Physiotherapy Services

On this page

  1. Questions and answers
  2. Key information on certification
  3. Outcome measure guidelines
  4. Outcome Measure form
  5. Process updates
  6. Background research
  7. How to move to payment under the Cost of Treatment regulations
  8. ACC contact details

New purchasing arrangements for physiotherapy went live on 16 November with the introduction of the Physiotherapy Services Contract. Recent rises in costs for physiotherapy since ACC introduced the Endorsed Provider Network (EPN) contract were unsustainable for levy payers and the ACC Scheme, and the new contract will drive greater value for money without compromising service to clients.

Under the new arrangements the EPN, which delivered ‘free’ physiotherapy, has been replaced by a new approach to purchasing in which ACC pays physiotherapists a lower fee for service in return for enabling them to part charge clients for treatment. Decisions on whether to charge, and by how much, are made by individual practices.

The contract is an interim arrangement for one year. During this period, ACC will work with the sector on solutions to longer term issues. These include simpler accreditation processes, an enhanced quality framework and achieving good client outcomes. A long term contract incorporating these changes will come into force in November 2010.

A key feature moving forward is the increased focus on client outcomes, with physiotherapists now required to report against client outcome measures. These will generally include the Patient Specific Functional Scale and the Numeric Pain Rating Scale, or others depending on their relevance to the client.

Questions and answers

  1. What are the forms we will have to use?
  1. Do I need to complete my initial assessment form when the patient first presents to me with their injury without seeing anyone else?
    Yes – your initial assessment form must be completed for all your new clients, along with ACC45 claim for cover form, which must be sent to ACC for a cover decision.
      1. Do I need to complete an initial assessment form when the client has been seen by another treatment provider or physiotherapist?
        Yes – all physiotherapists (Contracted and Regulated) will need to do so. If the patient is new to your clinic then you will need to complete your initial assessment form.
          1. Does my initial assessment form need to be sent into ACC electronically?
            ACC is aiming to support your business’ ability to submit forms electronically to improve the time efficiency of approving treatment for clients. Until we go electronic you won’t have to submit your initial assessment form unless the client requires further treatment. At this point you will need to submit it manually along with your Physiotherapy Request for Further Treatment form (ACC32R).
            When ACC enables electronic form submission, we will require you to submit an Initial Assessment form, the Reactivation Consultation Assessment (ACC32A) and the Physiotherapy Request for Further Treatment (ACC32R) forms electronically. We are aiming to have this available by April 2010.
              1. Which outcome measure should I use?
                Physiotherapists must evaluate treatment outcomes using the Patient Specific Functional Scale (PSFS) and the Numerical Pain Rating Scale (NPRS), or another nominated outcome measure. Do so using your existing (paper and/or electronic) systems.
                This applies to new clients who have their initial assessment on or after 16 November, and to existing ACC clients from that day for whom a Request for Further Treatment is submitted after 16 November 2009.
                ACC does not require outcome data for ACC clients for whom a Request for Further Treatment has not been submitted, but who started their treatment before 16 November 2009 and who are subsequently discharged after 16 November 2009.
                  1. When does the Reactivation Consultation Assessment (ACC32A/PT05) need to be completed and sent into ACC?
                    When there has been a gap in physiotherapy treatment of 12 months or more, and further treatment is required.
                      1. What’s the difference between treatment Profile Numbers and Treatment Trigger Numbers?
                        Treatment Profile Numbers are allocated to specific diagnoses, where experience shows the number of treatments required to complete the healing process for that condition.
                        Treatment Trigger Numbers indicate the number of treatments after which ACC would like to seek a review of the treatment delivered. Any treatment provided for a particular individual will be considered in consultation with the physiotherapist providing treatment.
                        Please refer to the information found in the introduction for the ACC Physiotherapy Treatment Profiles.
                          1. What treatment limit applies when there is no applicable Treatment Profile Trigger Number for a personal injury, and do I need to request approval for this?
                            A limit of six treatments will apply. For more treatment, the vendor must submit a Physiotherapy Request for Further Treatment form (ACC32R) to ACC. ACC will not pay for treatment provided without prior approval.
                              1. What will be approved beyond the applicable Treatment Profile Trigger Number?
                                Up to the number the provider requests, but no more than six treatments.
                                  1. I am an hourly rate regulated physiotherapist who has moved off the old EPN contract onto the hourly rate regulations. What service codes do I use to invoice treatments approved under the old EPN contract but occur after 15 November?
                                    PHY3 – this is the regulated service code for all treatment provided under the regulations and will be paid at the regulations rate from the date you change over from the EPN contract to the regulations. Therefore, when an ACC32R has been approved under the EPN contract but is being used from 16 November, vendors who have moved from EPN to hourly rate billing should bill under service code PHY3. This applies to the flat rate treatment provider as well.
                                      1. If a vendor holds both the Physiotherapy contract and the Hand Therapy contract, where ACC pays for ACC32s until the contract expires on 31 October 2010, what will happen when the provider bills ACC for the ACC32R?
                                        The physiotherapist will need to use service code 32R and indicate that this applies to their hand therapy client.

                                        Key information on certification

                                        Certification of physiotherapists against the Allied Health Sector Services Standard is a key requirement of the ACC interim contract for physiotherapy services, which will be offered to certified physiotherapists from 16 November 2009.

                                        The following set of questions and answers provides information to assist physiotherapists on issues relating to certification, including meeting certification requirements before 16 November 2009.

                                        1. What do I need to do about certification between now and 16 November 2009?
                                          If you do not have certification, and you want to sign up for the new contract, you should contact a Designated Audit Agency which undertakes audits against the Allied Health Services Sector Standard. More information on which Designated Audit Agency to contact is available from your professional organisation or from ACC via email, health.procurement@acc.co.nz, or by phoning ACC on 0800 400 503.
                                            1. Do I have to be certified by 16 November 2009 to join the new contract from that date?
                                              Yes. But in the event that the audit occurs close to 16 November, and certification is imminent, you should request your auditing agency to notify ACC that this is the case so that you can join the new contract.
                                                1. Will my current certification be satisfactory for the new contract, or will I have to be certified again?
                                                  Current certification will be satisfactory – however, there may be changes to the way future surveillance is undertaken within your existing certification. These will be addressed at the time surveillance is undertaken.
                                                    1. What are the likely changes to certification?
                                                      The period for which you are certified may be extended (from three to four years), and provisional requirements amended. The way in which an audit agency samples the number of sites will change and there will be an ability for the audit agency to audit fewer components of the Allied Health Sector Services Standard.
                                                        1. If my surveillance visit is late, must I have a new audit?
                                                          No, ACC has agreed that where a surveillance audit was due and has not been undertaken, it can now be done later without affecting your current certification status. There is a six-month leeway on the surveillance audit date.
                                                            1. What should a surveillance audit be like?
                                                              The purpose of a surveillance audit is to monitor continued implementation of systems, and should include:
                                                              • any changes made since certification
                                                              • any requirements made at the time of the certification audit
                                                              • reviews of client satisfaction
                                                              • quality management systems and a means for management of any complaints.
                                                              Note:
                                                              The surveillance audit should be shorter than a certification audit.
                                                                1. Will the new audit be cheaper?
                                                                  ACC does not set the price of certification, but as anticipated changes to certification should simplify the process they should not increase the cost.
                                                                    1. Will the audit cycle be different?
                                                                      It is proposed that, for a successful initial audit, a maximum period of four years certification can be awarded. Where a vendor is having a re-certification audit and currently holds certification (ie has maintained uninterrupted periods of certification) the period for which certification will be awarded will be four years. This change is likely to take effect from 16 November 2009.
                                                                        1. Will DHBs have to be audited against two sets of standards?
                                                                          Where a DHB holds certification against the Health and Disability Services Standards, they will be required to meet certain additional criteria within the Allied Health Services Sector Standard rather than having to undertake a full audit against both, due to the overlaps between the standards.
                                                                            1. How will certification add value to my practice?
                                                                              Certification helps you demonstrate that your service is run effectively using a range of systems that support a minimum set of recognised standards. Audits can also assist vendors to identify opportunities for improvement. Certification can act as a sign your business is well established and has the necessary structure and processes in place to provide high quality services.
                                                                                1. Will the focus be more on quality clinical practice rather than just procedural issues?
                                                                                  ACC expects audits to focus on service delivery. The new Physiotherapy Service contract will place increased emphasis on client outcomes, and this will also be reflected in audit requirements against the Allied Health Services Sector Standard.
                                                                                    1. What new directives is ACC going to give auditing bodies to ensure a more focused and consistent approach to certification?
                                                                                      The Conformity Assessment Body agreement held between ACC and audit agencies is in the process of being updated. The update will include requirements including conformance with ISO standard 17021 and 19011. This will assist in ensuring a more focused and consistent approach in addition to the requirement for these audit agencies to hold third party accreditation.
                                                                                        1. Will there be more auditing bodies?
                                                                                          There are currently eight Designated Audit Agencies able to conduct audits against the Health and Disability Services Standards. If these agencies want to sign an agreement with ACC and can demonstrate they have physiotherapist auditors with appropriate skills and expertise they will be able to provide audit services to contracted physiotherapists.
                                                                                            1. Can I change auditing bodies at any point in the cycle?
                                                                                              It is easiest to change audit agencies when a re-certification audit is due. If you want to change audit agencies midway between certification audits, you can transfer but this may incur an additional cost because the audit agency will have to undertake a full document review as part of the transition process. This is consistent with ISO standard 17021, with which Designated Audit Agencies will be expected to comply.
                                                                                                1. Will I still be able to sign up for the new contract if my auditing body can’t fit my audit in before 16 November 2009?
                                                                                                  It is unlikely that this will be an issue based on discussions ACC has had with a number of audit agencies. However, if this is an issue, ACC would request that the vendor concerned, along with the audit agency, contact the ACC Physiotherapy Programme Manager on (04) 918 7211 to discuss how this can be managed.

                                                                                                  Outcome measure guidelines

                                                                                                  Guidelines for the completion of both the Patient Specific Functional Scale and the Numeric Pain Rating Scale are now available for physiotherapists.

                                                                                                  To view and download the guidelines, see the Guide to Outcome Measure Reporting (DOC 243K).

                                                                                                  Outcome Measure form

                                                                                                  To view and download the new Physiotherapy Outcome Measures form (PDF 1.0MK) [Updated December 2009]. You can also choose from several different formats, which we have made available to you. These are:

                                                                                                  Process updates

                                                                                                  Key information on the ACC32 process (PDF 22K).

                                                                                                  A range of process related issues were covered in these updates sent to all physiotherapists in the week beginning 9 November 2009:

                                                                                                  Background research

                                                                                                  Download the following background research:

                                                                                                  How to move to payment under the Cost of Treatment regulations

                                                                                                  You retain the option to provide services as a regulation provider under the Cost of Treatment regulations instead of under the interim contract. More information about this option is available by contacting our Health Procurement Team on 0800 400 503 or by emailing health.procurement@acc.co.nz. Or you can download Changing from an EPN contract to payment under the Cost of Treatment regulations (PDF 32K).

                                                                                                  ACC contact details

                                                                                                  If you want to discuss your individual options with ACC, eg a move to payment under the Cost of Treatment regulations, or some other aspect of your own contract, please contact our Health Procurement Team:

                                                                                                  If you have more general questions, comments or suggestions to make on the process or options that might be considered, please channel them through your professional representatives so they can develop a unified view on behalf of the sector.

                                                                                                   

                                                                                                   

                                                                                                  Last updated: 3 February 2010