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ACFI update challenges pain management practices


Allied health professionals have raised concerns over a health department clarification about pain management claims by providers, with one saying it means they may have to let some workers go.

The Department of Health published an update on its website last Thursday, 22 November, to clarify requirements of Aged Care Funding Instrument (ACFI) Complex Health Care pain management items via seven frequently asked questions (FAQ).

It included advice that allied professionals issued with a “limited” registration by their relevant national board would not meet the requirements to provide pain management treatments under ACFI items 12.4a and 12.4b.

“It is expected that for the purposes of providing complex pain management treatments under [these two ACFI items] an allied health professional will hold general registration issued by the National Board for their profession and must be acting within their scope of practice.”

The Australian Health Practitioner Regulation Agency (AHPRA) works with 15 national health practitioner boards in implementing the National Registration and Accreditation Scheme.

Alwyn Blayse, who is CEO of allied health company Allied Aged Care, said the news raised a number of concerns for employers, therapists and residents.

“The entire industry relies on limited registration allied health therapists to meet residents’ needs,” Mr Blayse told Australian Ageing Agenda.

“This change is unfair as AHPRA recognises that limited registration therapists may provide services as long as they are under supervision.”

Mr Blayse said his organisation employed 11 limited registration physiotherapists and one limited registration occupational therapist, all of whom were on a pathway to full registration.

The therapists eared their qualifications overseas and are employed in regional areas in Queensland where the organisation was unable to find allied health professionals with general registration, he said.

The AHPRA registrations of these workers includes a list of facilities they been approved to work at by their national board, said Mr Blayse, who is also a physiotherapist and a supervisor of practitioners with limited registration.

“Is the Department of Health saying it is better equipped to judge an allied health professional’s qualifications than our own professional board?”

Mr Blayse also questioned why this distinction was not included in the ACFI User Guide.

According to the guide, an allied health professional can provide pain management services under these two items if they are an occupational therapist, physiotherapist, podiatrist, chiropractor or osteopath and “have a current certificate of registration issued by the national board for that person’s profession.”

In a response to questions from Australian Ageing Agenda, a spokesperson for the Department of Health said the health professional registration requirements for these two ACFI pain management items have not changed and that it had regularly communicated the requirements to the sector.

“The FAQ was published to clarify the long standing policy intent of the ACFI User Guide that health professionals who provide complex pain management treatments require general registration to qualify for the higher ACFI funding for providing services to residents with assessed complex health care needs,” the spokesperson told AAA.

“To qualify for funding under 12.4, an ‘appropriately qualified’ health professional for ACFI claims should hold general registration with both the relevant Board of Australia and AHPRA.”

The user guide does not mention “limited” or “general” registration and AAA has sought a further clarification from the department on this.

ACFI recognises that the greater the complex pain management needs of the resident the more qualified the treatment provided needs to be, the spokesperson said.

“ACFI 12.3 provides funding for pain management treatments delivered by health workers, including allied health professionals with limited registration, acting within their scope of practice.”

If a person other than a relevant allied health professional or registered nurse provided the treatment specified in the directive for ongoing treatment for complex pain management, it may be out of step with the Quality of Care Principles, the spokesperson said.

Mr Blayse said if this clarification was correct it could lead to them having to let go of workers and reduce their services at many regional aged care facilities.

“That means elders will not be seen and facilities will lose significant funding,” he said.

AAA is also waiting on a response from AHPRA.

Aged and Community Services Australia said it was also investigating the issue.

Read the department’s update here.

Comment below to have your say on this story

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4 Responses to ACFI update challenges pain management practices

  1. Owen Allen November 28, 2018 at 1:03 pm #

    There are two essential problems with the ACFI funding model as concerns physiotherapist and occupational therapist services. The fundamental problem with the ACFI funding model around complex pain management is that it actually prescribes and limits the professional work of an allied health professional (Physiotherapist or occupational therapist) to such a degree that retention of fully registered staff is very difficult. In otherwords, rather than encouraging or using the full scope of a registered allied health professional, the Commonwealth Department hampers the provision of a service that would normally be provided to a person in the community. This creates a need to have fully qualified overseas physiotherapists and occupational therapists brought into employment. These professionals need a workplace through which they can attend to the processes of registration and, with support and training that will be offered by th employer, and the supervision of their work by the employer, not only is a high quality of care maintained, but the professional is supported in the full Australian registrations, and I have seen at least one physiotherapist grain full registration and now become a team leader through this process. These professionals are competent, professional, and very good learners. All other employment safeguards apply in moving less competent immigrant workers, on. The Department is failing in it’s own duty of care to older persons, and certainly failing businesses attempting to solve the very difficult problem of providing services in rural and regional Australia.

  2. Dr Drew Dwyer November 28, 2018 at 1:23 pm #

    The AHPRA has clear lines for this and supervision for the limited registration can be directed given the ability for the practice to be supervised ( for eg. by another professional and to do pain management in an RACF) they have supplied the 3 areas of limitation

    Again this is the dept using rules to take needed pain management money away from the consumer…its poor practice and forces the neglect in care as the industry struggles to meet the rules of this deplorable tool.

    For the measly $217 for HHH this is a disgrace to even work with such restraints when the evidence of pain management is so clear.

    No wonder there is an RC over the industry…and this is one issue that requires a full investigation and the general public need to know that this is the reality of providing care to the frail and vulnerable elderly…..in a so called RACF.

    if you go to any pain clinic in this country you will see the “known practice methods being used and funded” why is the RACF under so much restraint to meet the pain needs of its patients…..yes they are patients too.

  3. Alwyn Blayse November 28, 2018 at 1:57 pm #

    Thanks for getting some answers from the department.

    If anyone feels strongly about this please share the petition we intend to take to Ken Wyatt. I’m sure there will be official industry responses as well but it’s important on this issue we all stand united and work together to protect our residents facilities and organisations we work with.

    http://chng.it/qVJXWxwTvQ

  4. Mary Carroll November 29, 2018 at 9:13 am #

    Might be worth looking at the Administrative Appeals Tribunal decision in 2015 relating to supervision of practice. It was published in 2015 but it may be of some help

    http://www6.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2015/796.html?context=1;query=DLW%20Health%20Services;mask_path=au/cases/cth/AATA

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