Private Health Insurance Reforms and Pilates

You may have heard via social media, news or even received information from your health insurer that there are about to be some changes to the way that Private Health Insurance companies fund natural therapies, including Pilates.

The review was undertaken by the NHMRC (National Health and Medical Research Council) which is the body that selects and funds research into areas that will be beneficial for public health, but that requires government funding rather than Private or Industry funding (as distinct from Big Pharma etc). The review was part of a series of reforms ordered by the Turnbull Government in October 2017 to reduce the cost of Private Health insurance, making it more affordable for more of the community.

The reforms included:

Allowing Insurers to discount premiums for 18-29yo by up to 10% (meaning younger, healthier people are not subsidising care for older people with more health concerns)
An agreement with Medical Technology Association of Australia to reduce cost of medical implants
Allowing people to select a higher excess to lower premiums
Changing coverage for the listed natural therapies to ensure taxpayer funds (since the government subsidises Private Health Insurance) are not directed to therapies that do not demonstrate evidence of clinical efficacy (i.e. there’s no evidence that they are more effective than placebo).

All of this is intended to reduce the cost to the consumer either by directly reducing the cost of premiums, or by reducing the cost of claims to the insurer, which are then passed on to the consumer as higher premiums. (Whether this actually does reduce costs to us, the consumer will remain to be seen…)

As part of these legislative changes, Pilates and yoga have been identified as services that will no longer be funded by health insurance (and the wording of the legislation means that it doesn’t matter who provides these services.)

But that doesn’t mean you can’t continue with your “Pilates” treatment at Como Physiotherapy….
But Pilates fixed my Back Pain, how can they say it doesn’t work?

Recent reviews of ALL of the exercise programs for Chronic and Acute low back pain (and other injuries but let’s start there) have suggested that it doesn’t really matter what type of exercise you do, just that you do it regularly. What this means is that there isn’t one type of ‘magical’ exercise that will cure all that ails you, and many different exercise types can be highly beneficial in the treatment and management of low back pain (and other issues).

So, ultimately, it does work. It’s just not magically better than any other exercise program that is administered by a qualified movement expert. And THIS is the most important point… this doesn’t mean that your back pain is going to be just as well managed doing Pilates with a physiotherapist as going to do F45 with a personal trainer, or even Pilates with a personal trainer / pilates instructor – the key difference is in the appropriate selection and graduation of the exercise program by a professional who understands your injury, your life situation, and what best fits your needs for progressively loading your system until there are no more barriers for you getting back to doing the things you love. I mean, that’s why you come to a physio, right?

The reason that Physiotherapists (and we at Como Physiotherapy) have jumped on to the system of movement, breathing, and exercise that is informed by the Pilates Method is that it offers a beautifully rich and varied environment for challenging a patient’s body. Traditional exercise therapies can be a bit one dimensional, only training the body in limited directions and situations. This, I think, is why Pilates style exercises DO show superior improvements (for back pain) in the short term (see here as an example) – because they expose people to greater variety, richer context, and reduce fear of movement faster. In the long term, however, we get “wash-out effect” in the research, where it doesn’t seem to show long term which type of exercise is more beneficial, just that appropriately prescribed exercise by a suitably qualified movement professional is highly beneficial.
So why has the Government removed funding for Pilates then?

Even in high quality research run by experienced Physiotherapists (who have university degrees of 4-5 years and years of experience managing pain and injury with exercise prescription) the results show that Pilates may be superior to other forms of exercise in the short term, but not in the long term. (Exercise is far and away superior to no exercise in the management of pain remember). However, only a fraction of the Pilates classes on the market are run by such expert practitioners. Many Pilates instructors will wax lyrical about how their course required hundreds of hours of teaching and instruction, however this still does not make them a physiotherapist. A physiotherapy course (even undergraduate) is closer to 3600 hours conservatively, and then add the years of experience and professional development required to stay registered, and it becomes obvious why you can’t compare Apples to Oranges, so to speak.

This means that the Private Health funds have (rightly) cut funding to all Pilates classes, because they have no way of regulating whether you are getting high-quality, evidence-based exercise and rehabilitation therapy, or simply another exercise class.

At Como Physiotherapy, we support this move as it demonstrates that the government values high value treatment provided by qualified professionals and differentiates these services (such as ours) from other exercise services from less qualified instructors.

In the long run this “should” mean that both the Government and the Insurance companies are paying out less money for services that are have little scientific support in the management of Pain, Injury, or health-conditions. By paying out less money, this puts downward pressure on the continually rising cost of maintaining your Insurance policy. (whether or not it does is another story)…
The Good News

In a recent message from the Australian Physiotherapy Association, we have been informed that we (Physiotherapists) will still be able to offer our patients Pilates Informed rehabilitation and exercise that IS STILL COVERED by Private Health Insurance, because (as the Government agreed) “Physio is still Physio” – meaning that whether your Physio decides that the best treatment for you are exercises from the Pilates repertoire, exercise in a pool, in a gym, or a walking program, this is still within the evidence-based scope of practice of your physio. You can still receive Pilates-centric exercise intervention run by a qualified physiotherapist, and use your Private Health to rebate this, legally.

However, to ensure that the public are not confused by the difference between evidence-based care and lower value interventions that have no scientific backing, we are no longer able to use the name Pilates when we refer to therapeutic exercise classes.

This may be a little confusing for current and future clients who wish to “do Pilates” for their back pain. Rest assured that we will still be offering high quality, physio supervised exercise treatments, we just won’t be calling it “Pilates” anymore. In reviewing our exercise and rehabilitation services recently, we came to the same conclusion that simply calling these services “Studio Pilates” does not reflect the true value or quality of care we provide. We have referred to these services as Studio Pilates for many years mostly because it is easy for our patients to understand and for branding. However, we believe that the clinical exercise and rehabilitation services we offer stands well above “simply Pilates” and as such we have decided to now refer to these services as Clinical Exercise and Rehabilitation.
What it DOESN’T mean

It does not mean that Physios can’t teach Pilates or are not allowed to teach Pilates.

We can still run Pilates classes, and call it the same thing, but you wouldn’t be able to claim it on your Private Health Insurance.

However, as we feel our patients deserve to use their health insurance for such a fantastic treatment as targeted exercise, we will continue to provide the same high quality, Physiotherapist-led exercise and rehabilitation services under the banner Clinical Exercise and Rehabilitation.

These health insurance changes all take effect as of April 1st, 2019. However, HBF has announced publicly to their members that they will be implementing all the changes from January 1st. We will be sure to keep all our clients up to date with any further changes or updates, but rest assured you are still able to continue claiming for our exercise and rehab services with your physiotherapist as you have been before.

The Como Physiotherapy Team.

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