes – key metrics which private health insurers are keen to address.
Insurers are currently funding these programs, but as they too start to incur margin pressure (driven by the current demands of private hospitals), the funds will increasingly focus on evidence that these health investments are delivering a return.
The Allied Health industry needs to ensure that investment in new service models is sustainable
Legislation was first introduced in 2007 which allowed private health funds to pay out for hospital programs which either substituted for in-patient care, or funded services for members suffering a chronic disease designed to prevent future hospitalisations.
Since then, the funds have introduced programs like rehab in the home, nursing in the home and an array of chronic disease programs (e.g. cardiac, diabetes, mental health) with an evidence base that they reduce future admissions. Randomised controlled studies support their efficacy, while in-home care has been shown to reduce the length of in-patient rehab and hospital stay by direct substitution.
Without strong evidence that expanded service models lead to a reduction in hospital episodes (either primary or secondary), or future allied health claims, we question whether funding these new allied health services will be sustainable.
Addressing chronic lower back and neck pain
To date, there are limited programs – an example being the GLAD Program for hips and knees – that can demonstrate a direct impact on hospital admissions or length of stay, but none address chronic lower back and neck pain.
This is despite the fact that the addressable claims cost of chronic lower back and neck pain in Australia for insurers is estimated at over $940m per year, made up of $390m in hospital admissions (2% of total) and $540m in ancillary claims costs (7.8% of total claims).
The getback Program now has evidence that it reduces both hospitalisation and future ancillary claims – supporting its sustainability as a first line treatment for chronic lower back and neck pain and dysfunction.
- A comprehensive study published in the Journal of Rehabilitation Medicine in 2019 entitled ‘Therapeutic and economic effects of multimodal back exercise: A controlled multicentre study’ reviewed clinical outcomes of a population of 2,324 patients. 1,829 in the intervention group used getback devices and 495 in the control group had conservative physiotherapy treatment only. Patient pain and dysfunction was graded from 1-4.
A key outcome of the study was that both therapeutic and economic effects are more pronounced in patients with higher levels of back pain, which implies a higher propensity for hospital avoidance by patients associated with more severe dysfunction. This was also substantiated by this study, as patients in the intervention group had a statistically significant 36% lower rate of (all cause) hospitalisation (p=0.02) over the two years of the study.
- 2. getback™ has also commissioned Deakin University to review the impact of the getback program on patients presenting with back and neck pain at 12 months following intervention (average 18 sessions conducted over 9 weeks).
Preliminary findings in the paper (currently being reviewed for publication) are also statistically significant, showing reduction in disability at 12 months of 81% (p<0.001) with sustained improvement in all strength planes of 44-88% from preliminary assessment recorded at 12 months.
What is the getback advantage?
Not all device based therapy is equal. getback™ is the only program which:
- Has rigorous clinical evidence which is reproducible;
- Ensures individual programs can be customised to the clinical presentation of every individual;
- Ensures all data including range of movement, strength, co-ordination and program compliance are captured in real time;
- Allows patients to understand how their strength (in all planes of movement) compares with other people their age and gender – a strong motivator for improvement and repeat visitation.
Following program completion, clinics can provide patients with an ongoing supervised maintenance program for a weekly fee. This provides much needed cash flow to offset rising operating costs.
getback™ is currently engaging with health funds and sharing these results. This may result in a separate funding approach such as a chronic disease program (which increases the level of cover), however major funds would prefer that the program is available to all members nationally to ensure equitable access.
We are now seeking Partners to expand our footprint nationally.
For further detailed information, please contact John Meckiff (john.meckiff@getback.com.au) or 0410 657 540, or request a call back details here
