Early Intervention Physiotherapy Framework (EIPF) services guidelines

The provision of early intervention physiotherapy services

These guidelines are in line with the Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act) and the Accident Compensation Act 1985 (AC Act).

WorkSafe will have regard to these guidelines when making decisions for the provision of early intervention physiotherapy services under the Early Intervention Physiotherapy Framework service model, to people who have an accepted claim under the Victorian Workers Compensation Scheme.

Throughout these guidelines, any reference to WorkSafe includes WorkSafe’s agents and self-insurers.

Physiotherapy services can be provided without pre-approval from the agent. However, in order to attract the higher service fees under the EIPF fee schedule, the physiotherapist must be registered with WorkSafe as an EIPF Provider.

Early Intervention Physiotherapy Framework services

WorkSafe can fund services delivered under the Early Intervention Physiotherapy Framework (EIPF) to assist people to effectively recover from workplace injuries and safely return to work and normal life.

The EIPF is a service model that recognises the importance of early treatment in facilitating return to work and return to health outcomes, and seeks to support practitioners through the provision of training, tools and resources, and more service options. Physiotherapists registered by WorkSafe to deliver services under the EIPF can be paid fees in accordance with the EIPF fee schedule.

Any physiotherapist can enrol in the EIPF by completing the required online training modules and signing a declaration to provide services in line with the WorkSafe Victoria developed Clinical Framework for the Delivery of Health Services.

This framework is a set of guiding principles intended to support healthcare professionals in their treatment of an injury through the following.

• Measurement and demonstration of the effectiveness of treatment.
• Adoption of a biopsychosocial approach.
• Empowering the injured person to manage their injury.
• Implementing goals focused on optimising function, participation and return to work.
• Basing treatment on best available research evidence.

What we can pay for

WorkSafe can pay the reasonable costs of early intervention physiotherapy services a person needs as a result of a work-related injury or illness under Victorian workers compensation legislation.

The treatment or service must meet the following criteria.

• Be clinically justified, safe and effective.
• Be likely to achieve measurable improvement in a person’s functioning.
• Promote progress toward a person’s functional independence, participation and self-management.
• Be for rehabilitation purposes for a work-related injury only.

Be delivered in line with the Clinical Framework.

• Be required as a result of an accepted work-related injury or illness.
• Be provided by WorkSafe EIPF registered physiotherapists.
• Have a satisfactory level of evidence to support they are effective and achieve or maintain a measurable functional improvement.
• Be focused on achieving recovery and return to work outcomes.
• Be reasonable, necessary and appropriate in the circumstances.
• Be billed in accordance with the EIPF fee schedule.

WorkSafe will periodically review a person’s entitlement to physiotherapy services to make sure treatment and services remain reasonable, clinically justified, outcome focused and payable under the legislation.

Post-operative physiotherapy

Physiotherapists providing services under the EIPF are eligible to be paid in accordance with the EIPF fee schedule for treatment occurring after endorsed surgical and procedural interventions, see Post-operative physio eligible procedure list. This post-operative rate recognises that certain procedures return the injury to an acute state, and that more intensive treatment and greater communication between stakeholders is required to achieve optimal rehabilitation and return to work outcomes.

The post-operative item number can be billed for a maximum of 3 months of treatment following an endorsed procedure, provided the procedure occurs within 2 and a half years of the date of the work-related injury.

The 3-month eligibility period commences from the first post-operative physiotherapy service following an endorsed procedure.

Workplace assessment and report

Physiotherapists can play a key role in safe and sustainable return to work and health. Accordingly, WorkSafe encourages physiotherapists providing services under the EIPF to consider whether conducting a workplace assessment would help a worker.

A workplace assessment is a proactive intervention that can be used to facilitate better return to work and health outcomes for workers. Some general guidelines for when a workplace assessment may be appropriate include the following.

• As an early intervention tool to initiate a return to work.
• To confirm the availability and/or suitability of modified or alternative duties.
• To confirm timeframes for a worker to return to work if certified totally or partially unfit for work.
• To discuss suitable work duties and hours to support a return-to-work plan.
• If the worker has reported difficulties in sustaining employment.
• To discuss and address any identified return to work barriers.

WorkSafe recognises that workplace environments and conditions vary greatly. Accordingly, workplace assessment reports submitted to the agent will differ according to the individual circumstances of the workplace.

A workplace assessment report completed by an EIPF provider should contain the following basic information.

• Worker details (name, claim number, employer, DOB, date of injury, nature of injury and/or diagnosis).
• Workplace assessment details (date of visit, location, attendees).
• Pre-injury duties and hours (brief description).
• Current status of worker (including certified capacity, work status, and RTW goals).
• Identified barriers and proposed solutions and/or alternatives.
• Suitable duties identified.
• Conclusions (duties and positions identified, current capacity and how this relates to identified duties, recommendations for future RTW supports).
• Other, such as follow-up discussions with GP, worker, employer and other stakeholders.

The Workplace Assessment and Report item is billed on an hourly basis, to a maximum of 3 hours. The fee for a Workplace Assessment and Report includes:

• time spent arranging the assessment
• travel time to the worker's workplace
• time spent undertaking the assessment
• report writing.

Prior approval from the worker's employer is required before a Workplace Assessment is conducted on premises.

Extended consultations

WorkSafe can pay the published fee schedule rate for extended consultations where the physiotherapist, using the appropriate request form, has submitted written clinical justification of the need for direct patient contact time of greater than 30 minutes for each session for workers who have the following injury or illness.

• A moderate to severe acquired brain injury.
• A spinal cord injury.
• Extensive burns.
• Multiple orthopaedic fractures
• Limb amputations.
• Crush injuries.

Prior written approval (see link below to access form) is required for all extended consultations. Consultations can only be billed as a single consultation on any one day.

Extended consultations can be for periods of either:

• 31 to 40 minutes
• greater than 40 minutes.

Return to Work Case Conference

A Return to Work (RTW) case conference is used to facilitate continuity of care, return to work and communication between relevant parties. If a RTW case conference is required, contact must be made with the agent to facilitate the case conference and ensure appropriate representation from WorkSafe. The worker, employer, and any member of the treating team can also be involved in the case conference. Administration and any follow up after a RTW case conference is included in the published fee schedule rates.

Travel

Travel is only payable with prior written approval from WorkSafe.

A request for travel must include the following information.

• Worker's name and claim number.
• The specific conditions and injuries to be treated.
• The clinical justification as to why travel is required.
• The approximate distance and cost per episode of travel (round-trip)
• The number of travel episodes requested

WorkSafe can pay the reasonable costs of travel on a per kilometre basis for physiotherapists providing treatment outside their clinic other than when conducting a Workplace Assessment and Report as the travel allowance is included in the report fee. Travel is defined as the physiotherapist driving a registered motor vehicle from their clinic address to an approved consultation outside of the physiotherapist’s clinic.

Approved consultations outside of the physiotherapist’s clinic are paid at the standard or extended consultation rate, where applicable. The cost of travel is paid on a per kilometre basis.

For more information refer to the EIPF fee schedule. WorkSafe expects a worker to seek treatment from a physiotherapist within their local area. Travel can be paid only where the below conditions are met.

• No other physiotherapist offering an equivalent service is situated within a 30-kilometre round trip of the worker.
• Travel to the worker is clinically justified.

The per kilometre rate paid for travel is different for regional and metropolitan areas. Travel is paid at the applicable rate where most of the travel occurred. For example, 10km in a regional area and 20km in a metropolitan area would result in payment for 30km of travel at the metropolitan rate. Metropolitan and regional areas are as defined by the Victorian Department of Health.

Travel must be recorded from the rooms nearest to the worker's location where a physiotherapist has more than one practice address.

The physiotherapist must record the distance from one appointment to the next when workers are treated consecutively, not from each appointment to the practice.

When invoicing for travel, the physiotherapist must record the:

• number of metropolitan and/or regional kilometres travelled
• applicable metropolitan or regional rate
• item number.

Refer to the EIPF fee schedule for further information.

The agent can also reimburse the reasonable travel expenses of a worker attending a physiotherapist. Refer to the WorkSafe Travel expenses for medical and hospital services policy for information regarding reimbursement of travel expenses.

Services we will not pay for

Under the Victorian workers compensation legislation, WorkSafe cannot pay for the following EIPF services.

• Services that are not required as a result of a worker’s accepted injury or illness.
• Services for a person other than the person with an accepted claim.
• Services that are not a reasonable cost as determined in accordance with the Victorian workers compensation legislation.
• Services provided outside of Australia without prior written approval from WorkSafe.
• Services provided by a person who is not registered under the Health Practitioner Regulation National Law to practice in the physiotherapy profession.

Under WorkSafe’s determination of reasonable costs, WorkSafe will not pay for costs relating to the following.

• More than one initial consultation by the same provider or clinic unless there are exceptional circumstances. For example, following a hospital admission or surgery, or where a significant period of time has elapsed since the worker last received treatment.
• Items that are not billed in accordance with the EIPF Fee Schedule.
• The provision of multiple disciplines or concurrent physical treatments or consultations (for example, early intervention physiotherapy, physiotherapy, chiropractic, osteopathy, or acupuncture), with exceptions such as group exercise or group hydrotherapy.
• Group consultations which do not involve 2 or more patients receiving constant overall supervision and intermittent attention. The maximum number of patients in a group should not exceed 6.
• Multiple certificates of capacity within 28 days unless there is a change in the functional tolerances and/or capabilities of the worker which will influence the hours or duties they are able to perform at work (applies to subsequent certificates).
• Where there are multiple EIPF certifiers, WorkSafe will pay for only one EICERT/EICERTT item number within 28 days, unless there has been a change in capacity (as defined above).
• Pharmacy items such as creams and gels supplied by health professionals.
• Fees associated with cancellation or non-attendance or services not provided to the worker.
• Services where their rendering cannot be substantiated by contemporaneous clinical records and/or attendance records.
• Treatment or services provided by telephone or other non-face to face mediums that do not align with WorkSafe's telehealth policy.
• Telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals, that do not align with WorkSafe's telehealth policy.
• Multiple claims for travel to and from the practice for community consultations provided consecutively.
• Consumable prosthetics, aides and appliances used in the course of the consultation.

• Services provided more than once on the same day to the same worker.
• A single service billed to more than one claim held by the injured worker.
• Unsolicited treatment or consultation with a worker.
• Treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1 or level 2 evidence that the treatment, service, prostheses or equipment is safe and effective.

How much we can pay

WorkSafe can pay for early intervention physiotherapy in line with our fee schedules.

You can find past fees online:

Sometimes there is a difference between what a provider charges and what WorkSafe will pay as the reasonable cost. If the provider charges more than what WorkSafe will pay, workers will need to pay the difference. In this instance, WorkSafe recommend the provider advise the worker prior to providing any services.

WorkSafe's invoice requirements

There are defined instructions for invoicing WorkSafe for EIPF services.

Who can provide these services

Any physiotherapist can enrol in the EIPF by completing the required training and signing a declaration to provide services in line with the Clinical Framework.

WorkSafe will only fund services through the Early Intervention Physiotherapy Framework delivered by providers that meet the following conditions.

• Registered with the Physiotherapy Board of Australia, other than as a student.
• Registered with WorkSafe for billing purposes
• Satisfactorily completed the WorkSafe training modules.
• Signed a declaration committing to provide services in line with the Clinical Framework and related Service Standards.
• Received confirmation from WorkSafe of enrolment in the EIPF.
• Provided evidence of current professional indemnity insurance coverage of at least $1 million.

Join the EIPF

WorkSafe provides information on how to join the EIPF.

Accessing services

Workers can access physiotherapy services for a work-related injury or illness without prior approval from the agent or a referral from a medical practitioner.

WorkSafe does not require any information from a physiotherapist before commencement of initial treatment for a worker's work-related injury or illness.

However, once treatment has started the physiotherapist must submit to the agent a WorkSafe Allied Health Recovery Management Plan (AHRMP) including baseline measures and psychosocial risk questionnaire screening after the initial treatment has commenced. This must be submitted within the first 5 sessions. If the worker has previously attended a different physiotherapy clinic, an AHRMP is expected from the new clinic within the first 5 sessions.

The initial consultation fee includes the time taken to complete an AHRMP for submission to the Agent.

Subsequently, a WorkSafe AHRMP with updated outcome measures and treatment goals may be requested by the agent.

The agent reserves the right to determine whether the additional requested services are reasonable and appropriate in the circumstances of the worker’s claim.

A copy of the AHRMP must be retained in the worker’s clinical records.

WorkSafe response

For services that do require prior approval, WorkSafe will respond within 10 working days to advise if:

• the request has been approved
• the request has been denied
• further information is required to make a decision.

Where further information is required, WorkSafe will advise whether the request has been approved or denied within 10 working days of receipt of the additional information.

To assist in making a decision regarding a request for further physiotherapy services, a request may be reviewed by a WorkSafe Medical Advisor and/or Clinical Panel. The Clinical Panel and/or Medical Advisor may contact the requesting physiotherapist to seek further information and/or discuss the proposed treatment prior to making a recommendation to the agent regarding the request.

WorkSafe will respond to the request when they have received the recommendations.

Service delivery expectations

WorkSafe expects that all providers delivering early intervention physiotherapy services as part of the Victorian Workers Compensation Scheme follow the below principles.

• Provide culturally safe and respectful services.
  • Protect the person’s human rights and report any concerns of abuse, neglect or discrimination to the appropriate regulatory body or complaints body.
  • Support the person to maximise their independence, promote recovery and self-advocacy.

WorkSafe also expects that any treatment provided is reasonable, clinically justified, outcome focused, and in line with the Clinical Framework.

WorkSafe has reporting and engagement expectations for all providers delivering physiotherapy services to workers. WorkSafe expects providers to communicate, collaborate and provide information to WorkSafe and other relevant parties as required.

For example:

• Providers should work with treating health practitioners or other providers, such as medical practitioners to enable the most appropriate treatment.
• Providers should work with occupational rehabilitation providers, treating health practitioners and employers in relation to return to work.

Providers are required to comply with the requirements set out in these guidelines and in the Application for registration to provide services to workers.

If a provider does not meet these requirements or WorkSafe has concerns about the provider’s conduct or services delivered, WorkSafe may take appropriate action in accordance with the legislation.