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Personal Submission their submission

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Posted 22 March 2005 - 09:23 PM

September 2004

Injury Prevention, Rehabilitation and Compensation Amendment Bill No 3)

To The Health Committee

On The Injury Prevention, Rehabilitation, and Compensation Amendment Bill (No 3)


This submission is from *********************. My telephone number is *********** however my email address is: *******************

General Position:

Unfortunately ACC legalisation continues to be complex and is beyond the understanding of the ordinary citizen. The aim is to make the ACC scheme (hereafter known as the scheme) fairer and is certainly something that is needed now! Clearer and fairer would be to the betterment of the New Zealand people. This Bill fails to address the basic wrongs of the scheme and does not even live lip to the Bill's title when mentioning injury prevention.

Advertising Budget for ACC:

ACC is a monopoly the most recent advertising placed in the newspapers on or around the 28 May 2004 was a waste of money. Each full-page advertisement cost around the $9,000 mark which is the amount that some beneficiaries and "Non-Earners" live on per year. I found the waste of money to be abhorrent and extravagant, what was the message to the public? I thought the woman who had her head stitched up probably had a case for medical misadventure as her stitching was so badly done. Please do not insist that it is just advertising it was supposed to be as real as possible and that is what ACC had called for when ordering the advertisements. "A stupid costly mistake by a monopoly" is how many saw the campaign.

Privacy Issues and the Initial Form ACC45:

An ACC 45 is the first form you fill in when you need treatment for an injury. Many people who have signed ACC 45 would not even know that they have signed any sort of declaration, the form is structured to look like you are signing to agree with what you have just written.

This is not so as you are actually agreeing to the following "Patient Declaration" which is on the back of the page in yellow it states:
I declare
    that the information given in this form is true and correct and that I have not withheld any information likely to affect my application. I will inform ACC of any changes in circumstances which may affect my entitlements.
I authorise:
    the collection and release of any information about me to the extent that this is needed to prevent future injuries determine cover and/or assess my entitlement to compensation, rehabilitation assistance, medical treatment and/or the appropriate level of care and personal attention that I should receive.

    the treatment provider to lodge this claim for me.

    Injured people especially those in severe pain should not have to deal with complicated privacy issues and it is unfair to expect them to do so. The injured person or the authorised representative dealing with forms are filling them out quickly so that the medical professional can get on with the job of assessing the problem. In return the patient is signing away his or her privacy rights mostly without the patient's knowledge.

    Access to Treatment for the Injured Poor of New Zealand:

    To understand how the scheme fails New Zealanders, you need to look at the people who use the scheme and the different ways in which they are treated. The new bill does nothing to change existing legalisation that has created a climate within the Corporation that allows acutely injured people to become disabled These people are known as "Non-Earners" The "Non Earners" hereafter known as the "Injured Poor" suffer not only from their injuries but they are denied access to health professionals for treatment because they do not have the money to pay.

    The Injured Poor are a socio-economic position and many of them are Beneficiaries. They are the poor of New Zealand's society existing on income on average $11,000 a year depending on circumstances and type of benefit (see Appendix A: Benefit Rates from Ministry of Social Development).

    The ACC does pay something towards the treatment of these people but even ACC realise that the amount is not enough. (See Appendix B). It is the surcharges that are a financial burden. Almost all G.P's invoice patients with either a co-payment or surcharge; it is the same for a consultation to see a Physiotherapists and Chiropractors. Nineteen dollars does not cover the cost of treatment but $19 is all ACC will pay towards treatment.

    The Injured Poor have few choices:
  • They turn to WINZ but that department does not pay for ACC related costs.

  • They make arrangements to pay off the extra amount per week and that may include G.P. fees other Health Professionals fees and the After Hours Surgery.

  • The same arrangements are made to pay off prescription costs to the Pharmacy. Medication is an area that is difficult to understand sometimes the patient's medication will be paid for by ACC and yet other person does not have access to that privilege. It seems to be a privilege.

  • Patients' go back to the Hospital for treatment instead of using their G.P.

  • Most poor people do not have the money and hope that the injury will right itself and don't seek medical advice.

  • Find Medical Professionals that do not charge surcharges. This is rare and even Family Planning has a two week wait.

This Bill seeks to make the system fairer:
  • Poor New Zealanders deserve to have their injuries funded by the ACC system.

  • The ACC 45 declaration needs to be on the front of the form.

  • People need to be provided with the resources to engage in dispute with ACC so that they arc equal to the unending onslaught of the Department.

  • Too many small mistakes are being made at the Case Worker level and that is costing the New Zealand tax payers money in the Courts.

  • It is totally unfair to dump ACC people onto the WINZ system

The ACC System;

The ACC system makes the Work and Income system look good. Work and Income can be self advocated where as Lawyers who specialise in ACC law negotiate the ACC system. We should be looking at making the system simpler so that Lawyers become the last resort. New Zealanders should not be losing their homes so that they can fight the injustice of the system.

It is a waiting game the system always has the upper hand many times I have seen someone finally win something only to be brought back into the ACC office for something else. For the Department it is never over. The people involved don't have the resources or the energy to engage in dispute with ACC. This is unfair.

ACC 45

I object to this form because of the following in Part C: Patient Declaration, which is on the bottom left hand comer, encompasses 2.5cm. This area you sign stating that you have read and understood the important Patient Information and Patient Declaration".

Where is that information? On the back of the form! Surely such important things should come be on the front of the document.

It is a time of great stress and the ACC system takes advantage of this by producing a form with a patient declaration on it. ACC now has great power that power is provided by your information.

Access to a user friendly form is imperative. The form is grey and yellow which a terrible colour for visually impaired people. The patients' declaration should come with information from the Privacy Office.

Advertising Budget

I see no reason or need for ACC to have an advertising budget. Money should be spent on people, their injuries and information about entitlements. ACC lags behind Work and Income New Zealand (WINZ) in this respect. WINZ has comprehensive information available in pamphlet form displayed hi the public waiting area where as ACC displays nothing of this kind for their clients.

Access to the Health System

The government is discrirninating against some people who are in the "Non-Earners" low socio-economic group by pulling in place financial barriers so that members of that group is unable to access health care funded by the government. Poor people should be able to access the Health System for their injuries.

If you are serious about acute injuries not becoming disabilities then I propose that all people who have a Community Service Card be made exempt from co-payments and surcharges.

Changes to the ACC System

A person has the right to all records held by ACC but receives little real information in the way operational reports. All reports from Health Professionals are sent to the ACC Case Workers and then decisions are made. If the wrong information goes to ACC then the wrong decision is made. The person is totally unaware of what is going on until the decision letter arrives. If things are wrong for instance the report states you are in a wheelchair and you are not (mistakes) then the decision has to be reviewed it gives the author of the report no chance to recant any mistakes and the Case Manager has to go by the Health Professional's report. Cases end up in review on account of small mistakes. The review process is lengthy and has a long waiting period.

I would like to see reports automatically sent to Claimants after all it is the Claimants information. Then a period of grace perhaps three weeks allowed before the Case Worker uses the report makes a decision. This way any obvious mistakes can be altered before review. It can be simple mistakes that stop people having access to equipment, again an acute injury changing into disability. I see this a preventative measure.

ACC Support Network of Groups

It is imperative that the support groups receive finding for the work that they do on behalf of New Zealanders. I believe that all funding should be separate from ACC. The support and help that people receive is of top quality. Self help groups arc necessary as only they can understand what the person is going through and their help is necessary when putting together all the information that goes before ACC.

ACC I Work and Income Relationship

If ACC decides that someone is no longer going to be on ACC payments the next choice for that person is WINZ. If WINZ can't help you then the next step is the street. The Social Development ministry is responsible and the Sickness/Invalids benefit statistics increased. WINZ are more likely to be empathetic towards people being cut from a benefit because they are probably going to see that people again. Someone within WINZ will have to deal with the problem.

ACC has been described as having no heart and even less responsibility and WINZ is their back stop. I believe that it is totally unfair to lump ACC people onto the WNZ system. If that person has a documented long term injury and has ended up on a benefit that the Ministry of Social Development should be allowed to recuperate the cost of that persons benefit from ACC.

Appendex A

Appendix B
Section 1

Chiropractor Services

Brief Description
Chiropractic treatment is concerned with the diagnosis, treatment and prevention of disorders of the musculoskeletal system, and the effects of these disorders on the nervous system and general health. This treatment emphasises manual treatments, including spinal manipulation. Some chiropractors also use radiology for diagnosis, and physical therapy and nutrition for treatment.

ACC pays for chiropractic treatment through the Accident Insurance (Insurer's Liability to Pay Costs of Treatment) Regulations 1999 (the Treatment Costs Regulations). In order to claim for payments under the regulations, chiropractors must be registered with the Chiropractic Board and hold an annual practising certificate under the Chiropractors Act 1982. Chiropractors, to claim for the treatment they provide, must register with ACC as a treatment provider.

Service Items
ACC has no contracts currently established with chiropractors.

Under the Treatment Costs Regulations, ACC pays $19 per consultation (as specified in
Item 249 of the Schedule to the Treatment Costs Regulations).

Alternatively, chiropractors can elect to be paid at $47.30 per hour (or less if they normally charge a patient less).

ACC pays $15.30 per film for X-ray services provided by a chiropractor, up to two films per claimant per injury. (See Item 250 of the Schedule to the Treatment Costs Regulations.)

These payments by ACC under the regulations are not set at the full price paid for the treatment and chiropractors are able to seek further payments (often known as co-payments) from claimants that they treat.

Provider Reports
No standard reports are required from chiropractors.

Provider Engagement
The Registration Team is responsible for processing registration applications from chiropractors.

Service Approval
Prior approval of a Request for Additional Treatment (ACC32) form is required for treatment provided that exceeds the Chiropractic Treatment Profile Trigger number of visits. If there is no treatment profile then prior approval is required for treatment exceeding 16 visits (eg post-surgery).

Quality Management
Chiropractors must be registered with the Chiropractor Board in order to claim from ACC. Quarterly benchmark reports are sent out to chiropractors, reporting on average visits per claim in the management of specific injuries. Where appropriate, these are accompanied with best practice guidelines, including the recently released Chiropractic Treatment Profiles.

Key Points for Case Managers
  • Invoices for chiropractic treatment provided under the Treatment Costs Regulations arc paid through (MFP in full) by medical fees units.

  • Claimants can self-refer to chiropractors for treatment. As primary care treatment providers, chiropractors are often the first point of contact after an injury.

  • Treatment provided should always fit the criteria of being necessary and appropriate.

  • It is generally unacceptable to treat a claimant more than once per day, even if more than one injury site is involved.

  • Adherence to the Chiropractic Treatment Profiles is required. The profiles are available on the For Providers site on the ACC Internet and hard copies are available from ACC Healthwise.

Appendix B
Section 2

General Practice Services

Brief Description
General Practitioners (GPs) provide acute and non-acute treatment under Regulation for injuries. From 1 April 2004 some rural GPs will be able to provide these services under a contract with ACC.

Service items
Under regulation, ACC pays a standard consultation rate. Additional fees may be charged for certain procedures. These are specified with set fees in the 1999 Accident Insurance Treatment Cost Regulations GPs may also charge the claimant a co-payment for their services.

Provider Reports
GPs claiming under regulation for treatment services are not required to submit reports to ACC. They are only required to provide minimal details on the bulk billing schedules submitted to MedFees. This includes claimant name, (Injury Claim Form) ACC45 number, when the treatment was provided and details of consultation and any procedures.

Provider Engagement
GPs who wish to be registered with ACC, under Regulation must complete a Provider Registration Application form (ACC24) available or' the ACC website or from the Provider Helpline. The Registration Team processes these.

Service Approval
No prior approval is required for claimants to access this service.

Quality Management
The performance of GPs is measured by ACC through internally-generated provider profile reports, both at a population and individual level. If these reports highlight significant concerns regarding specific individual providers, they will often be requested to submit clinical records to assess their treatment in more detail.

Quarterly benchmarking reports are generated advising GPs of their performance for specific injury types compared with the rest of their class and/or best practice guidelines.

The College of GPs plays an important role in the promotion of best practice. In addition the majority of GPs have membership with an Independent Practitioner Association. These also promote best practice through education and working on behaviour changes with their members.
In order to remain registered with their professional body, there is a requirement for continuing education for which they are awarded points

Key Points for Case Managers:
  • Claimants self-refer to GPs and they are often the first point of contact after an injury.

  • They are often the medical practitioner who completes the Medical Certificate (ACC I S) for time off work.

  • As claimants can self-refer, it may not always be apparent that case-managed claimants are receiving treatment from the OP. It is worth checking whether this is the vase via the Medical Fees system.

Physiotherapy Services

Brief Description:
Treatment provided under Regulations. Physiotherapists that have a current annual practising certificate with the Physiotherapy Registration Board can register as a treatment provider with ACC. Physiotherapists have the option to be paid a set fee of $19.00 per visit or a $47.80 hourly rate. Claimants can self-refer.

Service Items
Regulation rates are $19.00 per visit or a $47.80 hourly rate. Claimants generally have to pay a surcharge for treatment provided.

Provider Reports
No reports are routinely required. However, approval of a Request for Additional
Treatment (ACC32) is required for treatment provided that exceeds the Physiotherapy Treatment Profile recommendations. If there is no Treatment Profile recommendation, then approval is required for treatment exceeding 16 visits.

Provider Engagement
The Registration Team is responsible for processing applications. Evidence of current membership with the Physiotherapy Registration Board is required.

Service Approval
Prior approval of a Request for Additional Treatment (ACC32) is required for treatment provided that exceeds the Physiotherapy Treatment Profile trigger number of visits. If there is no physiotherapy profile then prior approval is required for treatment exceeding 16 visits (eg post-surgery).

Quality Management
Providers must be appropriately registered with their Registration Body in order to claim from ACC (this ensures achievement of appropriate qualifications).

Quarterly benchmark reports are sent out which report on average visits per claim in the management of specific injuries. Where appropriate, these are accompanied with best practice guidelines. Physiotherapists that appear to be outliers are requested to validate their apparent outlier behaviour.

Key Points for Case Managers
  • Treatment provided should always fit the criteria of being necessary and appropriate.

  • It is generally unacceptable to treat a claimant more than once per day, even if more than one injury site is involved.

  • Adherence to the Physiotherapy Treatment Profiles is required. This is available on the Provider site on the ACC internet and hard copies are available from Heakhwise, ACC.


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