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Healthcare review

SIRA has undertaken a comprehensive Review of Regulatory Requirements for Healthcare Arrangements in the NSW workers compensation and CTP schemes.

Healthcare costs account for more than $1 billion each year in SIRA’s personal injury schemes, and this review aimed to ensure that injured people have access to the right healthcare, at the right time, for optimal recovery and return to work.

SIRA has published its final report which outlines the next steps forward, including the implementation of SIRA’s health outcomes framework to progress the schemes towards value-based care.

Regulatory requirements for healthcare

At the commencement of the healthcare review, SIRA undertook a consultation to inform revised regulatory requirements relating to the healthcare arrangements within the schemes, to manage costs and improve outcomes for injured motorists and workers.

The consultation paper and submissions are published online on the health outcomes framework consultation page.

Health outcomes framework

SIRA led a public consultation on a health outcomes and reporting framework for the NSW workers compensation and CTP schemes.

The proposed framework includes:

  • a vision for the delivery of healthcare within the WC and CTP schemes: “the workers compensation and CTP schemes regulated by SIRA deliver value-based care to injured persons covered by the schemes”.
  • how the achievement of the vision will be defined and measured.

The consultation paper and submissions are published online on the health outcomes framework consultation page.

Fees orders

As part of the larger healthcare review, SIRA commissioned a market pricing review to benchmark NSW workers compensation scheme health practitioner fees against other jurisdictions and payers. The review found that the scheme is out of step with other Australian workers compensation schemes and the NSW CTP scheme.

SIRA made changes to a number of fees orders for health providers on 1 January 2021 and will be making further changes to other fees during 2021. News about potential changes to surgical fees orders has been published online.

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