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 Anthony Zalakos, president of the Victorian branch of the Australian Rehabilitation Providers Association - the industry body representing providers of Workplace Rehabilitation across Australia. Anthony is also CEO of Recovre.

What’s working in Victoria?

The compensation authority’s commitment to RTW

“What I think is working really well is the regulator’s commitment to return to work,” says Anthony. “I think in recent times there has been a real positive shift towards RTW as opposed to claims cessation.”

Anthony says this is shown by the authority’s consultative approach towards stakeholders, engaging with them to ask what can be done differently to, “Facilitate more RTW outcomes, to get better results for injured workers, to create better working relationships with the agents and help them become more RTW-focused.”

RTW reporting

Anthony says there have been improvements in RTW outcome reporting.

“WorkSafe have put a process in place which we [ARPA] believe effectively measures RTW,” says Anthony. While the new system is not necessarily perfect, Anthony is confident it effectively measures RTW outcomes.

“Because of the new incentive model which tracks RTW and sustainable RTW, now they generally can report on different providers’ ability to get RTW. We think they’ve done that really well,” he adds.

RTW measurement and renewed focus

WorkSafe Victoria has introduced a new system that compares rehab providers on the basis of their RTW outcomes.

“Providers are now getting star-rated about how they’re performing from a RTW perspective,” says Anthony. “We [ARPA] believe this is important as it’s specifically about the Workplace Rehab provider, rather than overall scheme performance.” This way, the compensation authority can measure the rehab industry’s contribution to RTW outcomes while also promoting the priority of RTW.

Claims manager re-skilling
Anthony also explains how a claims agent’s role has had to evolve to one more focused on RTW.

“I think there’s acknowledgement from WorkSafe that agents have not had enough capability, or focus on managing RTW, versus the traditional claims management,” he says.

WorkSafe is addressing this by developing a new agent-role: as Agent return to work “advisor” or “specialist,” says Anthony. The hope is that this type of role will flag potential problem-cases of RTW and refer them to early intervention programs.

“They’ll manage a series of claims, but the theory being they they’ll triage effectively: they’ll know which claims need more focus from an agent perspective,” explains Anthony. “The person managing in the Agent RTW advisor role will be more experienced in and focused on RTW, and be more proactive in facilitating that.”

With this improved awareness of RTW importance, however, comes the risk of alienating other RTW professionals.

“The risk is that agents could start to take on workplace rehabilitation activities,” warns Anthony. “We’re concerned that some of the agents may not be able to implement that as effectively as WorkSafe would like, and are not required to meet the same criteria relating to qualifications, experience and independence as approved workplace rehabilitation providers.”

To address this, “ARPA has been working with WorkSafe to be clear about what the new role is, as opposed to what the Workplace Rehab Provider role is,” says Anthony. “WorkSafe wants to create a role that works really closely with providers, to get a better understanding of what WPR providers do. We think that working with us and hopefully working closely with agents will ensure their role doesn’t cross the line. We think it’s a positive direction,” he adds.

What’s not working

From an industry perspective, Anthony remarks that, “one of the biggest challenges we face within the scheme - with the agents - is that I don’t believe the services we provide as an industry are valued enough.”

This is evidenced by the compensation system’s overly-bureaucratic process, as well as models of payment that don’t allow recognition of varying levels of skill and experience of different consultants.

The paper-trail

Another issue is that the RTW process itself can be quite bureaucratic. “Whilst in Victoria they’ve done a great job consolidating the provider list and really working closely with providers - like having special forums for communicating effectively – I still think that agents tend to be overly prescriptive in what they request us to do,” says Anthony.

“In addition, the agents also want their own reports each month and certain things done in different ways which increases the administrative burden on providers.”

The worrying result of this process is that, “realistically, who the injured worker is insured by can often have an impact on what sort of rehab they get,” says Anthony.

“That’s an issue to me because fundamentally, injured workers should have the opportunity to get the best form of rehab and to get the best opportunity to return to work - not just the service that the individual agent allows the provider to do.”

“Many of the agents think they’ve got a model that creates more accountability and more likelihood of RTW, but what they’re really doing is making it more difficult for providers,” advises Anthony. “It becomes this issue at case manager/ consultant level and then all of a sudden the injured worker gets lost.”

Retaining industry talent

“The biggest single issue from the OR/ workplace rehab industry perspective is the ability for us to retain good people in the business,” says Anthony. “It’s the biggest problem across all the states and jurisdictions.”

Anthony suggests that offering a competitive salary to experienced professionals can be a difficult task under current funding models. Much of the funding model in Victoria is fixed fee, and when each agent requests something different it makes it difficult to remain profitable in a fixed fee environment. Consequently, the challenge of keeping experienced rehab staff where they are needed is costing providers, the compensation authority, and ultimately the workers, the best RTW outcomes.

VIC: wrap-up

Summing up, Anthony is generally positive about the relationship between rehabilitation providers and the Victorian workers’ compensation authority.

According to the 2010/11 RTW Monitor, Victoria’s durable RTW rates have bounced back to 76 per cent, after a steady decline from 77 per cent in 2005-06, to 69 per cent in 2008-09. Victoria is not alone in this trend, however, as New South Wales and Queensland also experienced significant reductions in durable RTW over the same period. This has been attributed in part to the Global Financial Crisis.