Preliminary classification and funding model of prosthetic limbs

Preliminary classification and funding model of prosthetic limbs

Enable NSW
Duration: February 2016 – October 2016

Background

Enable NSW is the government agency responsible for funding the provision of artificial limb services to eligible clients in NSW. Artificial limb services are provided on behalf of Enable NSW by commercial limb manufacturers. In 2013, AHSRI was engaged by Enable NSW to develop a classification system that could be used to classify and fund the range of artificial limb services provided by Enable NSW. Since that time, Enable NSW has been working with the sector on issues related to the implementation of the classification. In 2015, AHSRI was engaged to continue supporting this work through the development of a pilot study for the implementation of a casemix based payment system for prosthetic limbs in NSW. The NCCC maintained a support role with Enable NSW through much of 2016.

What we did

A pilot study methodology to test the classification system and funding rules was developed for Enable NSW. To develop the pilot methodology we consulted with Enable NSW staff and stakeholders and undertook some analysis of utilisation data provided by Enable NSW.

The pilot design included the following key features:

  • It would be able to test the effectiveness of the system in achieving more streamlined invoicing and payment processes and the performance of the classification itself.
  • It would also be able to identify any potential adverse impacts relating to clinical decision-making, client experience and the quality of the service provided.
  • The evaluation component of the pilot study will be ongoing throughout the pilot period involving a mixed-method approach.

A detailed document on the business rules and guidelines for piloting this casemix-based payment system for the Prosthetic Limb Services was developed. A data dictionary was also developed describing the data collection and variables to be used in the pilot.

Last reviewed: 1 June, 2017

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