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Introduction of a Private Hospital Services Table of Costs

WorkCover Queensland will introduce a consistent fee structure, in the form of a table of costs, for private hospital services for the treatment of patients with a workers' compensation claim. Consultation and feedback from our stakeholders is key to ensuring we continue to meet our customers’ needs.

Background

WorkCover is focused on getting the best outcomes for both employers and workers. This means:

  • workers receive timely medical assistance to facilitate their rehabilitation and return to work; and
  • treatment must be at a fair and reasonable price to minimise impact on employer premiums.

As the main provider of workers’ compensation insurance in Queensland, we also have a responsibility to maintain the financial viability of the workers’ compensation fund in this state.

Our current fee model for private hospital services is based on individual contracts with these hospitals across Queensland. The variety and complexity of these contracts makes it difficult to achieve consistent pricing and service delivery. It also hinders our flexibility to respond quickly to emergent events (e.g. extending the use of telehealth services during the COVID-19 pandemic).

Insights from research, analysis and consultation with other jurisdictions and key stakeholders, has indicated the introduction of the Private Hospital Services Table of Costs would minimise the disparity in fees and service standards and improve efficiency in billing.

What's changing

The introduction of a Private Hospital Services Table of Costs will require private hospitals providing services to patients with a workers' compensation claim, to invoice for services in line with item numbers and fees listed in the table of costs. The scheduled fees will be the maximum payable.

The table of costs will be maintained in a similar manner to our current Medical and Allied Health Tables of Costs with annual and/or interim reviews. This will ensure fees and services are in line with relevant industry and economic factors such as CPI and wage indexes.

Target dates for the introduction of the table of costs are:

  • Publication date: 1 November 2021
  • Effective date: 1 December 2021

All current Private Hospital Facility Agreements with WorkCover Queensland will cease on 30 November 2021.

Stakeholder feedback

We understand this represents a different way of working for private hospitals within the Queensland workers’ compensation scheme. As key stakeholders in this scheme, your feedback has been valuable and will help ensure we deliver a new process that meets everyone’s needs.

Two Open for Comment processes were held: one focused on the structure of the table of costs and the second focused on fees. The two-stepped approach allowed us to consider feedback on the structure prior to setting fees.

Step 1 - Open for Comment – table of costs structure

  • Commenced: Wednesday 17 February 2021
  • Closed: Wednesday 17 March 2021

Step 2 - Open for Comment - table of costs fees

  • Commenced: Wednesday 23 June 2021
  • Closed: Wednesday 4 August 2021\

Thank you for participating in our Open for Comment processes. Your feedback is greatly appreciated. Over the coming months we will continue to analyse feedback and refine the Private Hospital Services Table of Costs, ready for publication on 1 November 2021.

Resources

Contact us

If you have any questions please email us at communications@workcoverqld.com.au.