Many would be aware of the recent talk about changes to the Private Health Insurance rules governing the removal of rebates for many natural therapies. Pilates was lumped into this “Natural Therapy” basket, and whilst we were initially assured that Clinical Pilates was not supposed to be included in this reform, there has been quite a fight over the last few months (and more) to clarify where exactly Clinical Pilates fits in. Well it appears there has been a small win for the profession with The Department of Health just releasing its final clarification on the Rules governing its Private Health Insurance (PHI) reforms and agreeing that the use of exercises drawn from Pilates are acceptable and within the scope of physiotherapy practice.
HOWEVER…there are some very important and specific points mentioned in these changes and they can basically be summarised as the following:
- As previously advised and in keeping with the intention of the natural therapy reforms, Pilates-only sessions will no longer be funded as of 1 April 2019. This will include classes where “Pilates” is the only exercise regime offered, and where classes are marketed and conducted with “Pilates only” exercises. This would include Clinical Pilates classes, even those run by us here at SSPC, if Pilates is the only regime offered during the class.
- Pilates-informed exercises prescribed by physiotherapists as
part of an individualised program will continue to receive rebates in
one-on-one, group and class settings. The critical thing here is that Pilates
based exercises can make up only a small component of a broader
strength/exercise group class.
How will SSPC comply with these new PHI guidelines?
The key to PHI compliance will be based on three critical foundations:
- Individualised assessment of patients in one-on-one, group sessions and classes.
- Individualised program addressing current health problems, comprising a program of exercised-based interventions specific to that patient.
- High quality clinical notes that reflect physiotherapy practice.
SSPC has always abided by these guidelines, even before these changes in, so on the surface, not a lot will change.
Advertising and promotion
Advertising and promotion of sessions must reflect the fact that they are physiotherapy exercise sessions, not Pilates.
Scheduled physiotherapy exercise classes advertised or promoted as Pilates—in material such as timetables, pamphlets and online—cannot lawfully receive rebates.
What does this mean for SSPC?
Hopefully from a “functional” point of view, not much will change at all, and from your perspective as an SSPC client there should appear very minimal change to the program you have become so accustomed to. Speaking from a personal viewpoint, I know my classes have transformed over time from being very “Clinical Pilates” based to now being truly just an exercise class that happens to utilise the unique benefits of the Pilates equipment (and many other forms of equipment) to deliver an individual benefit to the client in a group setting. Nearly all SSPC physio’s have slowly transformed into providing exercises the client needs, on a number of differing pieces of apparatus and equipment, rather than sticking stringently to all the Pilates protocols and procedures. So you will find that your program does not change at all.
From a “clinic” point of view, you will notice some change. Our website, social media, newsletters etc will change to remove any reference to “Pilates Classes”. What the insurers will rebate is “physiotherapy” and “treatment” in a “group” setting, so in all likelihood we will market our classes as “Physiotherapy Group Treatment”. Pilates will not appear on any receipt or any marketing material. By the time I send the next email calling for preferences for our 2019 Group Treatment classes, I will have formalised the name, and explain how we will differentiate it from our other strength based classes.
From a “staff” point of view (other than admin changes with receipts etc) there is a lot more pressure on us as practitioners to write detailed clinical notes (same as we do in normal physio 1:1 consults) for every client in every class. This is obviously potentially very onerous, and we are working on methods to streamline how this will work. Again, I will clarify in mid January how this will work, but we will all need to spend a little more time at our computers during class time to record notes.
There will also be stronger obligation on us justifying our treatment programs, its relationship to your health program, and success of the exercise intervention. Your class physio may well give you a questionnaire at some stage to complete –if so, please fill it out and return it at your next session, and we will use this as the baseline for assessment over the year.
As part of this new process, every client will also need to have a clearly recorded individual treatment session, that outlines their health problem, goals, and referral to “Physiotherapy group treatment”. Many of our group clients concurrently see us anyway for individual treatment, but if you have not had a physio treatment session (individual) related to your current health issue for which you are doing classes, you will need to organise an appointment at some time in the new year.
HCF
HCF, (and possibly Teachers Fund), is the only insurer that has taken a harder and more stringent view of the Rules and we encourage our HCF clients to contact HCF directly to clarify their position.
As I said, I will update with more specific details in mid January but hopefully that gives a bit of overview for the meantime.
Regards
Anthony Lance
Physiotherapist
