Are workers’ compensation authorities supporting great rehabilitation and return to work outcomes? In this state-by-state series we ask representatives of the occupational rehab industry what they think.

Today we chat to George Hallwood, president of the South Australian branch of the Australian Rehabilitation Providers Association - the industry body representing providers of Workplace Rehabilitation across Australia. George is also CEO of Effective Australia.

What’s working in your state?

A move towards evidence-based rehab

“Rehabilitation companies in general have lifted their standards in recent times,” says George. He credits a large part of this shift to the principles outlined in the Heads of Workers’ Compensation Authorities (HWCA) national framework for rehabilitation providers.

“Traditionally, schemes have set all of the standards and providers have followed them because that’s what they’ve had to do,” says George. However, now that, “the national framework is based on principles, rather than specific standards,” George explains, “businesses have built their own models based on their own philosophies, the evidence available to them and their own approaches to rehabilitation.”

This means less red tape for workplace rehabilitation providers, and a better focus on great rehab outcomes.

“[This] has really made rehab companies think about all levels of the way they deliver service,” says George, “and [the way] they administer their business and build in staffing, training and development, and quality in a way that’s never been demanded of them before.”

Employer buy-in

“Employers are improving their understanding of injury management and the importance of supporting RTW,” observes George. “We’re seeing RTW as a real focus for employers; more than ever before.”

“Some of the changes to the WorkCover act in South Australia have probably triggered some of that focus, because they’ve solved the other levers [i.e. availability of lump-sums for exiting the scheme have been reduced] so rehabilitation and RTW are the major focus now in South Australia. Employers are supporting keeping injured workers at work and are assisting with RTW.” The introduction of Rehabilitation and Return to Work coordinators for larger employers has also supported this focus.

Awareness of screening tools

“The last couple of years we’ve seen far more use of screening tools within the rehab industry and a greater understanding of screening tools – to identify those people that will need specific supports, particularly around psychosocial issues.” This use of screening tools is a good start to streamlining and improving the RTW process, while enabling cost-saving.

What’s not working?

Scheme’s focus on claim, not RTW outcome

“There’s an increase in focus on claims outcomes at the moment,” says George, “rather than on rehab and RTW.

“The claims focus is about cost-control and compliance with the legislation, whereas a rehab focus is about maximising physical and mental recovery and restoring them to the workplace and the community,” explains George.

While it seems logical that these factors are both aligned in a workers’ compensation scheme, the focus on cost-control often sacrifices the intent of legislation, which is to support peoples’ RTW.

“It’s very easy for a scheme to make the mistake of providing bonuses [to claims’ managers] for cost-control, or liability reduction,” says George, but the danger is that this, “can be achieved simply by ceasing somebody’s income maintenance payment”.

“As soon as a contract has built-in bonuses for those outcomes, it’s easy for the agent to miss the importance of RTW and recovery, in favour of the things that they’re being rewarded for – which is liability reduction,” maintains George. “In South Australia there appear to be significant perverse outcomes as a result of the contracted reward structure.”

Delayed referral

While WorkCover SA promotes a certain amount of rhetoric around early intervention, George says “the reality is not that at all.”

“We’re seeing very late referral for rehabilitation – up to hundreds of days after injury,” says George. “This is probably the major cause of delayed RTW and other rehabilitation outcomes - this would be the major contributor to what’s not working in South Australia.

“There’s a wide body of evidence that demonstrates the value of early intervention, but schemes are still delaying referrals to the stage where recovery and RTW rates are significantly reduced – and in some cases, just not possible.”

Slow uptake of useful screening techniques

“Part of the delayed referral issue is the quite valid argument that the earliest intervention would be to refer all claims out to rehabilitation from day one,” George says. “But, we all know that a high percentage of people would return to work whether they have rehab services or not, so that would be a massive cost to a scheme - with very little benefit.

“That’s where screening tools are really valuable: the leaps forward in understanding of screening tools in recent years are probably the solution for that problem.” George explains:

“If all injured workers were screened at four weeks post-injury, that screening would give schemes a great level of confidence that the people they were referring-out – based on that screening – would be the ones who would need rehabilitation services. In many ways, it’s a little disappointing that schemes and agents are not quite getting the value of the screening, although the rehab industry is.”

Lack of RTW priority

“The other disappointing area is that a number of the recent initiatives from the national (HWCA) rehab framework are not being supported by some of the schemes,” George says. “In South Australia, 13-week [RTW] durability is not being supported by WorkCover at all, or by the agents,” (not by the agents because WorkCover’s not supporting it).

“13-week durability is about protecting injured workers from re-injury or other issues that might cause a failure in the success of RTW,” says George, “but also supporting employers ensuring workers with a place back in employment are in employment that’s sustainable.

“Rehabilitation companies audited against that national [HWCA] framework are failing that aspect of the audit – but they’re failing it because the scheme itself doesn’t support monitoring 13-week durability. So, the messages are being confused, which is sad with something as valuable as the national framework.”

While WorkCover SA might argue that this exclusion comes down to cost, George suggests there’s only a small price to pay for great long-term results.

“In NSW, WorkCover worked with industry to come up with a small set fee to cover the monitoring and reporting of durability of an injured workers’ claim, once it has been closed,” he says.

“And there’s no more to it than that, unless the rehab provider finds that there’s something going astray – and of course there’s generally nothing going astray. So, in most cases, that fee is not very much at all in the scheme of things. If it’s keeping even a few injured workers in the workplace who might have fallen over otherwise, that’s certainly a few dollars of the claim well spent.”

SA: wrap-up

“I think there was probably a bit of stagnation around rehab up until two or three years ago,” observes George, “and I think we’ve seen the foundation for a leap forward in rehabilitation service delivery and outcomes now.”

George’s comments are in line with the RTW Monitor results from 2005-06 to 2008-09, which saw SA’s durable RTW rate improve by 5 per cent over the period to a rate of 71 per cent. Unfortunately, since then the figure has fallen to 70 per cent in 2010/11 – making the SA durable RTW rate drop from second-lowest to the lowest in the country.

George, however, suggests these results may not be so bad if we take into account the factor of delayed referrals, as well as the significant use of claim levers like exit redemptions.

“Obviously, for everybody who has exited the system through a lump sum, that’s somebody who can’t exit the system from a return to work. So, the RTW outcomes in South Australia have been skewed significantly by lump-sum exits,” says George.

“Even more disappointing is that schemes are still blaming the rehabilitation industry for these poorer outcomes and higher costs, when it’s blatantly obvious the major cause of that is delayed referral.”