VWA expectations for the delivery of osteopathic services to injured workers

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1 Information on Osteopathy Who can provide osteopathic services to injured workers? VWA Victoria (VWA), will only pay for osteopathic services by healthcare professionals who are: registered by VWA to provide osteopathic services, and registered with the Osteopathy Board of Australia. VWA expectations for the delivery of osteopathic services to injured workers VWA expects that all osteopaths providing services to injured workers as part of the Victorian Workers Compensation Scheme integrate the principles of the Clinical Framework for the Delivery of Health Services to Injured Workers (Clinical Framework) into their daily practice. The Clinical Framework is based on the following principles: 1. Measurable treatment effectiveness must be demonstrated. 2. A biopsychosocial approach is essential for the management of pain. 3. Treatment must focus on empowering the worker to manage their injury. 4. Treatment goals must be functional and focused on return to work. 5. Treatment must be based on the best evidence available. Further information can be found at VWA.vic.gov.au/hcp Referral requirements Referral from a medical practitioner is not required for provision of osteopathic services VWA considers osteopathy to be a primary contact service. A referral from a medical practitioner is therefore not required. Edition No. 6 May 2014

2 How much will VWA pay? VWA will pay the reasonable costs of osteopathic services up to the maximum amount, as detailed in VWA s Osteopathy Services Fee Schedule, which can be found at VWA.vic.gov.au/hcp What VWA will pay for VWA will pay the reasonable costs of osteopathic services that meet all of the following criteria: Treatment is for a work-related injury or illness The provider is currently registered as an osteopath with VWA The service is in line with the principles of the Clinical Framework What VWA will not pay for Non-attendance/cancellation VWA will not pay for appointments where injured workers cancel or do not attend. Telephone conversations VWA will not pay for telephone consultations or conversations, either to the injured worker or other related parties (such as the employer, VWA, VWA Agents, self-insurers or other healthcare professionals). Concurrent osteopathy, chiropractic and/or physiotherapy treatment VWA considers osteopathic, chiropractic and physiotherapy treatment to be similar. When an injured worker is receiving osteopathic, chiropractic and/or physiotherapy treatment at the same time it is difficult to effectively measure the benefits and outcomes of treatment. At the same time and for the same claim, VWA will only pay for either: o osteopathic treatment, o chiropractic treatment, or o physiotherapy treatment. Group physiotherapy sessions such as hydrotherapy, pilates, and exercise programs may be allowed. If a worker is receiving concurrent osteopathic, chiropractic and/or physiotherapy treatment the worker will be asked to select the treatment that they believe to be the most beneficial for their work injury. More than one consultation on the same day VWA will not pay for more than one osteopathy consultation provided on the same day to the same injured worker. Provision of more than one allied health service on the same day Where an osteopath is registered with VWA for more than one allied health service (for example, osteopathy and remedial massage), VWA will not pay for provision of more than one service type to an injured worker on the same day. 2

3 VWA will not pay for consumable items (i.e. tape, ultrasound gel, dry needles, wax therapy) used as part of a consultation with the provider. VWA will not pay for any item invoiced without sufficient description or marked as miscellaneous. Gym and Swimming Programs VWA can pay the reasonable cost of gym and/or swimming programs required as a result of a work-related injury or illness when requested by an osteopath. For more information please refer to the VWA Policy for Gym and Swimming Programs. Certificate of Capacity A Certificate of Capacity needs to be completed if the injured worker s capacity for work is impacted due to a work related injury or illness. For example, where an injured worker s capacity for their pre-injury employment is affected and they have no capacity for any employment or they are fit to work in suitable employment. First Certificate of Capacity o Can only be completed by a medical practitioner. o Can be issued for up to a maximum of 14 days, unless special reasons apply and approval is obtained from the Agent or self-insurer. Subsequent (Continuing) Certificate of Capacity o Can also be completed by a registered osteopath, registered chiropractor, or registered physiotherapist. o Can be issued for a maximum of 28 days, unless special authorisation is obtained from the Agent or self-insurer. The Certificates of Capacity can be downloaded from <add link> and is available as a supplied template for use on a range of clinical management software. Reporting requirements of osteopaths Information is required by the Agent/self-insurer and/or employer to assist in the injured worker s return to work. As a provider, you must: Submit an Osteopathy Treatment Notification (OS100). The treating osteopath is required to complete the Osteopathy Treatment Notification by the fifth consultation. This form must be forwarded to the injured worker s employer or Agent or self-insurer advising that treatment has commenced and providing information regarding the goals, strategies, and proposed outcomes of treatment. This information assists the treater, employer and the Agent or self-insurer to manage the worker s return to work. Please Note: For workers who are part of the Community Integration Program the request, approval and submission of outcome measures for services will form part of the independence planning process. 3

4 Equipment and Related Services VWA can pay the reasonable costs of equipment and related services required as a result of a work-related injury or illness when requested by an osteopath. For more information please refer to the VWA Policy for Equipment and Related Services. Restricted consultations Osteopaths may apply to provide a restricted consultation (at the practitioner's rooms) for workers with moderate to severe acquired brain injuries, crush injuries, extensive burns, spinal cord injuries, multiple orthopaedic fractures and/or loss of limb amputations. Other complex injuries will be considered on merit. The Restricted Consultation application form must be completed by the treating osteopath to apply for approval to use the restricted consultation item number within their fee schedule. It is recommended that osteopaths do not use the restricted consultation item number until they have been advised in writing that their application has been accepted. Osteopaths are able to invoice for the completion of the Restricted Consultation application form using item number OS1 06 (restricted consultation application). 4

5 VWA Victoria VWA Agents Agent contact details are all available at VWA.vic.gov.au/agents Advisory Service Phone (03) Toll-free Head Office 222 Exhibition Street, Melbourne 3000 Phone (03) Toll-free Website worksafe.vic.gov.au For information about VWA in your own language, call our Talking your Language service The information contained in this publication is protected by copyright. VWA Victoria encourages the free transfer, copying and printing of the information in this publication if such activities support the purposes and intent for which the publication was developed. 1 WSV1049/05/01.11