EnableNSWPAR Information Session

March 2013

Kathy McCosker – Business Services Manager

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• Fast Facts about EnableNSW PLS• Prosthetic Limb Service Tender• Funding Guidelines• ABF Modelling• Questions

Today

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PLS Fast Facts

In 2012 the PLS has assisted 2,570 consumers including:

• 1,370 minor repairs• 437 major repairs• 230 interim limbs• 129 primary limbs• 886 replacement limbs• 9627 consumable items

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Fast Facts

  2009/2010 2010/2011 2012/13YTD

Number received 162 260 291Total cost of received requests

N/A $ 514,945 $ 529,160

Percentage approved 79% 81% 79%Average processing time

2-8 weeks 14 days 7 days

Percentage requiring more information

N/A 65% 45%

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0

20

40

60

80

100

120

140

160

180

200

Foot Gel socks Knee Second prosthesis Terminal Device Other Silicone Variable cadence knee

Myoelectrics

Total

Total

Discretionary Requests by Type

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Discretionary Requests - Funding

0

20000

40000

60000

80000

100000

120000

140000

160000

Foot Gel socks Knee Second prosthesis Terminal Device Other Silicone Variable cadence knee

Myoelectrics

Approved Declined

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Discretionary Requests per month

0

5

10

15

20

25

30

35

January February March April May June July August September October November December

Approved Declined

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PLS Tender • Appointed a single PSP to each accredited public amputee

clinic to provide clinical support and interim limbs to new amputees

• Appointed a panel of PSPs to provide other amputee services including definitive and replacement limbs, associated repair services and supplies,

• Specialist paediatric panel and choice in PSP for upper limbs

• Maintained consumer choice for the manufacture of definitive and replacement limbs along with access to repairs and maintenance and consumable supplies.

• Provided PSPs with certainty regarding the volume of work that they will obtain for their business.

• New contract guidelines for both private and public PSPs have now been finalised and took effect on 1 February 2013.

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What are the changes?• Each public amputee clinic has one contracted PSP (public or

private) for interim limbs and clinical consultation services.

• The appointed PSP will assist with preparing prescriptions for interim, definitive and replacement limbs and can also provide repairs and consumable products. The PSP will provide advice regarding prosthetic needs independently of the consumer’s choice of PSP.

• Patients can then choose if they would like to use the clinic’s appointed provider, or select an alternative from the panel of PSPs, for all definitive / replacement limbs.

• The patient’s chosen PSP may communicate with the amputee clinic team to further clarify the prescription and discuss their prosthetic needs.

• Patients must be informed of their right to choose any provider from the Panel to manufacture their definitive/replacement limb.

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What are the changes?1. An Interim limb is defined as the first limb manufactured by a

prosthetist within the first four months following amputation.

2. A primary limb is defined as a first limb prescribed for an amputee outside the timeframe for an interim limb, that is, greater than four months post amputation. This can be in relation to time prescribed or time cast for limb. A primary limb is also defined as the first limb issued to an amputee for the provision of an approved second prosthesis i.e. adult second limb. These prostheses are generally approved after three months post amputation.

3. A definitive limb is defined as a replacement limb for either an interim or primary limb whereby both socket and components are replaced.

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Contract Management• To help the PLS maintain a high level of service and

to meet NSW Health’s obligations EnableNSW will seek feedback from each LHD on a regular basis on supplier performance and compliance under the contract specifications listed in the contract.

• An evaluation form will be available for completion by each LHD clinic to assist in monitoring PSP compliance with Key Performance Indicators (KPIs).

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Funding Guidelines• Updated and available on website at

www.enable.health.nsw.gov.au.

• Labour rate is set under the contract for 12 months.

• Components are funded from the standard components list and through the discretionary process – no change as a result of tender.

• Private accredited clinics were not included in the tender. Patients accessing PLS funding via a private clinic are managed through the contract arrangements for the PSP chosen to provide services.

• PLS does not fund interim limbs for private inpatients.

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ABF Modelling• Undertaking a systematic analysis of existing cost

and service use data on prosthetic limb componentry funded by EnableNSW

• Identify variables considered most relevant for incorporation in an ABF model for componentry.

• Develop a preliminary classification and funding model for prosthetic limb componentry including the use of silicone suspension.

• Prospective data collection to test classification

• Engage with industry in relation to activity based funding and silicone suspension.

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QUESTIONS?