Workers compensation regulation bulletin - Issue 72 (September 2019)

Have your say on SIRA’s health care review

Health care expenditure accounts for more than $1 billion annually in the New South Wales workers compensation and CTP schemes. Medical spend represents more than 30% of scheme costs.

SIRA is considering revised regulatory requirements to ensure that health care arrangements within personal injury schemes promote safety and quality in services and reflect the principles of value-based care.

It is important that injured people receive the right health care at the right time to optimise recovery and health outcomes.

SIRA is seeking your views of how best to achieve this in the workers compensation and motor accidents (CTP) schemes.

Scheme performance monitoring has highlighted increasing healthcare costs in some areas of the workers compensation scheme.

Preliminary analysis by EY indicates that both utilisation and costs have increased over recent years. Changes in utilisation year on year from 2016-2018 are outlined in the table below.

A consultation paper on regulatory requirements for health care arrangements in the NSW Workers Compensation and CTP schemes is now available.

Your views are sought on opportunities to deliver best value health care under the workers compensation and CTP schemes and to improve outcomes.

Regulatory requirements could include the following areas, among others:

  • health provider fee regulation
  • clinical safety and quality
  • control of cost-efficiency and effectiveness of care
  • insurer performance monitoring
  • provider performance monitoring
  • patient experience and health outcomes monitoring
  • coding and billing systems.

To read the consultation paper and make a submission visit the online consultation page.

Submissions are invited by 1 November 2019.

Submissions to the Compliance and Performance Review of the Nominal Insurer now available on SIRA website

SIRA has received more than 150 submissions in response to the Compliance and Performance Review of the Nominal Insurer.

The submissions have been provided to independent reviewer, Ms Janet Dore. The feedback from stakeholders and customers is valuable and an important contribution to the Review.

SIRA has commenced publishing the submissions and will continue to do so over the coming weeks. They are available here.

SIRA is committed to publishing as many submissions as possible, however, some submissions will not be published, either at the request of the submitter or for privacy reasons as they contain personal information about individuals. SIRA will also publish a summary of submissions.

The review is being conducted by Independent Reviewer, Ms Janet Dore, and supported by independent actuaries EY and authorised officers of SIRA. The Independent Reviewer’s final report is expected to be published in late 2019.

For more information, including the terms of reference and a biography of the independent reviewer, visit the Compliance and Performance Review of the Nominal Insurer webpage.