Pilates changes in April 2019
Quick links
- IMPORTANT – DO YOU Claim Rebates For Pilates?
- Frequently asked questions about the Private Health Insurance reforms
- Physio Group Treatment is the old ‘Pilates equipment group’
- Pilates Mat Classes
- Physio Group Treatment timetable
The short version
- ‘Pilates equipment groups’ will no longer be called Pilates – they will be called Physio Group Treatment, and this will be on all invoices, flyers, website etc.
- In order to access rebates through your health insurance, it will need to be related to management of a current medical condition
- Individual review sessions may need to be more regular to remain compliant
- All health insurers are likely to be a little different, so check with yours, but don’t be surprised if there is a bit of confusion!
Introduction
As you may be aware, the Federal Government has made some changes for which services attract rebates from Private Health Insurers.
The idea of their review was that consumers shouldn’t have to carry the burden for rebates paid to therapies that have little or no scientific evidence to support them.
This is very reasonable and we support this wholeheartedly.
We are a group of physios that are committed to providing therapies that are evidence-based and not based on pseudoscience that is endemic in health care.
Among the therapies that no longer attract health insurance rebates are aromatherapy, Bowen therapy, homeopathy, naturopathy, Tai Chi, yoga and Pilates.
We felt that some of these therapies are worthy of receiving rebates still – for example, Pilates, yoga, Tai Chi and Feldenkrais.
However, this has created a lot of confusion from health insurers and the media. Hopefully this will help out with explaining these changes!
If you still have questions, call us on 8356 1000 or email us on admin@adelaidewestphysio.com.au.
Pilates classes at Adelaide West Physio + Pilates
Our version of Pilates at Adelaide West Physio + Pilates is more accurately described as exercise influenced by (but not limited to) Pilates concepts. In the end, it is physiotherapy.
We are not bound by the traditional Pilates framework or exercises but it is more a blend of these concepts with a modern understanding of pain science and exercise.
For those with persistent pain, we use the concepts of graded exercise as part of persistent pain management.
There is evidence for specific strengthening in the management of many musculoskeletal problems, and we use the evidence that exists to influence what is prescribed in each person’s programme.
There are often weights, theraband, steps, treadmills, exercise bikes, floor exercises, stretches and other exercise equipment used depending on the needs of the person.
For example, if strengthening is a priority for a body part, there may some exercises performed on a piece of Pilates equipment with a Pilates name, but it is not limited to that.
There will often be other forms of strengthening in different formats, sometimes more functional and sometimes more isolated.
The key point here is that there is clinical reasoning – this is physiotherapy.
Physio, Pilates and the Private Health Insurance reforms
Apparently, these reforms were not intended to impact physiotherapy.
However, the review didn’t differentiate between Pilates-informed exercises prescribed by a physiotherapist as part of a treatment or rehabilitation programme and Pilates offered by fitness instructors and others.
The APA was able to argue successfully that if Pilates is taught by a physio, it is still physiotherapy, even if some of the exercises are drawn from the Pilates concepts or using Pilates-style exercise equipment.
As such, Pilates-informed exercises prescribed by physiotherapists as part of an individualised program will continue to receive rebates in one-on-one, group and class settings. This is confirmed on this Department of Health Private Health Insurance circular, which I have included below.
What this means to our class and group participants
These are the requirements for compliance with Private Health Insurance and therefore to be able to lawfully claim rebates from your private health insurer.
1. Individualised assessment of patients in one-on-one, group and classes.
This is something that we already do and have always done.
No one begins any of these formats without individual assessment to find strengths, weakness, limitations and establish goals of treatment.
This also means that coverage for individual one-on-on sessions and reviews will remain the same.
This requirement may also mean more frequent individual reviews to ensure that your programme continues to meet your needs and continues to be graded and progressed.
The required frequency of individual reviews of Pilates programmes may vary from fund to fund. That is something that HCF have stipulated for a number of years.
2. A programme of exercise-based interventions specific to the patient. In group sessions, that includes adjusting the group programme for individuals as required.
Once again, this is something that we already do as routine. It is the benefit of small groups!
3. In both groups and classes, the exercises need to address a current health problem.
The reforms don’t allow rebates to be paid for exercise classes that don’t address a specific health problem or set of problems.
Rightly or wrongly, they do not support the group or class codes to be used for maintenance or well-being or prevention.
4. High quality clinical notes that reflect physiotherapy practice.
Not your concern, but ours! We cannot reference Pilates in our clinical notes (even if some exercises have a Pilates ‘flavour’)
5. The sessions eligible for rebates by PHI cannot consist solely of Pilates.
Groups and classes cannot be just ‘Pilates’ exercises.
The majority of people currently doing Pilates groups or classes are doing exercises that are a blend of Pilates-influenced exercises and others.
6. We cannot call our groups or classes ‘Pilates’ in our note, programmes, timetables, or website.
They are now going to be called ‘Physiotherapy Exercise Classes or Groups’.
However, we can continue with our name and practice signage to include the word Pilates. Go figure!
NB: all health insurers are going to have slightly different rules.
It will be worthwhile to check with your insurer exactly what their stance is.
Please, if you have any questions, send them to us on admin@adelaidewestphysio.com.au and we will do our level best to answer them. Some questions may be insurer-specific, in which case it might be a question best directed to them.