FEATURE: FUNDING FOR EXERCISE-BASED THERAPIES HOW CAN AUSTRALIA’S MEDICARE SYSTEM BE REFORMED SO THAT EXERCISE-BASED treatment that is not evidence-based. THERAPIES Physiotherapy should be able to argue for higher rebates for musculoskeletal ARE PROPERLY conditions that have been shown to respond to load-based management, FUNDED? such as GLA:D for osteoarthritis, but the higher rebates and higher number of visits should relate to delivering high-quality of government support. Physiotherapy rebates as a physiotherapist trying the exercise-based treatment, not passive and EP charges may be slightly lower implement the first 5 visits of the GLA:D treatment. Other Allied Health groups compared to SEM physicians and there program before the rebates run out. such as chiropractic and osteopathy also is somewhat of a presence in public have the capacity to deliver exercise- hospitals, but similar logic applies. The Allied Health option which based treatments, but typically deliver The highest quality (longer consultations is perhaps the easiest to reform is non-evidence-based passive treatments. one-on-one focused on exercise exercise physiology. There are particular Groups like COCA may be in a position programs) physios and EPs are not conditions, such as breast cancer and to break away from traditional fully subsidised by MBS and hence, depression, where treatment benefit has chiropractic and eventually use higher are services that higher socioeconomic been shown after a healthy number of rebates for exercise-based treatments, patients can fully access, but poorer EP consultations (often >5 visits). It is if these are successfully trialled by patients can’t. And for Patient X – a no-brainer to offer higher rebates and physiotherapy. The same political issue we need to keep repeating it – these more consultations specifically for EP that is dividing medicine may apply in are services that will increase her and specifically for these conditions. that the government may only agree survival from breast cancer which to increased rebates for the evidence- the government is not fully funding. Physiotherapy may be more suitable for based treatments if funding is cut for load-base treatment requiring subtlety. the non-evidence-based treatment. A problem with the funding for the Allied For knee and hip osteoarthritis, back pain, Health group under the MBS is that it chronic tendinopathy etc., the amount This brings me back to SEM itself. I’ve lost represents a vast array of practitioners of exercise that the patient needs to count of the number of times I’ve been and provides no quality differentiation do must be very carefully dosed by told that “SEM is not a real between them (either between type a practitioner who understands the medical specialty,” but let of practitioner, or within the group). biomechanics of that particular me recount the most An anti-vaccine chiropractor who claims condition. However, notable occasions that all of Patient X’s cancer, tennis elbow a good deal of physiotherapy and knee pain can be cured by “spinal practice involves passive manipulation” gets the same MBS 38 VOLUME 36 • ISSUE 2 2018 tniopflaH/segamiytteg