NDIS Reforms

Allied health clinic owners: avoid chaos by focusing on strategic constants in a time of rapid change

David Kinnane · 20 November 2024 · Leave a Comment

Big picture:

In Australian markets for private allied health services, things are a bit all over the place at the moment:

Some clinics have closed, while new ones launch, and others aggressively expand.
Some clinic owners are going all in on the NDIS and future Foundational Supports, while others are reducing their NDIS work and looking to other markets.
Some clinic owners read every government announcement and paper, then scramble to adapt, while others wait to see what will happen.

Behind the scenes:

Each allied health clinic owner has to decide for themselves how best to respond to rapid changes, including:

new funding realities associated with pricing limits, more-limited NDIS supports, and (as yet undelivered) Foundational Supports;
potential increased professional regulation, e.g. flagged in the Scope of Practice Review and NDIS registration taskforce reports;
changed market dynamics, including frozen price limits and cost of living pressures;
government disability, health and education system overlaps and gaps;
shifting consumer preferences; and
technological advances, like telehealth and AI.

The problem:

“Agility” is a terrible business buzzword. But it’s almost impossible – and dangerous – to try to keep up with every change while running quality practices, helping clients, and managing a team. Attempting to respond to every change:

spreads limited resources too thinly;
weakens the focus on core competencies;
lures us into chopping and changing what we do without enough thought;
fosters a focus on short term opportunities and quick returns; and
can lead to organisational chaos, as we attempt to realign operations, processes, staff and culture to ever changing goals.

A solution:

Filter out transient factors, and instead re-commit to strategic constants, including:

core values;
client relationships;
key competencies; and
brand identity.

Case in point:

When Netflix transitioned from DVD-mailing to streaming, it understood that its key competitive value was derived from its core offering – delivering great content to customers – not from how it did it. This enabled it to make a major change to service delivery while staying true to its mission.

Zoom in:

Liao and Zhu (see link below) recommend a 4-step process for creating a strategically constant business in a time of rapid change. Paraphrased for allied health business owners, our key takeaways are as follows:

Start at the end: What’s your mission? What broad objectives can you set to achieve it in any market conditions?
Identify your strategic constants: What factors are relevant today and are likely to continue to be so in the future?:
1. Demand: The needs and preferences of your clients, e.g. for quality services, safety, convenience, and reputation.
2. Supply: Operational efficiencies, e.g. from workflows, delivery systems, and continuous improvement process in service delivery.
Match constants to capabilities: Review your strengths. Focus your strategy either on your demand or supply constants (not both to start with or you’ll lose focus and run out of resources).
Adapt around constants: Use your constants to set the boundaries for your decisions about how best to adapt to changes, including which services to offer, and which technologies to adopt.

Bottom line:

To create both stability (to take advantage of past successes) and agility (needed to evolve to exploit new opportunities related to your mission), clinic owners should review their business strategy and objectives to identify and prioritise strategic constants, while staying flexible about how to adapt to regulatory, market and other changes.

Go deeper:

Liao, J. and Zhu, F. (2024). How to Avoid the Agility Trap, Harvard Business Review, November-December issue.

Allied health providers: get up to speed on the key NDIS reforms that will affect your practice (a free resource)

Allied health NDIS providers: back yourself to try new things, and help more people: a case study

Paediatric allied health providers: let’s tackle our NDIS worries by improving our services, bit-by-bit, and monitoring general reform trends

Will NDIS reforms and foundational supports trigger the end for many paediatric allied health clinics?

Blood from a stone: What allied health NDIS providers can do to improve their lot

How will allied health NDIS providers survive? Some difficult choices ahead

Allied health providers: get up to speed on the key NDIS reforms that will affect your practice (a free resource)

David Kinnane · 2 October 2024 · Leave a Comment

Allied health providers: get up to speed!

NDIS reforms are accelerating (at least 10 announcements in the last month alone), and it’s hard to keep up while running a business. We’ve made a free video to help.

State of play:

Risks and opportunities
Key events and reforms
Potential implications

Sign up here:

Allied health NDIS providers: back yourself to try new things, and help more people: a case study

Paediatric allied health providers: let’s tackle our NDIS worries by improving our services, bit-by-bit, and monitoring general reform trends

The Government’s Draft List of Allied Health NDIS Supports: What’s In; and What’s Out

NDIS regulatory changes are coming. Allied health providers should stick together to advocate for choice and control

How will allied health NDIS providers survive? Some difficult choices ahead

Therapy Support Providers: Frozen pricing limits and shorter notice cancellation rules. What was the NDIA thinking?

Paediatric allied health providers: let’s tackle our NDIS worries by improving our services, bit-by-bit, and monitoring general reform trends

David Kinnane · 12 September 2024 · Leave a Comment

Many paediatric allied health providers are taking a wait and see approach with NDIS reforms.

We get it.

In just the last few months, we’ve faced:

disappointing news about frozen pricing limits;
the sudden passing of the new NDIS Amendment (Getting the NDIS Back on Track No.1) Act, which will will come into effect on 3 October 2024, with many new rules to come;
a very short consultation about proposed transitional rules around “in and outs” for NDIS supports;
conjecture about whether registration will become mandatory and, if so, whether existing professional registrations and certifications will suffice;
uncertainty around the implications of a new Foundational Supports regime; and
sometimes unfair media and social media criticism, including wild generalisations about the motives and ethics of providers based on the poor behaviours of a few bad apples.

All this VUCA – volatility, uncertainty, complexity and ambiguity – can be paralysing. And it’s not as if we have a lot of spare time to ponder or plan for it all while supporting participants, families, and staff through difficult business conditions.

But, even if you’re not up for a full service delivery review right now, there are plenty of small things we can do – or at least start – to improve participant safety and service quality for the people who matter most: participants and their families.

A. Taking small, positive actions can increase your sense of control in uncertain times and improve our care and services

Here are some simple quality improvement ideas we’ve extracted from the NDIS Quality and Safeguards Commission’s recent Quality support for children guide:

Improve families’ confidence in your team

Ensure your register of Working With Children Checks on all staff is complete and up to date.
Even if you are an unregistered NDIS provider, have your team complete NDIS Worker Screening Checks. (It seems likely these checks will become mandatory for most staff who interact with people with a disability.)
For each of your professional staff, run annual checks of the AHPRA registration and/or membership status with the NASRHP member peak bodies (as appropriate).
Double check the currency and adequacy of your professional indemnity insurances and the status of insurance arrangements for each professional staff member.
Train all staff, in detail, on the NDIS Code of Conduct and remind staff they must abide by it. (This Code applies to both registered and unregistered providers.)
Consider incorporating the NDIS Code of Conduct and professional Ethics Code requirements into your existing organisational Code of Conduct so the key expectations are set out in one place.
Review the NDIS Early Childhood Support Standards for early childhood support. (Although these apply to registered providers, there is no reason quality unregistered providers shouldn’t understand and comply with them.)

Improve client decision-making supports

Train (or refresher train) your staff to communicate with children in a range of ways that clients prefer, including through the use of assistive technology, augmented and alternative communication, and visual supports.
Review the strategies and set-ups you use to support children to feel safe and calm in your workplaces.
Think about how you can better support children to speak up when they are unhappy, uncomfortable or feel unsafe when working with your practice.

Enhance client privacy and dignity

Review spaces for safety and ensure confidential conversations happen in private spaces.
Review and communicate your privacy policy and confidentiality arrangements to families in an accessible way.
Always ask for consent to share information with others and remember that consent can be withdrawn.

Improve client safety

In addition to Working With Children Checks and NDIS Worker Screening clearances, make sure staff are trained at least annually in CPR/first aid.
Institute a plain English Incident Management System. (For unregistered providers, benchmark the policy to requirements of the NDIS rules.)
Make sure your team members are trained about the laws relating to restrictive practices as they apply to your supports and practices.
Review your emergency and disaster management procedures. (For unregistered providers, benchmark them to the standards required of registered providers.)

Improve transparency around competence

Review and explain to families the scope of services you provide (and don’t provide), your qualifications to provide them, the associated costs, risks and benefits, and the expected timeline for supports.
Increase the transparency of your disclosures to clients around staff qualifications and experience.
Explain staff supervision and training arrangements to clients (and the public).
Review and update your referral policies for when the services sought are outside of qualifications and experience. (Make sure there are no secret commissions or conflicts.)
Review your Complaints Management System Policy. (For unregistered providers, benchmark it to the level required of registered providers under the NDIS rules.)

Improve the integrity, honesty and transparency marketing materials

Review your marketing materials to ensure they are up-to-date, accurate and honest.
Be clear about what families can expect and your terms of service: the who, what when, where, why and how much.
Train your team to ensure that no one engages in “hard selling” practices or plays on family fears, e.g. around service scarcity and waitlists.
Review the accessibility of consent forms and processes to make sure they are understood.
Restate how you manage and avoid potential conflicts of interest.
Increase the quality of your written reports, based on evidence-based assessments, that can be shared with families and other professionals working with clients.
Do what you say you will do in a timely way – including revisiting policies on your timeframes for reports.

B. All too much right now? At least keep your eye on these 7 bigger themes

If you’re still intent on a ‘wait and see’ approach, at least pay attention to key themes underpinning many of the proposed reforms. Watch the following general trends because they are likely to affect your business planning and service delivery models in the longer term:

A focus on providers working more collaboratively with the family and the rest of the client’s support team – not in isolation – including with regular team meetings.
An emphasis on using evidence-based functional assessment tools to measure baselines and progress more rigorously.
More focus on goal-setting with families, skills measurements, and outcomes that promote increased participation.
A general preference for delivering supports in homes, in the community, and in education settings.
More direction to providers to:
- provide strategies and tools that enable young children to take part in play, daily activities and routines (rather than doing therapy at the expense of play, rest and social opportunities); and
- coach family members, educators, and support workers to use evidence-based strategies in real world situations.
An expectation that providers will honestly and transparently:
- discuss supports that are unlikely to be funded by the NDIS; and
- help families find other ways to get help, e.g. through mainstream or community services.
A policy objective of reducing conflicts of interests and duplication of functions as part of proposed transition to “navigators”.

Bottom line

In the short term, allied health NDIS providers – including sole traders – should take small, incremental actions to ward off fears about the future of the NDIS, and increase service quality and safety standards and to improve our supports for participants and their families.

We should also start thinking about strategies to build tighter collaborative networks with other providers, deliver more services in home, school and community settings, increase the rigour of functional assessments and outcome measures, and, ultimately, eliminate over-reliance on NDIS-funding to secure our long-term success.

NDIS regulatory changes are coming: allied health providers should stick together to advocate for participant choice and control

David Kinnane · 2 August 2024 · Leave a Comment

For allied health NDIS providers, significant regulatory changes are coming:

The Independent NDIS Review recommended significant reforms, including the development of a risk-proportionate model for the visibility and regulation of all providers (including us).
An NDIS Provider and Worker Registration Taskforce is providing advice to the Government on how to deliver it.

Uncertainty abounds. We don’t know what the new rules will look like. We don’t know how they will apply to allied health providers.

At the same time, we’re grappling with pricing limits, worker shortages, inflation, and other business risks. It’s no surprise that many of us complain about upcoming regulatory changes in terms of mandatory registration, increased compliance costs, and more red tape.

The danger of all this negative talk about costs and risks is that it sounds defensive and even self-indulgent. But, when it comes to regulation, allied health providers have an overwhelmingly positive story to tell and an important role to play in advocating against changes that could reduce NDIS participant choice and control in the real world.

Allied health professionals are already well-regulated. Most allied health providers work hard to deliver evidence-based supports to participants, and to improve their service quality in response to participant feedback. Like participants, we want the NDIS to work. We want the NDIS to deliver for participants.

What do we want?

We want participants to have more choice and control over the supports they purchase and the providers they work with. We want the NDIS to be safer for participants. We want the NDIS to be sustainable. We want the NDIS to be cost-effective for participants and taxpayers. We want to stamp out abuse, fraud and other criminal, unethical and bad behaviours. We want more innovation, competition, and investment to increase productivity, service quality, value for money, and options for participants.

What do we not want?

We don’t want to return to the bad old days of pre-NDIS block funding with no participant choice or control. We don’t want market failure caused by a lack of providers. We don’t want anti-competitive behaviours or markets dominated by a few big providers. We don’t want more thin markets or market failures. We don’t want to drive quality providers out of business with increased compliance costs that are disproportionate to the risks or the size of their activities.

We’re arguing with each other about the wrong things, based on wrong assumptions

In the wider provider sector, too much time and energy is expended arguing about the pros and cons of registered versus unregistered NDIS providers, and their eligibility to deliver different support types to participants. Generalisations infect the debate on both sides.

Despite the work of the NDIS Provider and Worker Registration Taskforce to allay concerns, some providers assume that mandatory registration will mean the imposition of expensive quality compliance processes and external audits on all providers. Some assume that participants want to work only with registered providers; or that unregistered providers are unregulated cowboys and girls; or that the services of registered providers are guaranteed to be safer and of higher quality than the services of unregistered providers. All these assumptions are false.

Key points we need to communicate better to participants, the Government, and taxpayers

Allied health providers are a diverse bunch. Some of us are big, multidisciplinary, multisite practices, and some of us are part-time sole traders offering mobile services. Some of us are 100% disability-focused, while others provide services to participants and people without disabilities. Some of us work in clinics, while others work in participants’ homes, in schools, workplaces, and a whole range of community and other settings.
Allied health professionals are already well-regulated. For example:
- Practising physiotherapists, occupational therapists and psychologists are regulated by the Australian Health Practitioner Regulation Agency (AHPRA) in partnership with each profession’s National Board and are subject to AHPRA standards.
- Certified practising speech pathologists, dietitians, exercise and sports science practitioners, and audiologists are regulated by their professional peak bodies who, themselves, are members of the National Alliance of Self Regulating Health Practitioners (NASRHP), and therefore subject to NASRHP standards closely modelled on AHPRA standards.
- All these allied health professionals are subject to standards on scope (areas) of practice, codes of ethics/practice and/or professional conduct, complaints procedures, competency standards, course accreditation, continuing professional development, English language requirements, mandatory declarations, professional indemnity insurance, practitioner certification and recency and resumption of practice requirements.

All allied health providers delivering NDIS-funded services are regulated by the NDIS Quality and Safeguards Commission to some degree:
- Some allied health providers are registered with the NDIS Quality and Safeguards Commission, including some of the larger providers, and providers who provide behavioural supports and/or use (high risk) restrictive practices. Among other things, registration involves providers implementing quality compliance processes to meet NDIS Practice standards and undertaking regular external audits. (In practice, it is time consuming and expensive for providers to get and maintain registration.)
- Some allied health providers are not registered with the NDIS Quality and Safeguards Commission, including many sole traders, other small providers, and providers who offer their services to both NDIS participants and other clients, and/or service mixes that include disability specific services and other services. These providers are often referred to as “unregistered providers”. However, they are subject to the NDIS Code of Conduct and can be fined and banned by the regulator.

All allied health provider services are subject to the Australian Consumer Law, including consumer rights and guarantees.

Many participants prefer to work with (generally smaller) unregistered allied health providers or a mix of providers. For example, Professor Helen Dickinson and her colleagues found that many of their interviewed participants spent funds on allied health services and that, “while many allied health providers and therapists are not NDIS registered, these providers typically hold registration or accreditation with their appropriate professional bodies…[and] that NDIS registration would not provide any additional level of safety or quality”.

The evidence from the Royal Commission was clear: registration doesn’t guarantee safety. As Disability Sector Leader Dr George Taleporos states in no uncertain terms: “Registration does not keep people safe.” Dr Taleporos has also warned of several possible adverse consequences of mandatory registration, including service shortages, reduced competition, and less choice and control for participants.

Best world outcomes

If things go well, we’ll end up with:

a proportionate and graduated regulatory system that takes into account the diversity of allied health provider businesses and services and their existing regulatory frameworks;
clear rules that don’t conflict with or duplicate existing rules;
a minimum of red tape so we can focus our limited time and resources on service delivery to participants and improving quality;
clear communication of the rules to everyone affected;
external monitoring of compliance with rules;
enforcement when noncompliance is identified;
proper adjudication of disputes about regulator decisions;
sanctions for non-compliance; and
continuous evaluation and adjustment of the regulatory system as things change.

Final thoughts

For many allied health providers, the real debate is not about mandatory registration, but about what ‘registration’ will actually mean under the new rules for different allied health providers. To make decisions about the future of our businesses and disability services, we need to know how much it will cost to comply with new rules, how long it will take to obtain registration (whatever that means for a given provider), and how much time (and how many management and worker resources) will be needed to maintain it. An important open question is whether, under the new system, price limit controls will extend to services purchased by self-managed participants.

The devil will be found in the details. If the government gets this wrong, we’ll see an exodus of allied health providers from the sector, reducing participant choice and control over who they work with for their supports.

Allied health providers should engage with participants to ensure this doesn’t happen.

Breaking (potentially good) news update

As so often happens, immediately after publishing this article, the NDIS Provider and Worker Registration Taskforce published its Advice. While this will take some time to read through in detail, a quick read of the registration recommendations looks promising for allied health providers:

For AHPRA-registered allied health professionals (such as physiotherapists and occupational therapists), the Taskforce has recommended that the registration by AHPRA be recognised as registration for the purposes of NDIS where this can be achieved. (This recommendation is in relation to registration only and does not apply to worker screening.)
For self-regulated allied health professions whose peak bodies are members of NASRHP (such as speech pathologists and dietitians), the Taskforce has recommended “consideration be given to the appropriateness of extending a recognition of those registration schemes to self-regulating allied health professionals, noting that any such assessment would need to consider the requirements of the self-regulated environment and other relevant matters”. Again, this recommendation is in relation to registration only and does not apply to worker screening.

If this advice is accepted, it has the potential to considerably reduce the regulatory burden associated with reporting to two regulators (e.g. the NDIS Commission and AHPRA/peak bodies) and to streamline the process for practitioners. As the Taskforce notes, “it would remove the main barrier to registration which has been raised with the Taskforce by allied health practitioners who are currently not registered NDIS providers”.

But, of course, a lot will depend on specifics, and the Government’s response to the recommendations.