Healthcare services

Victorian only service. Receive mix of funding from commonwealth and state governments, also see patients a=under MBS funding or private fee paying.

Some CHS are affiliated with hospital networks, others are independent not-for-profit organisations. Primary aim is to provide services (including allied health)  to local community aimed at either health promotion or chronic disease management and prevention.

Fees will depend on income of participant and funding stream

If aged 65 or over (50 years or older for Aboriginal and Torres Strait Islander) referral is to My Aged Care. Some community health centres may accept referrals for people aged 65 or over without going through My Aged Care if they are independent in dressing, showering, and shopping-will depend on if have funding for community health patients. Different funding for services available through My Aged Care-will have an assessment first to determine level of help and services required.

If having trouble with every day tasks, may be eligible for Commonwealth Home Support Program (CHSP)-need an assessment via My Aged CAre to determine eligibility (Regional Assessment Service)

If more complex needs, may be eligible for Home Care Package-need to have assessment via My Aged Care to determine needs.

Cost: varies with different fee structures, if on ‘average income’ usually around $10-15 per session. If pensioner usually around $10 per session.

Referral: can be GP, OAHKS, other health professional or self referral. If over age of 65, referral is via My Aged Care

Pros: -Offer groups, often including GLA:D®.
-Physios experienced in pain management and behaviour change.
-Often onsite access to other allied health if required including dietetics, podiatry, psychology, counselling, health coaches
-Can arrange interpreters if required
-Cheaper than private

Cons- Can have lengthy waiting times
-Difficulty navigating referral system with My Aged Care if over age of 65
-Usually during working hours (e.g. 9-4.30) only

Anyone referred to community health aged 65 or over needs to be referred via the Commonwealth government agency My Aged Care (https://www.myagedcare.gov.au/)  unable to refer directly to community health centre.

Patient will be contacted by My Aged Care, and have an assessment from a RAS (Rapid Assessment Service); referral then forwarded to community health service.

If patient has more complex needs, an ACAS (Aged Care Assessment Service) will be done however these may have longer waiting times.

Provides a medicare rebate for up to 5 sessions of allied health per calendar year. Depending on the practitioner, this may fully cover the cost of the appointment, or the patient may have to pay a ‘gap’ fee.

This is 5 in total, not 5 per discipline (e.g. 3 physiotherapy sessions and 2 dietetics sessions).

If start 5 sessions towards the end of the year,  can use some sessions the following year, however those sessions would be considered part of the 5 for the current year (i.e. you are not able to carry extra sessions over to the following calendar year). There is also a requirement for at least 3 months from the commencement of a care plan before being eligible for another care plan (so can’t have 5 sessions in December of one year and another 5 in January the following year).

These sessions only include one to one sessions with a therapist, they do not cover groups such as GLA:D®.

Referral: Requires a GP to set up the care plan.

Cost: Varies-rebate currently approximately $53 dollars. Some practices no charge, others have a gap fee

Pros:
-Usually quicker access than via CHS
-May offer “out of hours” appointments for patients who are working
-Cheaper than private out of pocket feepaying

Cons:
-Limited number of sessions (maximum 5)
-Doesn’t include groups such as GLA:D®
-Requires GP visit to arrange
-Private practitioner won’t receive any information or referral from OAHKS unless given to patient at OAHKS assessment

See here for more details

Private practice physiotherapists accept self referral, as well as health practitioner referrals. If patients have private health insurance with ‘extras’ cover, they can receive a rebate from their private health insurance fund for services such as physiotherapy, podiatry and dietetics. The services included will vary with individual policies.   Normally there is a cap on the amount which people can receive annually as a rebate.

Some health funds have ‘preferred providers’  where patients receive a higher rebate if they see a health practitioner on the preferred provider list.

If referring/recommending groups services GLA:D®, advise patients to confirm with their health fund the group physiotherapy sessions are covered as again this can vary between policies.  Also confirm if telehealth services covered if applicable.

If patients don’t have private health insurance extras but are able to afford private allied health services such as physiotherapy, can suggest could use combination of care plan and full fee paying if a care plan doesn’t provide suitable sessions. For example, if suggesting GLA:D®, can use care plan sessions for initial and post GLA:D review appointments, but patient pays out of pocket for GLA:D sessions.

If wanting patients to find practitioner to provide GLA:D®, refer to website www.gladaustralia.com.au to find list of local providers.

Patients may also wish to see a private orthopedic consultant or private physicians eg. sports physician.  A GP referral is required for this, and whilst patients will receive some rebate from Medicare, there is normally an out of pocket fee for this.

Referral: self, GP or health professional (if for appointment with private orthopaedic consultant requires GP referral)

Cost: Varies from approximately $80 upwards for physiotherapy
GLA:D® varies from approximately $600 for 12 sessions upwards
Private consultant appointment varies from approximately $250 upwards

Pros: Quick access
-Often offer out of hours services
-More locations-may be closer to home/work than CHS

Cons
-Cost

Up to 10 individual and 10 group sessions subsidised by Medicare; arranged via GP.

Need a re-assessment with GP after 6 visits.

Can include psychologist, social worker, occupational therapist, counsellor.

Can also include online sessions if eligible e.g. due to rural/remote setting

Generally metropolitan Melbourne public Hospitals do not provide outpatient services for allied health (e.g. physiotherapy, dietetics) for chronic conditions such as OA.

Some health networks have community health as part of the organisation and would come under community health referrals.

Most metropolitan Melbourne health networks have an OsteoArthritis Hip and Knee Service (OAHKS) as part of the orthopaedic pathway. OAHKS are usually staffed by either advanced practice physiotherapists or rheumatologist.

Patients who are referred by their GP to orthopaedics for hip and knee OA are usually seen in OAHKS for an assessment to determine the appropriate care pathway-either referral on to orthopaedics for consideration of surgical management; or referral for non-operative management.

For onward referral to orthopaedics, generally required to have:
-GP referral to OAHKS service (including provider number of GP)
–Medicare number of patient (if asylum seeker awaiting status or overseas visitor gets complicated-and patient may end up having to pay for any medical services. Important to be picked up and clarified prior to appointment being arranged. Usually will be picked up by intake, and Medicare number should be checked by reception when arrive for appointment-however any doubts check with Health Information Services or relevant department in local setting so patient not receiving an unexpected (potentially very large) bill at a later date.
–imaging confirming severe (KL Gr 3 or 4) osteoarthritis
-list of medication including analgesia
-known allergies
-PHx including co-morbidities
-Pain score (VAS)
-Functional limitations including walking distance
-Willingness for surgery 

Dietitian vs nutritionist-nutritionist able to give general advice and information e.g. public health advice; dietitians also able to provide clinical advice to individuals for their specific health condition.

Community health, EPC or private options as above.

Healthy weight for life-a very low calorie diet, plus exercise; fully funded if have private health insurance cover including joint replacement by most private health insurers https://oa.hwfl.com.au/static.php?item=overview

Eligibility for funded program:
-BMI 28+
-knee or hip OA
-knee or hip symptoms that have or are likely to in the foreseeable future necessitated referreal to orthopaedic surgeon for evaluation OR
–an existing symptomatic knee or hip joint replacement that could benefit from weight loss, improved fitness or muscle strength OR
-a knee or hip joint replacement procedure is planned and weight loss, improved fitness and muscle strength prior to surgery is desirable

Not recommended for people with acute cerebrovascular or cardiovascular disease (including unstable angina), kidney disease, liver disease, type 1 diabetes or severe psychological disturbances

Require GP referral to see private specialist.

Generally 12 month waiting period from when join private health fund and requires high level cover to include joint replacement.