Exercise physiology services policy

The provision of exercise physiology services

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

WorkSafe will have regard to these guidelines when making decisions for the provision of exercise physiology services to people who have an accepted claim under the Victorian Workers Compensation Scheme.

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

Exercise physiology services

WorkSafe can fund exercise physiology services to assist people to effectively recover from workplace injuries and safely return to work and life.

Exercise physiologists are qualified allied health professionals who prescribe and deliver exercise-based interventions to facilitate function, recovery, and independence. Exercise physiologists use evidence-based decision making to support individuals, groups, and the wider community. Exercise physiologists can provide services on land or in water.

What we can pay for

WorkSafe can pay the reasonable costs of exercise physiology 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.

The treatment or service must be referred by a medical practitioner.

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

Consultations

Worksafe can pay the reasonable costs for the following consultations in line with the Exercise physiology services fee schedule.

• Initial consultations
• Standard consultations
• Group consultations
• Restricted consultations
• Aquatic exercise
• Telehealth consultations
• Travel expenses.

Further information can be found under the section ‘Accessing services’ in these guidelines.

Return to Work case conference

A Return to Work (RTW) case conference brings together a worker and their supports in a collaborative setting to promote recovery and return to work goals.

The case conference will include:

• the worker
• treating health practitioner(s)
• WorkSafe
• an occupational rehabilitation consultant
• the employer, where appropriate.

A RTW case conference will be requested by WorkSafe or an occupational rehabilitation consultant. A treating health practitioner can request a case conference by contacting WorkSafe or the occupational rehabilitation consultant directly.

Confirmation of contact with WorkSafe and/or the occupational rehabilitation consultant must be kept in the worker’s clinical records.

Either WorkSafe or the occupational rehabilitation consultant must attend the RTW case conference. RTW case conferences are not approved for contact between treating health practitioners where a WorkSafe representative or an occupational rehabilitation consultant is not present. RTW case conferences do not include a one-to-one discussion with a member of the Clinical Panel.

Administration and any follow-up required after the RTW case conference is included in the RTW case conference fee.

Services we will not pay for

Under the Victorian workers compensation legislation, WorkSafe cannot pay for the following exercise physiology 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 approval from WorkSafe or the employer.
• Services delivered by providers who are not approved and registered with WorkSafe to provide these services.
• Services that were provided without a referral from a medical practitioner.
• Services that were provided without prior approval from WorkSafe.

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

• Treatment and services that do not align with the Clinical framework.
• Items that are not billed in line with the WorkSafe exercise physiology services fee schedule.
• Services delivered by a provider not approved by WorkSafe to provide the services.
• Where two or more people are booked and/or treated at the same time, WorkSafe will not pay for individual consultations. Payment will be made at the applicable group consultation rate.
• Consultations provided more than once on the same day to the same worker in relation to a single claim number.
• A single service or consultation billed to more than one claim held by the worker. If a single service or consultation is treating injuries under multiple claim numbers, it should be billed to the most active claim only.
• 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 received treatment.
• Non-attendance or cancellation of appointments.
• Multiple invoices for travel to and from a community setting for consultations provided consecutively.
• Services provided to a worker without the worker requesting an appointment.
• Services provided by telephone or other non-face to face platform not in line 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.
• Consumable items used in the course of the consultation.
• Pharmacy items supplied by health professionals, such as creams and gels.

How much we can pay

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 recommends the provider advise the worker before providing any services.

Exercise physiologists must comply with WorkSafe’s instructions for invoicing.

Who can provide these services

Exercise physiology servicesare delivered by providers who are approved and registered with WorkSafe to provide these services.

WorkSafe will fund only exercise physiology services delivered by providers that meet the following conditions.

• Are fully accredited members of Exercise and Sports Science Australia.
• Maintain the requisite insurance coverage to deliver exercise physiology services.

Find out how to register as a provider.

Accessing services

WorkSafe can fund exercise physiology services only if a medical practitioner provides a referral before beginning the service. WorkSafe does not allow exercise physiologists to provide referrals to other health services.

After treatment has begun, the exercise physiologist must complete a WorkSafe Allied Health Recovery Management Plan (AHRMP), including baseline measures and a psychosocial risk screening questionnaire.

Allied Health Recovery Management Plan

An initial AHRMP must be completed and submitted to WorkSafe advising that treatment has begun. This provides information regarding the goals, strategies, proposed outcomes and timeline of treatment.

• The initial AHRMP must be submitted before the fifth consultation.
• If the worker has previously attended a different exercise physiology clinic, an initial AHRMP is expected from the new clinic before the fifth consultation.
• The initial consultation fee includes the time taken to complete the initial AHRMP for submission to WorkSafe.
• A copy of the initial AHRMP must be retained in the worker’s clinical records.
• For workers that are part of the Community Integration Program, the request, approval and submission of outcome measures for services will form part of the independence planning process.

WorkSafe may request a subsequent AHRMP as part of a Clinical Panel treatment review. A worker’s employer may also request a copy of an AHRMP.

Subsequent AHRMPs must include updated outcome measures and treatment goals. Standardised outcome measures are preferred as they are reliable, valid and sensitive to change. Consistent use of relevant standardised outcome measures helps track progress over time and determine whether the worker’s condition is improving, worsening, or not changing.

Initial consultations

The initial consultation is the first consultation provided by the exercise physiologist for assessment and treatment of the work-related injury or illness. It should be delivered on a one-to-one basis with the worker. The session duration must represent reasonable and appropriate clinical practice.

The sessions must include the following.

• Initial assessment, including history taking and physical examination.
• Intervention and/or treatment.
• Tailored goal setting and treatment planning.
• Expectation setting around recovery and return to work.
• Screening for barriers to recovery.
• Record of clinical notes.

The initial consultation fee includes the time taken to complete an AHRMP for submission to WorkSafe. This must be submitted before the fifth consultation.

An initial consultation can be billed only once by the same provider, clinic or clinical group.

Standard consultations

A standard consultation is any consultation occurring after the initial consultation provided by the exercise physiologist. It should be delivered on a one-to-one basis with the worker. The session duration should be a minimum of 20 minutes and represent reasonable and appropriate clinical practice.

It may include the following.

• Reassessment.
• Intervention and/or treatment.
• Reviewing progress towards goals and adapting treatment plan when goals are not being met.
• Expectation setting around recovery and return to work.
• Monitoring barriers to recovery and acting on these when goals are not met.
• Record of clinical notes.

Group consultations

WorkSafe can pay the reasonable cost of group consultations provided by the exercise physiologist that meet the following criteria.

• A minimum of one and maximum of 6 participants in the class or group session.
• Constant overall supervision and intermittent individual attention to each WorkSafe participant in the group from the exercise physiologist.
• Maximum payment rate is for each person.
• Clinical notes must be completed for all WorkSafe participants.

The total duration must represent reasonable and appropriate clinical practice based on the total number of participants.

Restricted

Restricted consultations require prior written approval from WorkSafe and can be only requested by the treating exercise physiologist where a prior consultation has been delivered.

WorkSafe can pay the reasonable costs of restricted consultations where a worker requires extra time beyond that of a standard consultation. This is because of the complex nature of the injury.

This may include the following.

• Moderate to severe acquired brain injury.
• Crush injuries.
• Extensive burns.
• Spinal cord injuries.
• Multiple orthopaedic fractures.
• Limb amputations.
• Other complex neurological conditions.
• Other severe injuries not listed above.

The ‘Restricted consultation application form’ must be completed by an exercise physiologist to apply for approval to use the restricted consultation item number.

Exercise physiologists should not bill the restricted item consultation item number until they have written approval from WorkSafe.

The restricted consultation item number can be approved for a maximum of 6 months for each application. If restricted consultations are required after this time, the exercise physiologist must complete another ‘Restricted Consultation application form’.

Aquatic exercise

Exercise physiologists may deliver services in the form of aquatic exercise. Aquatic exercise consultations can be delivered on a one-to-one basis or as part of a group consultation.

Aquatic exercise group consultations must meet the following criteria.

• A minimum of one and maximum of 6 participants in the class or group session
• Constant overall supervision and intermittent individual attention to each WorkSafe participant in the group from the exercise physiologist.
• Maximum payment rate is for each person.
• Clinical notes must be completed for all WorkSafe participants.
• The group session or class should be a minimum of 30 minute. The total duration should represent reasonable and appropriate clinical practice based on the total number of participants.

For an onsite aquatic facility, WorkSafe will not pay for pool entry fees. For an external aquatic facility, casual pool entry fees for the worker can be reimbursed in line with WorkSafe’s gym and swimming memberships fee schedule.

Telehealth consultations

Telehealth attendance means audio-visual or audio only consultation between the exercise physiologist and worker. Audio-visual connection is always preferred where possible. WorkSafe can pay for telehealth exercise physiology services in line with the Telehealth policy.

Travel costs for consultations in the community

WorkSafe can pay the reasonable costs of exercise physiologists travel providing approved services in a community setting. Settings include a worker’s home, care facility, an aquatic facility, a gymnasium or a workplace.

Prior written approval from WorkSafe should be requested for travel expenses. A request to WorkSafe for travel must include the following.

• Worker's name and claim number.
• Specific conditions and injuries to be treated.
• Clinical justification as to why travel is required.
• Approximate round-trip distance and cost for each episode of travel.
• Number of travel episodes requested.

Where an exercise physiologist has more than one practice address, travel must be recorded from the rooms nearest to the worker's location. The exercise physiologist must record the distance from one appointment to the next when workers are treated consecutively, not from each appointment to the practice.

The cost of travel is paid on a per kilometre basis. Costs can be paid only where the following applies.

• No other exercise physiologist offering an equivalent service is situated within a 30-kilometre round trip of the worker. WorkSafe expects a worker to seek treatment from an exercise physiologist within their local area.
• Travel to the worker is clinically justified.
• Travel is not already included in the consultation rate.

Travel rates are different for regional and metropolitan areas. Travel is paid at the 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.

When invoicing for travel, the exercise physiologist should include the prior written approval from WorkSafe. They should record the:

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

Clinical Support Service

WorkSafe recognises that treating people with a work-related injury or illness often comes with challenges for providers.

The Clinical Support Service provides direct access to WorkSafe’s Clinical Panel experts, a group of highly experienced and qualified allied health and medical professionals. The service provides free support and advice for medical and health service providers related to the treatment of workers with an accepted claim.

Providers can contact the Clinical Panel for support with the following.

• Completing AHRMP, treater questionnaires, treatment plans and reporting.
• Applying the principles of the Clinical framework and using outcome measures.
• Managing complex treatment and recovery barriers.
• Preparing for, and having difficult conversations with workers
• Brainstorming discussions around treatment pathways and available support when progress starts to plateau.

Service delivery expectations

WorkSafe expects that all providers delivering exercise physiology services as part of the Victorian workers compensation scheme follow these principles.

• Provide culturally safe and respectful services.
• Protect the person’s human rights and report any concerns of abuse, neglect or discrimination to an appropriate regulatory 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 exercise physiology 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.