Modality Jiggery Pokery*

by Rebecca Barnett

You may have noticed there is a Federal election looming. You may also have noticed that, as part of the lead up to said election, the Department of Health is rolling out a suite of reforms related to private health insurance on April 1 (story starts at 17.52).

What you may not have noticed, however, is the rather curious circular that the Department of Health quietly released late last year in relation to the provision of “banned” natural therapies as an element of another treatment after the April 1 deadline for their removal.

The scenario that the Department focuses on in its advice is physiotherapists providing Pilates-based exercises within a treatment. Here is an excerpt:

The Department considers that an insurer may lawfully pay benefits if a physiotherapist, providing services to a patient within the accepted scope of clinical practice, uses exercises or techniques drawn from Pilates as part of that patient’s treatment as long as the exercises or techniques are within the accepted scope of clinical practice.

AMT was curious about how this advice might apply to remedial massage therapists providing, let’s say, Pilates-informed exercises in the context of a remedial massage treatment plan. We wrote to the Health Minister, Greg Hunt, seeking clarification. While we were on the case, we flagged the seemingly anti-competitive nature of the application of the new private health insurance rules, which appear to unfairly impact on certain types of health practitioners, and flagrantly disregard the original intent and purpose of the Natural Therapies Review.

In the context of these new private health insurance rules, it would seem that all non-evidence based therapies are equal but some non-evidence based therapies are more equal than others depending on the context in which they are delivered. (Apologies to George Orwell.)

Here is AMT’s letter to Minister Hunt and the response from the Minister.

Letter to the Federal Minister for Health, Greg Hunt
Response from the Minister

Confused? To ensure that you remain compliant with this advice from the Department of Health, as well as the private health insurance rules and the conditions of the various funds, ask yourself these questions before issuing a health fund receipt for remedial massage:

  1. Do I meet AMT standards, as articulated through the AMT Code of Practice (of particular relevance here are the AMT standards for record-keeping, receipting and informed consent).
  2. Was that a remedial treatment I just provided?
    • have I clearly identified a presenting condition? (this could include presentations such as chronic stress, insomnia, mood-related disorders etc, however these sorts of conditions should always be treated with a multi-disciplinary approach. Referrals from GPs and other allied health practitioners should be noted in the client notes)
    • have I conducted a clinical assessment and negotiated a treatment plan with the client to address the condition?
    • have I reassessed the client during and/or post-treatment, and documented progress and changes?
    • have I recorded all of the above in the client file?

In other words, a remedial massage is not defined by the techniques you use in the treatment but rather working within the remedial massage scope of practice to assess the presenting condition, and then use this information to establish and carry out a treatment plan, and then reassess. You can still use/recommend Pilates-based exercises or yoga but you can’t run a claimable group class.

*Not the same as modality hokey pokey which may or may not routinely occur after the AMT Annual Conference dinner.

As the self-titled accidental CEO of AMT, Rebecca Barnett clearly also suffers from a terrible case of impostor syndrome and should really stop apologising for her position. She remains a fiercely loyal champion of massage therapists in spite of this.

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  1. Pierre Belanger
    22/03/2019 - 10:57 am

    I was not aware of these therapies being “banned”… I thought they simply removed them from health funds because of lack of clinical research. As far as I am aware they can still be practiced in Australia.

    I would maybe help our cause (Massage Therapists) if we’d have a more professional membership system with only one association. But that would mean many presidents, secretaries, etc. loosing their prestigious positions and pay…
    Maybe then would we be taken more seriously as a profession in healthcare.

    • Hi Pierre. It seems that you may have misunderstood the convention of scare quotes, which we used around the word “banned” with deliberate intent. Here is a definition that may help:

      Scare quotes may indicate that the author is using someone else’s term, similar to preceding a phrase with the expression ” so-called “; they may imply skepticism or disagreement, belief that the words are misused, or that the writer intends a meaning opposite to the words enclosed in quotes.

      The problem is that, when you read the new health insurance rules in the actual legislation, there are more serious and far-reaching implications than just the exclusion of health fund benefits for those therapies. The legislation does, in effect, “ban” those therapies from being used in hospitals – a pretty serious state of affairs, I think you would agree. This has already had negative impacts in terms of being able to research those therapies in clinical trials. There’s some detailed explanation of the implications of the legislation here which you might find helpful:

      In relation to your comments about professionalism and one membership system, if you can find a way to unite the diverse communities that operate under the broader umbrella of natural therapies, then we’re listening. You might also want to have a conversation with some of the presidents and secretaries whose put in hundreds of hours of voluntary labour without getting a zack in return.

  2. Graham Thomas
    22/03/2019 - 8:32 pm

    I read the reply from the Honourable Greg Hunt MP Minister of health, what scares me the most is I understood it.

  3. I guess my concern is that Physiotherapists and possibly the Dept of Health are:
    a] Not understanding that there is a difference between a service/modality and a provider. The practice of pilates, yoga so forth are modalities in themselves and like massage have governing bodies that have worked to develop ASQA recognised educational standards. When a physiotherapist states that they can do whatever modality they like it is akin to saying that a crime is only a crime if conducted by a criminal if. it conducted by a priest or a police officer then it is something else. If the modality is no longer covered then it should not be covered regardless of the service provider.
    b] That there is a lack of understanding of the role of private health insurance and the role of a physiotherapist. That is the cover is for acute, goal centred time limited interventions. What the physiotherapists are trying to do is make exercise and movement modalities covered but only be them. This allows physiotherapist to then provide GST exempt services that are subsidised by rebates. Such actions mean that they are performing anti competitive practices as the service is the same to that delivered by other practitioners who are placed at a pricing disadvantage. In the end long term exercise and movement not a specified health intervention as detailed by the AHPRA codes of conducts. I would be asking how their practices and lobbying for special treatment are not being reviewed by ACCC.
    c] Converting valuable and limited health dollars and exercise interventions only to the richest 45% of Australians who can afford private health insurance. There is no doubt that exercise and good diet are excellent interventions for determining good health outcomes. However, these are services and provisions that should be uniformly available and if subsidised should be more targeted. Essentially the actions of trying to have exercises and movement therapies covered through the expensive and regressive private health insurance system undermines the Australian Dept of Health policies of equitable sustainable health interventions. The policy speak for this is called the social gradient of health and disease.

    • Sharon Livingstone
      03/04/2019 - 9:38 am

      Focusing on, and blaming, physiotherapists for the decisions made by the Australian Government is misguided. Physiotherapists have equally been impacted by this decision and have to change how they operate due to the confusion created by the information provided by the Australian Government. Perhaps it would be better for our focus to be on the implementation of the Australian Government’s new position and the confusion it has caused to all practitioners and consumers alike. Perhaps it is also an opportunity to reflect on how private health insurance is managed, and to call into question the reason the review into natural therapies was commenced.

      • Actually, the impact on physiotherapists is decidedly unequal in their favour. The fact that the Department of Health has openly stated in this response that it only consulted with the APA, and did not include other key stakeholders such as the Australian Pilates Method Association, is concerning. The effect of this advice is anti-competitive.

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