Assistive Technology Inquiry

Joint Standing Committee on the NDIS

Submission from the Australian Orthotic Prostetic Association

Orthotics and Prosthetics in Australia

Orthotist/prosthetists assess the physical and functional limitations of people resulting from disease, illness, injury and disability, including limb loss, diabetes, stroke and cerebral palsy. Orthotic and prosthetic services may involve the provision of orthoses and prostheses to restore function, prevent deterioration, and improve quality of life. Orthotist/prosthetists are commonly employed in hospitals, private clinics, research institutions as well as rural and remote regions, working independently and as part of multidisciplinary healthcare teams to support the community.

Orthotic and prosthetic services are essential for many NDIS participants and a substantial majority of the profession operate in the NDIS. Orthoses and prostheses currently represent the third largest category of assistive technology by expenditure. In 2016–17 orthotic and prosthetic services constituted 8% of the total participant spend on assistive technology. It is forecast that the NDIS assistive technology market will reach $1 billion by 2020.

Orthotist/prosthetists are tertiary qualified allied health professionals. An Australian Qualification Framework level 7 is required to practice as an orthotist/prosthetist consistent with education standards for other allied health professions. Orthotic/prosthetic students complete training alongside physiotherapy, podiatry and occupational therapy students.

The Australian Orthotic Prosthetic Association (AOPA) is the peak professional body for orthotist/prosthetists in Australia, with certified practitioners comprising 80% of the practicing profession. AOPA is responsible for regulating the profession and is a founding member of the National Alliance of Self Regulating Health Professions (NASRHP) in partnership with other professional organisations, including Speech Pathology Australia, The Australian Association of Social Workers and Exercise and Sports Science Australia. AOPA is recognised by the Commonwealth Government as the assessing authority responsible for conducting migration skill assessments for orthotist/prosthetists.

Executive Summary

The low number of orthotist/prosthetists and current inappropriate pricing arrangements may impose barriers for some NDS participants that require assistive technology. There are fewer orthotist/prosthetists in Australia than recommended by international guidelines and this may prevent participants from accessing orthotic/prosthetic services, particularly in rural and remote regions. Regulations and guidelines should be reviewed to ensure that any barriers do not prevent participants from accessing assistive technology.

Current pricing arrangements for providers may similarly inhibit access to assistive technology for participants. Currently, orthotist/prosthetists are subject to a lower price- cap when compared to other allied health providers and this may have negative effects on the assistive technology market. Pricing arrangement should be reviewed to correct inappropriate price caps.

Recommendations

The NDIA, Quality and Safeguard Commission and Government should review the relevant guidelines and regulations with consideration of their effect on the orthotic/prosthetic workforce and how they may impair access to assistive technology for NDIS participants.

The Joint Standing Committee on the National Disability Insurance Scheme should request that NDIA immediately address current pricing arrangements that inhibit the orthotic/prosthetic market to ensure access to assistive technology for all participants.

The Australian Orthotic and Prosthetic Workforce

There are fewer orthotist/prosthetists in Australia than recommended by international guidelines. This may impose barriers for some NDIS participants that require orthotic/prosthetic services. Regulations and guidelines should be reviewed to ensure that any barriers do not prevent participants from accessing assistive technology.

An analysis of the Australian orthotic/prosthetic workforce indicates that all Australia states territories have fewer orthotist/prosthetists than recommended by international guidelines, as illustrated in figure 1.The geographical dispersion of orthotist/prosthetists is of significant concern, as only 15% of orthotist/prosthetists reside in rural and remote regions.

The low number of orthotist/prosthetists in Australia and poor geographical dispersion of the workforce may impose barriers for some NDIS participants that require orthotic/prosthetic services and assistive technology, particularly those in rural and remote regions. Where participants are not able to access orthotic/prosthetic services, they may be unable to receive essential assistive technology. This may include ankle foot orthoses for children with cerebral palsy and prostheses for persons with limb loss or amputation.

Regulations and guidelines

Regulations and guidelines should be reviewed to ensure that any barriers –– including poor geographical dispersion of orthotist/prosthetists –– do not prevent participants from accessing assistive technology. Future guidelines and credentialing processes should be considered with reference to the potential detrimental effect for participants seeking requiring assistive technology. Similarly, pricing arrangements should be reviewed with reference to their effect on access to services and the availability of assistive technology for participants.

Recommendation

NDIS Pricing for Orthotic and Prosthetic Services

The current pricing arrangements for providers may inhibit access to assistive technology for some participants. Currently, orthotist/prosthetists are subject to a lower price-cap when compared to other allied health providers. This may prevent some providers from entering the scheme and may have negative effects on the assistive technology market.

Orthotist/prosthetists must currently operate under a lower price-cap when compared to other allied health providers. This is due to an inadvertent change in the relevant provider registration group that has not been corrected by the NDIA.4 This change has not been addressed by the introduction of the NDIS Quality and Safeguards Commission. As a result, orthotist/prosthetists are relegated to a lower price-cap that represents a departure from the stated benefit of price regulations.5 As a result of this lower price-cap, orthotist/prosthetists may be less readily able to compete with other allied health professions when providing similar services. As an example, both orthotist/prosthetists and podiatrists typically provide foot orthoses for eligible NDIS participants. However, where the orthotist provides the orthoses, they are restricted to a lesser clinical fee than the

podiatrist performing the same service. This provides a significant financial and market

detriment for orthotist/prosthetists. This was recently identified by the Productivity Commission in the NDIS Costs Position Paper. 6 The Productivity Commission identified that current pricing arrangements are excessive and benefit ‘some providers and participants over others’. 7

This lower price-cap for orthotist/prosthetists may impair the viability of the scheme, especially for providers involved with the provision of assistive technology. If orthotist/prosthetists are not able to compete with other services under the lower-price cap, they may be less likely to enter the NDIS market. Where providers identify that the scheme does not provide sufficient financial incentive to practice, or otherwise imposes price regulations that do not allow providers to operate effectively, they are less likely to join the scheme, effectively inhibiting the market. This is particularly pertinent for the orthotic/prosthetic workforce given the poor geographic dispersion of providers. 8

Additionally, participants requiring assistive technology may experience detrimental consequences. If prospective providers do not enter the scheme due to the inappropriate pricing arrangements, participants are less likely to have access to the appropriate providers in all regions. This may restrict participants from accessing assistive technology, essentially those in rural and remote regions.

Recommendation

Citations

1 Ridgewell, E. et al, (2016). Demographics of the Australian Orthotic and Prosthetic Workforce 2007-12. Australian Health Review, 40(5). 2 Ridgewell, E. et al, (2016). 3 Ridgewell, E. et al, (2016). 4 See, AOPA NDIS Price Review Submission 2017. 5 Productivity Commission NDIS Costs Position Paper, 36. 6 Productivity Commission NDIS Costs Position Paper, 36. 7 Productivity Commission NDIS Costs Position Paper, 36. 8 Ridgewell, E. et al, (2016).