Dialogue forum for Administrators of Amputee and Artificial Limb Services within Australia: Industry Feedback forums

The ALS Managers' Dialogue forum is committed to encouraging feedback and as such hosts an Industry Feedback Forum whenever possible, usually to coincide with the I.S.P.O. (Australia) conference. Feedback and discussion takes place and this often sets some of the issues that the dialogue forum will tackle as part of its voluntary committment to improve the Australia wide standards of service.

View Feedback Session notes:

• 16 November 2001
• 1st November 2000
• 3rd November 1999
• 27th August 1998

---

Feedback Forum 16 November 2002

A question was asked as to what the Managers' forum were doing.
Kate Moylan (convenor) and Bill Contoyannis (secretary) mentioned that areas that the forum was dealing with were published on the website and where relevant, actual minutes may be there.
The website had discussion papers for comments by anyone in the industry and the policies of all the ALSs were slowly being listed there also.
This prompted a request for an update of what was happening in each State re: ALS which was briefly covered by Kate Moylan (NSW), Mike Ainsworth (SA) and Weston Wiggins (TAS).
In the absence of further issues being tabled or raise, the feedback forum was closed by Kate Moylan.

The following was published in the December TechLINK, 2001

The ALS Managers Industry feedback forum was held on the 16th of November. Many thanks go to those who helped co-ordinate this Australia wide. Unfortunately in terms of discussion, it was less than a success with few issues being tackled. It appears that despite an early request from the forum, few issues were raised to be placed on an agenda prior to the meeting.
This created confusion with the ALS managers waiting for issues to be raised by the industry audience and the audience expecting the managers would raise issues.
The managers are looking at ways to improve this in the future and as always value input.
Generally the areas of discussion that are being tackled by the managers' forum, as well as discussion papers and drafts are available on the website at www.alsa.org.au. Recently individual State/Territory policies and surveys have been added to the site.

The ALS managers' forum is still seeking industry representatives beyond AOPA and the AUA with whom they already meet. (please contact ALS Managers' Forum c/o REHABTech rehab.tech@eng.monash.edu.au)

Australia Industry Feedback Forum, November 1st 2000, Adelaide

Kate Moylan welcomed everyone present and opened the meeting at 3.12 p.m.  Kate is the new convenor of the ALSA Managers’ Forum in place of Ron Simard of QALS who is on secondment to another department within Queensland Health.

Minutes:  There were none although there are items to be  discussed which arose out of last year’s Forum.

The convenor gave a progress report on the following issues:-

National Indicator of Cost (NIC)
At last year’s forum it was noted that there is no mechanism in place for calculating how much of the ALS funding is spent on Administration.  The ALSA volunteered to take this on and has been busy collecting and processing data over the past year.  The resulting report is now on the ALSA website.  The final figure arrived at as a National average is 10.37% based on the structure outlined on the website.

Coding Structures
ALS Managers discussed this issue earlier in the day with Colin Aburn (AOPA President) who unfortunately has had to go on to another meeting and so is unable to with us this afternoon.  Colin Aburn has committed AOPA to creating a new and better L-Code system listing to replace the current DVA historical codes.  Objections to this were called for.  None were received but is was noted that AOPA has been involved in a similar Orthotic project.

Cross Border Memorandum of Understanding (MOU)
The ALS Managers also discussed this document during their meeting today.  All managers have in principle agreed to sign the document however they are waiting on feedback and possible wording changes from Kerry Whittle (Amputees United of Australia).  Once this has occurred the document will be finalised and should be signed off within 6 months.

 National Amputee Database
This issue has almost been finalised, there is agreement between ALS Managers however most of the physical documents are still with the ALS bureaucrats waiting to be signed.  Again it is envisaged that signing should be completed within 6 months.  It was hoped that this could be signed off today but due to bureaucratic hold-ups this is just not possible.
 

QUESTIONS FROM THE FLOOR

 NIC
Someone asked a question regarding the NIC figure of 10.37%.  Kate explained that the figure is a national average of the cost of wages, stationery and any and all overheads associated with running the ALS schemes (including RehabTech) in each state or territory and then divided by 9 to obtain a national average.  The full derivation is described on the ALSA website.  Individual state/territory  figures are not listed so as to maintain confidentiality.
Note 1)  the ALS management in one state was almost tendered out but to totally privatise would have been more expensive so at the last minute it was decided to remain government funded.
Note 2)  No comparison has been done with other equipment schemes, however this would be an interesting comparison.

Component costs were discussed  The NIC should give an indicator of this, but it is important that price changes are reported to RehabTech as soon as possible to get a true indication.

 Cross Border MOU
Kate spoke again to this issue.  She noted that patients must meet guidelines set down by the host State.  It was asked how Managers planned to stop one state being inundated by excess patients.  That is why there is a provision in the MOU for States to have a capped transfer level for each other.  Once this is reached, the host State has a right to recoup funds before any more cross border services are offered.  If services being sought appear to be very excessive a state will recognize this and it will be addressed.
The inequity in hourly rates is sure to aggravate fund transfers but whilst a uniform costing is not available this is inevitable.
It was asked how Victoria calculates accurate cross border numbers and the suggested answer was that it is very difficult to do.
 

 General topics which arose

Are there any guidelines for visiting services?  i.e. for doctors in clinics?

Kate noted that in NSW all clinics have a doctor.

In QLD they have what is known as an oversight committee.  This consists of a rehabilitation physiotherapist, a prosthetist and 3 amputees.  QALS asks the committee for recommendations of what an amputee clinic should have as standard.  They were advised that a clinic must have a minimum of a rehabilitation or amputee specialist, a prosthetist and a physiotherapist.

Kate asked whether a representative from each state (present at the forum today) could form a committee or “Consultation Group” to discuss the NIC and other issues perhaps on 2 or 3 occasions via a teleconference.

 Invitation for Feedback

AOPA should set up a sub-committee re opinions on professional issues and can also have recommended prices for services.  Industry should also have a spokesperson re prices etc.

The Medical Industry Association of Australia is a very powerful lobby organisation that could be used as a model.  It is run by the members, not by administrators.

RehabTech will continue to facilitate issues.
 

 NIC -structure and issues was discussed

Some States have greater increases and some stay the same.  The indicator is not influenced by this.

Should there be “one-off” funding to create better funding?
If dollars are inaccurate will the client pay the rest?
If the ALS budget does come out at 80% how will the shortfall be met?

One state tried to get extra money and were prepared to increase the hourly rate but PSPs accepted their first offer of a contract so there was no need to increase.

Service standards need to be defined.  One of this forum’s objectives is to try and agree on a funding level for a standard of service.

PSPs must put in a viable business tender to be considered for ALS type work.

It was commented that components used in each limb are of course recommended by the person selling the limb.  Will the ALS consider this issue i.e. the PSP also being the wholesaler?   Massons and Otto Bock are the only two wholesalers in Australia who don’t have clinics attached to them.
ALS must rely on the prosthetist’s discretion.  Components which have the same standards and meet the same criteria must be considered equal.

The possibility exists that there is no incentive for clinicians to use better products.  If they can buy cheaply they can make an increased profit.  (Only Victoria can do this).

It was commented that the ALSs are not paying fairly.  Components cost the PSP nothing because if Supplier A sells a knee to Supplier B for $50 the ALS pays $50 to Supplier B which effectively cancels out the cost.  Clinicians can’t mark up components because they are paid an hourly rate.

Until the National Amputee Database is up and running it can’t be proven that more expensive components necessarily mean that they are better in terms of lasting longer, less visits or other outcomes.
Each state/territory should have component trials done.  The ALS is committed to and is already doing this.

It was also commented that private providers need to fill in a report on failed components.  They should submit this to RehabTech for listing and to create a database.  (RehabTech is already doing this but relies on receiving components or reports).

The comment was made that supplying clinics won’t report themselves.

There being no further discussions the ALS Managers’ of Australia Industry Feedback Forum was declared officially closed at 4.21 p.m.

It was confirmed that  Bill place feedback on the ALSA Website

Present:  Doug Jeffreys – Orthotic Specialist Centre (VIC), Joanne Pugh – Royal Childrens’ Hospital Melbourne (VIC), Nicholas Freijah – Melbourne Extended Care (VIC), Merrilee McClelland – Massons (VIC), Peter Hatters – Tasmanian Amputee Society Inc (TAS), Kerry Whittle – Amputees United Of Australia (TAS), Yvonne Whittle - Amputees United Of Australia (TAS), Nicholas Robjohns – OPSA (SA), Deanne Galvin – Prosthetic Orthotic Service ACT Community Care (ACT), Neil McKay – Prosthetic Orthotic Service ACT Community Care (ACT), Graham West – Queensland Health (QLD), Mike Ainsworth – OPSA (SA), Ian Burns – WALSA (WA), Michelle Janssen – OPST (TAS), Mark Raabe – Ortho Synergy Pty Ltd (NSW), Martin Masson – Massons (VIC) Kate Moylan – NSWALS (NSW) Convenor, Bill Contoyannis – RehabTech (VIC) and Naomi Alba – RehabTech (VIC).

Apologies:  Chris Flavell – NTALS (NT), Ron Simard – QALS (QLD)
 

FEEDBACK FORUM — 3rd November 1999
Representatives from prosthetic and manufacturing groups met prior to the ISPO Conference Hobart on Wednesday, 3 November 1999.

The previous year's feedback had brought out a number of issues which were acted upon by the ALS Managers’ throughout 1999.

Mr Ron Simard, Convenor of the ALS Managers’ Forum, welcomed 34 attendees and then opened the discussion on topics listed below (circulated prior to the meeting) as well as other issues raised during the session.

National Indicator of Cost (www.alsa.org.au/)

The purpose, structure and format of this addition to the website were outlined. It contains significant historical data and represents a starting point for industry input.

Comments/Discussion:

• Cost of administration should be added to represent more accurate costs.
• State figures are arguably not realistic but they are snapshots of time of what is actually happening.
• Industry can influence change.
• Mechanisms are in place to ensure that the data is being updated.
• Request for industry submissions were made. Ask industry to review/AOPA or other industry reviews. (The PMA would forward any existing reviews to the Secretary of the ALS Managers’ Forum.)

Ron Simard stated this issue was being addressed as part of QALS and that it was not necessarily an issue for other administrators or schemes. Realised components were different to hourly rates. Asked whether component costs were meant to be reimbursed and whether profit came from hourly rate alone, or if component prices may include profit also?

Comments/Discussion:

• Discounting is commercial reality and it would be very difficult to separate component costs from any discounts.
• Original funding model provided reimbursement of component cost only and the  hourly rate funded "all other costs".
• Hourly rate is a "flawed" model, so shouldn’t influence component cost.
• Negotiations in QALS can look at any model.
• What model can be adopted that is acceptable to all different manufacturers and administrative schemes?

State-to-State services

Comments/Discussion:

• Patients must be able to access services across State borders.
• ALSA are working on this issue. Emergency work will be done in any state. If a limb is required then ALS Managers will enquire as to whether the request is legitimate and liaise with the State originating work.
• A comprehensive arrangement needs to be worked out.

Feedback Session - 27th August 1998

Ron Simard, QALS Manager, welcomed attendees of the Australian prosthetics industry to an open session of the ALS Managers’ Forum at 1.30pm.

A brief presentation of the proposed listing,coding and costing of generic prosthetic types which allows for the establishment of national and possibly international comparisons of limbs whilst not limiting the technology or techniques which the health professional may apply.

Members of the industry discussed the following points:

• The legacy of Commonwealth DVA handover of the service to states has resulted in

ALS Managers having unrealistic budgets and limb subsidies varying from state to state.
• Need for a uniform policy on limb making services so that State governments can be lobbied for increased funding where inequalities exist.
• Introduction of a new national prosthetic code which allows changes to be made to list when necessary, e.g. price increases in imported components.
• That a generic code was limited. Any new code should include assessment time.
• That it was inappropriate to code types of limbs but desirable to do so for component parts.
• Suggested that proposed coding could be likened to parts catalogue which gives product type and price but does not allow for travel, storage and handling, and clinical input of the prosthetist.
• The ALS should recognize professional role of prosthetists and a new code should reflect this view.

• SOCKET Code
• Assesment / data collection CONSULTATION code
• List of REPAIRS Codes
• INSPECTION codes
• Inclusion of component group sections in TechGUIDE code

The session closed at 4.30pm
At the closure of the meeting, the Convenor thanked all participants. Any further comments should be forwarded to:
Secretary, ALS Managers' Forum c/o REHABTech rehab.tech@eng.monash.edu.au
Present: ALS Managers, James Barrientos of Brisbane Prosthetics, Peter Bednar of Hunter Area Health Service, Bill Contoyannis of REHABTech, Natalia Crompton of Royal Talbot Centre for Rehabilitation, Rowan English of Ballarat Health Service
Nick Freijah of North West Hospital, David Howells of Advance Prosthetics, David Hughes of Premier Prosthetics & Orthotics, Raelene Jarvis and John Tiss from RALAC Orthotics and Prosthetics, Bill Reed from Reed Prosthetics, Helmut Reis of Reis Orthotics, Ron Wright of Wright Orthopaedics and Damien Woolley of Prosthetics Specialist Centre.