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Private Hospital Services Table of Costs - FAQs

WorkCover Queensland (WorkCover) is focused on getting the best outcomes for our customers i.e. injured workers and Queensland businesses. Our priority is to ensure injured workers receive timely and quality medical and rehabilitation services to facilitate their return to work, at the right price for the employer.

As the main insurer for workers’ compensation in Queensland, we are also focused on maintaining the financial viability of the workers’ compensation scheme in Queensland.

In 2018, we started a review of our treating services model. Our medical and allied health expenditure had been rising  for a number of years with no substantial change in RTW outcomes. We conducted a jurisdictional analysis against comparable interstate schemes and private health insurers which identified the need for improvements in how we engage these services. This highlighted opportunities for us to optimise the current model for improvements in the quality, responsiveness, consistency and the cost of services.

We then undertook research and consultation with industry experts to explore several initiatives that would help us improve the efficiency and effectiveness of our current provider treating services model for better outcomes.

One of those initiatives included the review of our contracts with private hospitals within the workers’ compensation setting in Queensland.

Private hospital costs are a significant part of annual medical expenses for Queensland insurers.

Queensland insurers have indicated there are challenges with:

  • inconsistency in arrangements and fees
  • the ability to be responsive to emergent events
  • the lack of visibility to analyse and understand compliant to service delivery standards, and
  • the impact to BAU functions in maintaining existing arrangements.

Further, the approach of Queensland insurers to private hospital services differs to that of all other medical expenses within our scheme (i.e. these are regulated by a table of costs).

WorkCover will be introducing a table of costs for private hospital services focussing on four key areas:

  1. Day Facility Fees
  2. Overnight Facility Fees
  3. Theatre Fees
  4. Prostheses Fees (including handling fees).

These are inpatient fees covering surgical, other medical, advanced surgical, same day accommodation fees covering four bandings and type C stays, and theatre fees covering the Independent Hospital Pricing Authority (IHPA) theatre bands from 1A to 13.

These services cover much of the private hospital expenditure for Queensland insurers and align with the Private Health Insurance (Benefit Requirement) Rules 2011.

For psychiatric or multidisciplinary programs, WorkCover is proposing discrete specific contracts.

Section 217 of the Workers’ Compensation and Rehabilitation Act 2003 outlines the costs for which an insurer is liable for hospitalisation of a worker as an inpatient at a private hospital.  Specifically, 217(3) states WorkCover can limit the costs published via a gazette notice.

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

WorkSafe Victoria, the New South Wales State Insurance Regulatory Authority (SIRA) and ReturnToWorkSA all publish a private hospital fee structure (although it is important to note that each jurisdiction uses different terms e.g. rate order, fee schedule).

WorkCover is committed to introducing a table of costs for private hospital services. The proposed table of costs will focus on four key areas:

  1. Day Facility Fees
  2. Overnight Facility Fees
  3. Theatre Fees
  4. Prostheses Fees (including handling fees).

We value our existing relationships with all of our providers and will be seeking input and feedback through two public open for comment processes:

  1. the first focusing on the structure of the table of costs, and
  2. the second focusing on the fees applicable to those services.

The proposed table of costs will not cover psychiatric or multidisciplinary programs at this stage. Discrete specific contracts contracts will be considered separately for psychiatric or multidisciplinary programs.

Yes – the option for anonymous feedback is available.

However, if you have any specific concerns and you would like to discuss these, we encourage you to contact the Project Owner, Tanya Cambey on either phone 07 3006 6824 or email tanya.cambey@workcoverqld.com.au.

WorkCover is committed to five core customer strategy principles in all our interactions:

  • Fair and transparent
  • Empowered
  • Valued
  • Easy
  • Consistent

Any interested external party or stakeholder has the opportunity to provide feedback via the two Open for Comment processes.  All feedback is valued and will be considered in the design and implementation of a Private Hospital Services Table of Costs.

All information collected will be handled in accordance with the Information Privacy Act (2009). WorkCover will collate and consider all feedback received and the information will only be used internally to inform future strategy and design decisions relating to the Private Hospital Services Table of Costs initiative. Any submissions or feedback received will not be published on our website.

WorkCover will be implementing a Private Hospital Services Table of Costs effective 1 December 2021.

Current contracts held with WorkCover will be honoured through to the agreed end date. Any contracts that may expire prior to the proposed implementation date (i.e. 1 December 2021) will be reviewed and negotiated on an individual basis with all contracts finishing in line with the proposed implementation date (i.e. 1 December 2021). WorkCover has contacted all current contract holders and advised them of the initiative.

We have a few broad categories of table of costs:

  • Medical - covering MBS Items;
  • Allied health – this is broken up into specialties (e.g. physiotherapy, chiropractic, occupational therapy);
  • Public hospital – structured using Diagnosis Related Grouping (DRGs)  as agreed with Queensland Health;
  • Supplementary – covering extra reports and communication fees for GPs and specialists and our custom MRI items.

These table of costs are available on our website.

Yes, you will be bound by the Private Hospital Services Table of Costs. However, you can choose to enter into contracts with specific providers to pay more than the identified fee within the table of costs if your business needs dictate this.

WorkCover has yet to determine the fees that will apply for the identified services (this will form part of the second Open for Comment process). However, given research and analysis done to date, it is not anticipated that there will be a differing fee structure for metropolitan vs regional hospital facilities.

No. WorkCover is not exploring partnerships with hospital providers at the current time.

WorkCover is proposing to target four key areas in the Private Hospital Services Table of Costs:

  1. Day Facility Fees
  2. Overnight Facility Fees
  3. Theatre Fees
  4. Prostheses Fees (including handling fees)

as these services account for the majority of costs associated with private hospital expenditure for Queensland insurers.

Discrete specific contracts will be considered separately for psychiatric or multidisciplinary programs with an increased focus on outcomes for workers.

The proposed structure is based on the Private Health Insurance (Benefit Requirements) Rules 2011 and also mimics the current structure within financial agreements. WorkCover considers this approach will have the least impact on resources and stakeholders.

No. WorkCover is not pursuing a tender arrangements for the provision of private hospital services at the current time.

The second Open for Comment process, focused on fees, is expected to run for four weeks from June to July. Exact dates are yet to be determined. This FAQ will be updated once dates are confirmed.

WorkCover reviews all Medical Table of Costs annually with changes applying from 1 December each year. The Private Hospital Services Table of Costs will form part of this process. The Private Hospital Services Table of Costs will be maintained in a similar manner to our current Medical and Allied Health Table of Costs with annual and/or interim reviews. This would ensure fees and services are in line with relevant industry and economic factors such as CPI and wage indexes.

WorkCover has taken on board the initial feedback from stakeholders regarding the potential impact of the MBS Taskforce findings and the timing of the Private Hospital Services Table of Costs implementation. WorkCover is committed to continuous improvement and will undertake a post implementation review, including the collection of stakeholder feedback. This is currently being considered for mid-2022.