Physios want to break free (of shared care plans)

Another health profession is seeking to push practice boundaries by prescribing and billing patients straight to Medicare.

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To the chagrin of the AMA and RACGP, physiotherapy has entered the scope-of-practice chat.

Cutting out the GP middleman and letting physiotherapists bill Medicare for non-referred patients will result in broader savings to healthcare and reduced opioid prescribing, according to the Australian Physiotherapy Association. It also sees a potential role for limited prescribing by physiotherapists.

The call comes after organisations representing other allied health groups like pharmacists and nurses have lobbied for increased autonomy.

Doctors’ groups have warned that the plan risks missed diagnoses, misdiagnoses and care duplication and fragmentation.

The APA’s proposal is outlined in a white paper, which itself was compiled at the organisation’s annual conference last week.

Advancing primary care physiotherapy tops its list of priorities for the next decade.

Under the current arrangements, patients can either present to a physiotherapist of their own accord and pay full price, or they can be referred by a GP under a chronic disease management plan and access five Medicare-subsidised sessions each calendar year.

The APA argues that this system is overly complex and, for financially disadvantaged patients, causes delayed access to treatment and potentially unnecessary prescription of pain medicine.

Instead, it believes, patients with musculoskeletal complaints should be able to access MBS-funded physiotherapy from the get-go, without a GP shared care arrangement.

“What we’re looking at is getting equality and equal access to physiotherapy [in order to] reduce the chronic disease burden, so that we’re not seeing an expanding of chronic disease in Australia,” APA president Scott Willis told The Medical Republic.

“One way to reduce that [is removing the] barrier of having to see a GP to start with.

“We are hearing that the waiting lists to see GPs are significant, not just in rural areas but in metropolitan as well.”

Mr Willis said the model the APA was proposing would resemble the UK model of care, where physiotherapists are embedded in general practice teams as the first-contact practitioners for all patients with musculoskeletal conditions.

These first-contact physios are able to inject, prescribe and request diagnostic tests for their patients.

“If you look at the UK model, it reduces opioid prescriptions, reduces unnecessary imaging and reduces the chronic disease burden but increases the speed … to access quality, high-value care from a regulated profession that’s been proven to be effective,” Mr Willis said.

The key difference between the UK reality and the APA’s proposal, though, is that the APA is “not suggesting that embedding physiotherapists in GP practices is the model that is the most suitable to the Australian healthcare system and patients”.

Another initiative outlined in the white paper was the possibility of expanding physiotherapist prescribing rights within their scope of practice.

“When combined with the appropriate credentialling and training, we are supportive of prescribing being utilised in particular settings with the necessary controls over what types of medications are in scope,” the white paper said.

“A safe roadmap towards autonomous prescribing can be implemented through the design of a stepped pathway with a strong and properly monitored and evaluated program logic model.”

Mr Willis said that the APA was not looking to replace GPs or create fragmented care.

“We’re a profession that stands beside general practice and GPs … this would not be any different, in that we would still inform them of what’s happening with their patients,” he said.

“We believe that GPs are still a significant part of the patient journey and what we’re trying to do is just reduce the burden that GPs have at the moment.”

The RACGP told TMR it welcomed increased access to services but that any changes to access also had the potential to fragment patient care.

“The evidence is clear that patients whose care is continuous and coordinated have lower rates of hospitalisation and emergency department attendances, as well as lower mortality rates,” RACGP president Adjunct Professor Karen Price said.

“Coordinated care means there is usually a clear diagnosis at the point of referral.”

AMA vice president Dr Danielle McMullen, a GP in Sydney, said the organisation was alarmed by any proposal that would undermine the medical home model.

“Bypassing general practice will lead to poorer patient outcomes, missed or misdiagnosis and greater duplication in the health system which will ultimately cost the system more,” she told TMR.

Dr McMullen that that the AMA was supportive of allied health professionals working collaboratively with medical practitioners as part of a team, and that physiotherapists make important and valuable contributions to healthcare.

“However, we don’t support access to the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme independent of a collaborative arrangement with a medical practitioner,” she said.

“Only GPs are specifically trained to properly investigate and diagnose patients and to know the full range of clinically appropriate treatments for given conditions, including when not to prescribe.”

The APA white paper also outlines the association’s priorities around advancing health equity, multidisciplinary care, hospital-based physiotherapy, private health insurance, public health insurance and covid-19 recovery.