Insurer policy puts NSW back pain patients at risk


The New South Wales State Insurance Regulatory Authority (SIRA) has made a concerning change to its Low Back Pain Model of Care that signals a shift towards American-style healthcare focused on cost-cutting rather than quality care.

Specifically, SIRA has removed the term “physiotherapist” from the clinical care pathway, instead using the vague term “physical therapies.” This change opens the door for NSW accident patients with low back pain to be treated by non-AHPRA regulated exercise providers with limited qualifications and scope of practice instead of highly trained physiotherapists.

Approximately 18,000 NSW residents receive treatment for low back pain through SIRA each year. These patients require expert clinical care due to the complexity of their conditions. Physiotherapists have long served as leaders in evidence-based low back pain treatment, providing integrated, multi-modal care with proven outcomes.

Over 190 physiotherapists raised concerns about the change in SIRA’s public consultation last year, arguing it oversimplifies care and leaves patients vulnerable. But SIRA appears to have disregarded this feedback.

“SIRA’s discreet change was initially made without consensus or consult from the APA, and without demonstrating their methodology or supporting evidence which is in direct contradiction of evidence-based practice,” said Australian Physiotherapy Association National President Scott Willis.

The APA worries SIRA’s focus on saving dollars will compromise care for vulnerable NSW accident patients. These individuals often have complex medical histories and require comprehensive assessment and integrated treatment from qualified providers. Physiotherapists deliver such value-based care; limited-scope exercise providers do not.

“There are risks to patient care in NSW if patients are referred to practitioners that are not qualified to take on the responsibility of this scope of patient care and are instead provided treatment by a practitioner not held to Ahpra’s regulatory standard,” Willis cautioned.

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