Consultation C treatment service fact sheet
Consultation C allied health treatment service is for the management of workers with complex pathology and clinical presentations in the NSW workers compensation scheme.
The Consultation C treatment service definition was introduced in the Workers Compensation Physiotherapy, Chiropractic and Osteopathy (PCO) fees order on 1 January 2021 to replace the complex treatment service definition. This change addressed overlap between the complex and severe injury definitions and provided additional context where Consultation C may be clinically appropriate.
In 2022, the Consultation C definition was updated. It provides examples of some clinical presentations that may be relevant for the use of Consultation C services, however this list is not exhaustive. It also provides context on utilisation, expectations on the use of evidence-based risk screening/standardised outcome measures that support this higher-level intensity service delivery, and to demonstrate outcomes for people receiving care.
The Consultation C treatment service code was also introduced to the Accredited Exercise Physiology (AEP) Fees Order 2022. The Consultation C definition in the AEP fees order, and the revised 2022 Consultation C definition in the PCO fees order, commenced 1 August 2022.
Who is Consultation C designed for?
Consultation C is a treatment service code for the management of injured persons with complex pathology and clinical presentations that require a matched intensity and relevance of treatment.
Consultation C is reserved for when a practitioner is required to deliver a significantly increased level of specialty and intensity of treatment service to adequately address the complexity of an injured person’s presentation. It is SIRA’s expectation only a small number of workers will require Consultation C treatment sessions.
The Consultation C definition provides examples of some clinical presentations that may be relevant for the delivery of Consultation C services. This list is not exhaustive, and SIRA considers these examples will not always automatically require a Consultation C service.
It is expected two (2) or more evidence-based risk screening/standardised outcome measures relevant to the clinical presentation are documented to demonstrate clinical rationale for a higher intensity and increased level of specialty treatment services.
In line with the principles of value-based healthcare and the Clinical Framework for the Delivery of Health Services, all treatment services should aim to assist injured persons improve their function and encourage progression toward self-management. With progression towards self-management and independence, it is expected there will be an appropriate transition to shorter duration Consultation C treatment sessions and/or progression to lower intensity subsequent consultations, as part of their rehabilitation.
Clinical Framework for the Delivery of Health Services
SIRA expects all health providers delivering services to injured persons apply the principles of the Clinical Framework for the Delivery of Health Services (the Clinical Framework) into their professional practice. The Clinical Framework is based on the following principles:
- measurement and demonstration of the effectiveness of treatment
- adoption of a biopsychosocial approach
- empowering the injured worker to manage their injury
- implementing goals focused on optimising function, participation and/or return to work/health
- base treatments on best available research evidence.
Practitioners providing Consultation C treatment services should deliver evidence-based treatment, that includes measuring and demonstrating outcomes, and empowering injured persons to manage their injury and maximise their independence. Integral to the progression to independence is an appropriate transition to shorter duration Consultation C treatment sessions and/or progression to lower intensity subsequent consultations, as part of their rehabilitation.
An insurer may, in collaboration with a treating practitioner, engage an Independent Consultant. This may occur when a person’s recovery has not progressed as expected, or where an ongoing request for Consultation C treatment sessions does not appear to align with the current clinical presentation.
Engagement of an Independent Consultant is intended to be collaborative and provide peer support for practitioners, and may include;
- identifying potential barriers to recovery and return to work or return to activity
- establishing a plan for future injury management to achieve positive outcomes, and
- assisting with the transition towards self-management and independence for the worker.
Screening tools and standardised outcome measures
A key component in delivering value-based healthcare is the use of risk screening tools and standardised outcome measures (SOMs). When used consistently they:
- provide evidence-based measures regarding a person’s current or future health status
- support clinical decision-making and care planning
- enable tailored support, and
- enhance outcomes for people receiving care.
There is a broad range of evidence-based psychosocial screening tools and SOMs available to practitioners. Practitioners should use the screening tool and/or SOM most relevant to the person’s clinical presentation.
Common SOMs can be found on the SIRA website. SIRA will continue to enhance this practitioner resource page as an integral part of value-based healthcare implementation across SIRA’s personal injury schemes.
Practitioners are expected to measure and demonstrate the effectiveness of Consultation C treatment. This information, when provided to insurers via the Allied Health Recovery Request (AHRR), will assist with the review and approval process of Consultation C requests. Practitioners can report on SOMs in the Current signs and symptoms within Section 2: Clinical assessment. Risk screening measures can be included within Section 3: Capacity, where any factors that have impacted a worker’s progress, or may impact their future recovery, is provided. Reporting on these measures will provide additional context regarding the rationale for services requested within Section 5: Services requested.
Invoicing
Consultation C is to be invoiced on a pro-rata basis in 5-minute blocks, up to a maximum of one hour. The maximum 5-minute pro-rata fee is the fee provided in the relevant fees order at the date services are delivered.
Monitoring Consultation C
As part of the implementation of value-based health care, SIRA will monitor data and trends relating to Consultation C utilisation. This will include:
- health outcomes for people receiving Consultation C treatments
- the number of people receiving Consultation C treatments
- the injury types receiving Consultation C treatments
- the number of Consultation C treatments per claim
- utilisation of Consultation C treatments compared with other consultation types
- utilisation of screening tools and SOMs
- tapering of treatment towards shorter Consultation C pro-rata sessions, and progression to lower intensity subsequent consultations and self-management.
SIRA will work closely with insurers and peak associations as part of this monitoring program. Necessary supervision activities will take place if anomalous billing is identified.