Q-COMP - Working Together

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Review of Schedules of Fees for Medical Services
Medical Services Review
Future initiatives
Written Submissions

Review of Schedules of Fees for Medical Services

In 2004-2005, Q-COMP, the Workers' Compensation Regulatory Authority of Queensland, undertook a review of the Schedules of Fees for Medical Services delivered to injured workers and paid for by Queensland's workers' compensation insurers, prescribed under the Workers' Compensation and Rehabilitation Act 2003 (the Act).

Under the Act, Q-COMP is responsible for regulating the workers' compensation scheme, including medical fees payable in accordance with the Table of Costs.

There are currently three Schedules of Fees covering medical practitioners' workers' compensation services:

The Medical Item Schedule of Fees;
The Medical Table of Costs Supplementary Schedule for General Practitioners; and
The Medical Table of Costs Supplementary Schedule for Treating Specialists, Consulting Physicians and Psychiatrists.

The Medical Item Schedule of Fees contains almost 4,800 service items using all of the numbers from the Commonwealth Medical Benefits Schedule (CMBS) and covering all medical practitioners.

The two Supplementary Schedules outline fees for specific services to workers' compensation insurers, for example, medical reports and case conferences.

Aim of the Review

The aim of the review was to establish fair and affordable schedules of fees for medical practitioners' services under the Act that will support the provision of:

quality and timely diagnosis and treatment, including facilitation of rehabilitation of injured workers to assist in early return to work;
relevant and timely communication with insurers and employers in relation to the management of the worker's compensation claim; and
quality and timely issuing of workers' compensation medical certificates and reports to insurers regarding the worker's injury, to assist in the proactive management of the workers' compensation claim.

The review considered the Schedules of Fees utilised by insurers for services delivered by registered medical practitioners under the Act, including issues impacting:

General Practitioners;
Specialists; and
The Workers' Compensation Scheme as a whole.

Q-COMP Committee

The review commenced in July 2004 with the formation of a Consultation Committee appointed by the Q-COMP Board.

The Consultation Committee assisted the Board in determining appropriate measures to be taken to facilitate the continued and effective involvement of medical practitioners in the workers' compensation scheme by:

receiving and reviewing written submissions supported by verbal presentations where requested from interested stakeholders; and
providing a comprehensive and balanced
report to the Q-COMP Board identifying all relevant stakeholder issues relating to General Practitioners, Specialists and the impact on the Workers' Compensation Scheme as a whole.

Q-COMP recognised that engaging stakeholders in identifying the issues and developing strategies was critical for obtaining the best outcomes for the scheme. An inclusive and transparent consultation framework, extensive data analysis and modelling meant that the Board was able to approve the recommended fee structure and fee increases with confidence.

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Medical Services Review

During the consultation phase of the medical fee review issues other than fees were raised. To address these issues a Medical Services Steering Committee was established, which is responsible for developing a range of strategies to progress improvements to workers' compensation processes.

Steering Committee

The Medical Services Steering Committee was chaired by
Q-COMP. It included Q-COMP Directors representing employers and workers, as well as representatives from the following organisations:

Australasian Faculty of Occupational Medicine;
Australian Medical Association Queensland;
Australian Orthopaedic Association Queensland;
Australian Society of Orthopaedic Surgeons;
Medical Assessment Tribunals;
Royal Australian and New Zealand College of Psychiatrists Queensland;
Queensland Division of General Practice;
Queensland Workers' Compensation Self Insurers Association; and
WorkCover Queensland.

Relevant medical, insurer and Q-COMP representatives were invited to provide technical and other advice to working parties established through the Steering Committee.

What did they do?

The role of the Medical Services Steering Committee was to:

Consider stakeholder issues relating to workers' compensation processes and communication involving medical practitioners as identified during the Medical Fee Review;
Develop strategies to improve these processes and communication activities
Develop an implementation plan including time frames; and
Recommend the strategies and the implementation plan to the Q-COMP Board that had the potential to deliver improved efficiencies and cost savings.

The Committee reviewed processes and communication activities related to the:

issuing, completion and submission of Medical Certificates;
request for, completion of and submission of Medical Reports; and
medical providers involvement in the development and implementation of Rehabilitation Plans.

The Medical Services Steering Committee Report was submitted to the Q-COMP Board on 25 October 2005.

Key outcomes of the review

A core result of the review of medical services was the support expressed by stakeholders for the process and its success in facilitating increased understanding and awareness of each other's issues and views. This created a positive environment for implementing agreed changes.

The key issues identified for each stakeholder group are:

Workers

Earlier decisions on acceptance of claims and payment of compensation
Earlier commencement of rehabilitation
Earlier return to work

Medical practitioners

Fewer requests for medical reports
Where insurers do request reports, the requests should have a clear purpose and be relevant to the stage of the claim
Payments for medical services should be quicker
Development of communication guidelines for doctors and insurers.
A reduction in multiple sign-offs from doctors for suitable duties programs.
Increased use of alternative means of communication (phone/fax).

Insurers

Increased information on medical certificates
Reduced need for medical reports
Communication guidelines for insurers and doctors
Increased use of alternative means of communication

Employers

Earlier return to work of injured workers
Potential for reduced claims cost

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Future initiatives

The Medical Services Committee ("Steering" was dropped from the title) meets quarterly and continues to foster stakeholder participation through a number of working groups. Q-COMP is working in partnership with the medical profession, industry associations, government, unions and workers to develop agreed solutions and strategies for implementation in the near future.

Key initiatives include:

the development of a smart electronic medical certificate
the development of a secure means of electronic transmission of certificates and reports
a re-evaluation of the requirement on injured workers to make upfront, pre-liability or gap payments.