Case studies supporting concerns of OTA re WorkCover Queensland s Return to Work arrangements

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1 Appendix A. Case studies supporting concerns of OTA re WorkCover Queensland s Return to Work arrangements Information provided by OTA members some are panellists and others are not Examples of larger providers taking advantage of the exclusivity of the panel 1. Feedback from a panel member - Jacinta McCartin Sunshine Coast Since being selected on the Retturn to (RTW) panel in 2011 her revenue from WorkCover Queensland (WCQ) referrals has fallen to a sixth of what it was prior to the panel. This is despite her scorecard rating of 1 st out of 37 panel members. Jacinta is based in a regional area and suspects the bulk of the work is being given to large interstate providers who are prepared not to charge travel costs to get the work. She has no hard evidence of this but her figures support a major change in who is doing the work in this regional area. There is confusion regarding referrals for discrete occupational therapy services (i.e driving assessments etc that off panel providers can provide). She had an experience where a GP referred an injured worker (for whom Jacinta was already providing RTW intervention) for a driving assessment to another occupational therapist (OT) who was not on the RTW panel. Jacinta complained to WCQ and the driving assessment referral was then given to her. 2. Several regional OTs have stated that exercise physiologists were performing occupational therapy services in the form of home and Activities of Daily Living (ADL) assessments including prescription of equipment. This was in the Mackay region. Whilst this is a non panel service, it is commonly known that WCQ consultants will refer to RTW panel providers for discrete occupational therapy services. Providers are accepting the referral and allowing other allied health professionals to work outside their scope of practice. 3. WCQ customer service officers do not know the difference between OTs and other allied health providers in many cases. A WCQ representative stated during the tender process for the RTW panel that OTs should be happy that WCQ thinks everyone is an OT, implying that the profession has a high profile. In fact this statement is of profound concern as it suggests allied health practitioners are performing services outside their professional scope, effectively putting clients at risk and risking the Occupational Therapy profession s integrity. 4. A WCQ panel member has admitted (small business) of her experience of being flown to Cairns to visit a single worker all flights and travel time paid at a premium. 5. It was reported that a provider sent a representative (we believe to Cairns) to see a worker and they simply met in the airport before the return flight home. There is no commitment to authentic care (such as a worksite visit). 6. Numerous complaints relate to the lack of travel reimbursement and none-too-subtle threats about not being reappointed as a panellist. 7. An OT (non-panellist) reported that a competing firm (panellist) asked her to subcontract and provide a single service: pre-employment functional screening. The next week, they had 1

2 used a phantom address unit number next door to her premises on their website to suggest that they provide services in the area. An OT in Cairns reported that a company flew up from Brisbane to do a workplace assessment and then contacted her (a non-panellist) to do a driving assessment. She did the driving assessment but said it was not even warranted if the therapist had just done a basic assessment they could have written to the GP and got what they needed. So, a waste of WCQ s money (and affecting the employer s premium). 8. A very experienced regional OT has provided the following observations: Inexperienced therapists being used in referrals, including those with complex presentations; Therapists flying up from Brisbane to carry out workplace assessments in Mackay; Exercise physiologists are being used for ADL assessments (outside their professional scope of practice); Exercise physiologists are being sent to do workplace assessments when the employers have specifically asked for an OT (this is probably more the provider s deception than a WCQ decision, however it may also reflect the limited understanding of WCQ customer advisers with regard to the difference between the professions); and Panel providers conduct initial assessments in coffee shops and airports as they have no rooms in the area and have not arranged with the employer to have a suitable area available for a formal assessment. 9. Some panellists report they were unable to optimally service clients, due to funding restrictions by WCQ. This would extend to Workplace Assessments, Functional Capacity Evaluations, development of RTW plans, monitoring, and travel. Some providers established 'satellite' offices (in reality rent-by-hour spaces) on the Sunshine Coast, Gold Coast, Ipswich, and Toowoomba, in a bid to increase their 'coverage', when tendering for a spot on the panel. This saw providers undertaking unpaid travel (sometimes for 3-4 hour round trips depending on traffic) whenever a referral for a non-brisbane based client came through. When the risks of fatigue and KPI shortfall (as the travel was non-billable) were reported, providers were told to 'group' assessments in a particular location. This, however, meant delaying a client's appointment while waiting for another referral to come through in the same, or nearby, location. This is hardly optimal care. With regards to new graduates practising without supervision and/or support from a more senior consultant, there is the case of a new graduate employed by a large provider in Rockhampton essentially as a sole practitioner. This person was required to undertake New Employer services, including sourcing Host Employment and Vocational Assessments with minimal to no on-the-ground support. OTA does not believe a new graduate should be thrown into the deep end and expected to cope, while being remotely supported and/or supervised from Brisbane. 10. OTs currently providing preventative services to employers and who are not on the panel are prevented from providing claim work to the employer even though they are suitably qualified and understand the complexities of the workplace. WCQ send panel providers to 2

3 do another workplace assessment (often having them travel to that area) and then create the RTW plan. This duplication of functions costs the employer time and money and is not consistent with continuity of care. It is poor business sense and poor health care. 11. Prior to the introduction of the RTW panel occupational therapists who had built their business in workplace rehabiliation had developed long term relationships with employers. This was particularly necessary in regional areas where resources are limited. They provided longitudinal work aimed at preventing and managing injury including: risk assessment and management; injury prevention strategies; workplace wellbeing; workplace rehabilitation of workers injured at work and those with non-work related injury or illness. With the development of the RTW panel these relationships have been significantly affected. Employers report they wait longer for a RTW provider to be arranged, the provider sent by WCQ does not have the same level of understanding of the business, the occupational demands of the workers, the workplace culture and occupational risks. The provider takes much longer to preform the assessment and the quality of the intervention is low due to this lack of experience and knowledge. This information has been provided by a regional provider who has received feedback from past employers. Many small businesses feel they have no option but to go along with WCQ now their right to choose has been taken away. 12. Some OTs are asked by employers and workers to assess capacity to perform full duties after the cessation of the worker s WCQ claim. Both employer and worker are left in a very difficult position when the claim has been ceased and the worker has not returned to full duties. 13. An OT working for an entity on the RTW panel organised a work trial for a man following a total knee replacement. The trial involved loading timber in a timber yard. The man s leg blew up like a balloon after two hours. It was a totally inappropriate work placement. He later found work with a bus company doing public transport runs, which he does beautifully because he is used to driving big vehicle. This panellist has a standard test which involves testing beyond the demands of the job, informed by no clinical thought process at all. 14. A very experienced provider in the Daintree / Port Douglas area worked with hotels in that area for years. She did not get on the WCQ RTW panel and has to negotiate with providers from Cairns who have no idea what they are doing. Her customers complain about the quality of these RTW interventions. Cairns is notoriously poorly served by the RTW panel. The damage to the occupational therapy industry as a whole 1. As an experienced Occupational Therapist who has built a career in Occupational Rehabilitation since 1992 I am deeply concerned at the effect the WQ RTW panel has had on the standard of Occupational Rehab affecting QLD employers, injured workers and treating practitioners (Specialist doctors, GP, Physios, Hand Therapist, Occupational Therapists and Psychologists. WorkCover QLD s annual report shows stay at work rates but there is no measure of durability. I am regularly asked to assist employers to determine where the employer and worker stands with regard to work capacity once the workers compensation claim. Both parties have been left in extremely difficult positions especially as many have their workers placed in host placements and have no involvement in the workers rehabilitation. Previously I would be able to assist both parties throughout the RTW process including post claim. This would involve early recognition of permanent occupational restrictions and working toward reasonable adjustment in the workplace. 3

4 I have undertaken RTW Services as an off panel OT approved by Workcover QLD due to the complexity of the case. However, the regional employers who I have provided long standing services for, have not been able to use my services. I am aware of other non-panel OTs who has completed RTW services for Workcover QLD. Sue Smith Occupational Therapist Integrated Work Health/Back to Work Services 2. Feedback from OT graduate who left occupational rehabilitation after being hired as a new graduate by a panelist. Due to limited providers on the panel, often new graduates are not only put into tough or challenging RTW situations with minimal skills or knowledge, but this is also affecting new graduate OTs views of the Occ Rehab industry (potentially as over demanding or a field of burnout, which is a shame as a Occ Rehab is a great industry and there is a lot of opportunity to build on existing skills) and contributing to very high staff over!! However, if more providers are given the opportunity to serve the panel, then providers will have the opportunity to invest more time and skills into building the skills of their employees (particularly new grads), who will then appreciate the employer and industry, rather than feeling that they were hired to just meet high work demands from the WQ panel. This will satisfy both WQ and providers, as hopefully, staff turnover rates will decrease. Also, more providers = greater areas that can be serviced, and current providers need not stretch out or overwork their employees to travel and work beyond local areas (if not necessary). The quality of occupational therapy in workplace rehabilition is declining due to the trend of recruiting new graduates to workplace rehabilitation in order to meet the business demands generated by the RTW panel. There is a rapid turnover of new graduate OTs from rehabilitation providers (particularly the larger providers) due to high workload, lack of professional support and poor work conditions including long hours and limited remuneration. Graduates have moved away from this area of practice due to their poor experiences. This is a tremendous risk to the profession especially as it has been a core area of practice for occupational therapy since the profession s development. The loss of business to suitably qualified occupational therapists in Queensland 1. Work Rehab, owned by OT Jacqui Keys, lost 30% of revenue when she was not chosen to serve on the RTW panel. Jacqui employed 7 OTs at the time, as well as vocational service providers. Despite being accredited by Comcare, under the federal Worker s Compensation Scheme, and being asked to present at industry events on a regular basis, her business was deemed not good enough by WCQ. GPs continued to refer to her for 18 months after this and when asked why she could not provide a service she had to state that she was not good enough. Employers (such as the Department of Education Queensland) where she was a preferred provider tried to continue to use her services for non claim work, however this ceased after 12 months as she was unable to continue onto claim work. Jacqui was forced to relocate interstate and pursue Comcare and Income Protection insurance work with Sydney based insurers to ensure her staff in Queensland remained employed. She was 4

5 successful in this and has since returned to Queensland on the assumption that the RTW panel would be reviewed after consultation with the associations (as was stated on the WCQ website). This consultation never occurred. She currently has employers who she can provide RTW services to in other states, however not in her own state of Queensland. Employers cannot understand how she can provide services to their businesses in NSW but not to their worksites in Queensland when she is based in Queensland. It is illogical. 2. Carmen Mitchell, an OT who once specialised in workplace rehabilitation, no longer works in the industry. 3. Sue Smith, an OT specializing in workplace rehabilitation in the Ipswich and Lockyer Valley region for more than 20 years is no longer able to provide most of her long-term employers with RTW services. Many of these employers have expressed disappointment in the standard of RTW providers they are now required to work with or the lack of timely support from WCQ. Sue has longstanding relationships with many local treatment providers who regularly express their frustration with the limited skills of RTW panel OTs and other allied health practitioners who are managing workers RTW after complex injury. Sue has accepted subcontract work to remain in the industry and this has reduced her capacity to earn by half. An example of larger businesses growing larger and smaller regional based businesses dying out. 4. Cameron Fraser The RTW panel has had a severe effect on his business and he now undertakes primarily medicolegal assessments of injured workers. He is unable to provide the workplace rehabilitation service to his many long term employers. 5. Sven Rhoers The RTW panel has had a severe effect on business. He continues to seek alternate employment as he has been prevented from providing previous customers with the comprehensive workplace rehabilation service that was his specialty. 6. A regionally based OT in private practice for more than 25 years used to service numerous employers in the mining industry, Education Queensland and Queensland Health has closed his business as a direct result of the RTW tender. 7. Non-panel OTs have also lost business to the panel providers for discrete occupational therapy services. This is directly due to WCQ s use of the RTW panel and indirectly due to employers losing contact with their previous service providers. Larger panellists are given regular access to the employer through their RTW activities and then move to take over the other, non-compenstation work. Employer (client) feedback 1. The owner of a large Queensland based company that uses WCQ RTW services commented that no matter how well this company does in prevention and rehabilitation, WCQ appears to want to take control of non-insurance functions with an outstanding level of interference. This employer feels that the panel is another layer of unnecessary interference, particularly if no hard data is available to suggest QLD providers are performing particularly badly in comparison with other states. The owner s concern with regard to additional controls is that the focus of service providers is on making their data appear favourable to the controller, rather than on service improvement. This stifles 5

6 innovation, except in the area of getting around the rules the innovative approach of providers claiming non-existent offices being a major case in point. Those organisations most willing to bend the rules appear to be given the most referrals. There appears to be no commitment to referrals being based on points of difference in relation to the quality of service provided. Finally, this employer is astounded that governments still espouse the benefits of free trade, while not applying this to their own commercial interactions. 2. Another employer, with a nationwide presence and therefore regular interactions with workers compensation authorities in every state and territory, offers the following reflections on RTW arrangements in QLD: o This employer engages their own in-house rehabilitation co-ordinator to case manage, rather than using WCQ; o they engage therapists independent of WCQ to ensure a level of skill they are comfortable with, as they have no choice as to who WCQ sends; o the last time they asked WCQ to assist in identifying a rehabilitation provider for a specific condition, WCQ had "no idea" and they found someone themselves; o most insurers have Injury Management Advisors (IMA) with strong health/rehabilitation backgrounds, while WCQ does not; o they are not impressed with the compulsory administration fee they have to pay when they do not use the customer adviser rehabilitation management system, without apparent IMA support, nor with the inflexibility of not having a say in rehabilitation providers utilised; o the panel system is not only inflexible but anti-competitive and this employer is surprised that anti-competition laws allow it to stand; o they note a similar inflexibility with the WCQ Independent Medical Examinations (IME) panel, where employers have to take the next doctor that the WCQ computer system identifies. The employer manages this by calling back a week later, until the list comes up with someone they know does a good assessment and report; o they note that in NSW and Victoria the workers compensation arrangements allow the GP, specialist, employer and employee to all have a say in the engagement of the rehabilitation provider. If the GP or specialist requests a worksite visit but does not suggest a provider, the employer suggests one or produces a short-list of providers, and the employee gets the final say (but can also consult the full list of providers in the area). 6