EnableNSW PLS Update

September 2012

PLS Funding Guidelines• Current PLS funding guidelines have been posted on EnableNSW

website • Feedback was provided in the following areas:

– Interim contract funding – outside scope – Private inpatients – make available interim limb funding– Second prostheses – funds repairs to expired prostheses – Consumable supplies – remove limits, change to $ amount– Format of document – smaller, more manageable documents– Discretionary process – be removed

• Review guidelines pending new contract/procurement arrangements• Long term plan to break down the guidelines into segments• Produce annual report on PLS expenditure at a scheme level

PLS Tender• Interim limb contract arrangements in place up to 30 November

2012• Notice to industry of intention to procure PLS services released for

comment in May 2012– Not a sole provider for NSW or Metro Sydney– Panel of providers for SCHN– Interim limbs for rural areas– Consumers have choice for non interim scripts

• Changes made after industry consultation– ABF funding model and weighted funding replaced with pricing for 45 limb types– Upper limb scripts able to be taken to provider of choice

• Tender released to industry on e-tender website in July 2012

PLS Tender cont.• Specifications of tender (details on e-tender website):

– Appoint a single PSP to provide interim limbs and prosthetic consultation services at accredited public clinics

– Tenderer submits price for interim / non-interim / socket replacement – Consumers have choice of PSP for the provision of non-interim limbs and all

upper limbs– KPIs have not been mandated for provision of services other than interim

services being provided on site as an inpatient. PSP requested to advise on:• Warranty period for adjustments and services offered

• Maximum time from referral to assessment (metro and rural)

• Maximum time from assessment casting to fitting for a patient not presenting with complications that directly impact on prosthetic use

• Consultation support services on offer including method and timeliness

– Specific criteria applied to panel services for SCHN in relation to timeframes and service support

METRO CLINICS1 Pre operative consultations offered Yes / No2 Warranty Period for Interim limb Months3 Warranty Period for Interim limb socket replacement Months

4Maximum time from referral to assessment for interim limb for Metro Clinics (RFT Part C3 Appendix 1 - Section A)

Working Days

5Maximum time from approval to casting of interim limb for Metro Clinics (RFT Part C3 Appendix 1 - Section A)

Working Days

6Maximum time from casting to fitting of interim limb for Metro Clinics (RFT Part C3 Appendix 1 - Section A)

Working Days

7Average time from approval to fitting of interim limb socket replacement for Metro Clinics (RFT Part C3 Appendix 1 - Section A)

Working Days

8 Warranty time for Primary / Definitive Limbs Months9 Warranty time for Primary / Definitive Limb socket replacement Months

10Average time from approval to fitting for primary / definitive limb for Metro Clinics (RFT Part C3 Appendix 1 - Section A)

Working Days

12 Travel to and from the nominated facility Yes / No

13 Adjustment support provided (Response time) - verbal and/or hands on Hours

14Average time from approval to fitting for primary / definitive limb socket replacement for Metro Clinics (RFT Part C3 Appendix 1 - Section A)

Working Days

15 Additional support offerred - Tenderer to provide details Provide Details16 Quality initiatives - Tenderer to provide details Provide Details

Future Directions• Investigate a matrix model of funding to better understand the

underlying issues that impact on cost structures e.g. pattern of demand and the ability to create a homogeneous classification of limb types.

• Develop a classification system for payment of PLS approved components. This has included some preliminary retrospective coding of scanned prescriptions for K-levels over the last 5 years. The classification considered the following possible attributes: amputation type, K-level, age and weight.

• Investigate an explicit ‘cost per type of amputee’ and forecasts of expected number of prostheses and repairs to respond to the risk that the number of amputees increases over time.

$1423

$1069

Limb type = Blw Elb / Blw Knee

$2721

Limb Type = Through/Above Knee & Elbow

$2482 $4059

$1639 $4274

K Class = 0, 1, and 2 K Class = 3 and 4

Age Grp = 0-16yAge Grp = 17-60y and 65y+

‘R’ Variables for cost of components based on Limb Type, K Classification and Age

Future Directions cont.• Seek support from the University of Wollongong to assist in

presenting the statistical basis for moving to a model of activity based funding and for conducting data analysis.

• Test the initial component classification with the industry to determine whether the included factors are required and/or additional factors are needed.

• Establish a group of clinical experts to review literature and develop Prescription and Provision Guidelines (PPGs) for silicone suspension.

• Investigate a business model for the procurement and provision of silicone (TCI) in parallel.

Other• Collection of co-payment now undertaken by Enable

NSW• Establishment of a terminal devices bank for SCHN• Enable NSW initiates engagement at a national level to

progress a more co-ordinated approach to artificial limb schemes