Pain management and network pain management policy

What WorkSafe will pay for

The WorkSafe Agent (the Agent) can pay the reasonable costs of Network Pain Management Programs and Pain Management Services where required as a result of a work-related injury or illness under Victorian workers compensation legislation (the legislation).

Who can refer into a Network Pain Management Program or Pain Management Service?

A request for a Network Pain Management Program must be accompanied by a referral from:

• a medical practitioner
• physiotherapist; or
• psychologist

A request for Pain Management Services requires a referral from the worker’s treating medical practitioner.

Background

Network Pain Management Programs (NPMP) and Pain Management Services (PMS) are multidisciplinary, group based, education focused programs which are designed to assist workers with musculoskeletal injuries and persistent pain to manage their condition.

NPMP and PMS focus on developing strategies to assist workers who are having difficulty managing their injuries and participating in functional activities due to their pain. NPMP and PMS aim to improve a worker’s health outcomes by:

• educating the worker about their pain
• setting early expectations around returning to work
• educating the worker about the risks and benefits of treatments for pain
• rationalising and reducing medications where possible
• improving mental health and physical capacity
• teaching self-management skills and supporting a timely transition to self-management

For the purposes of this policy, persistent pain or chronic pain is defined as per the National Pain Strategy as constant daily pain for a period of three months or more in the past six months.

This policy must be read in conjunction with the following:

Definitions

In this policy Network Pain Management Program (NPMP) is an evidence-based outpatient program, conducted primarily in a group setting that provides multidisciplinary healthcare interventions and education to adult workers and is:

• developed and delivered by a provider who has met specific service standards established by the WorkSafe and agreed to comply with program and reporting requirements
• provided by a multidisciplinary team of medical and allied healthcare providers that have skills and experience in delivering pain management treatment
• a program to assist workers with persistent pain to increase their functional ability and improve their quality of life

Pain Management Service (PMS) is an inpatient or outpatient program, generally conducted primarily in a group setting that provides multidisciplinary healthcare interventions and education to workers and is:

• developed and delivered by a provider who has been approved to provide services by the WorkSafe
• provided by a multidisciplinary team of medical and allied healthcare providers that have skills and experience in the management of injured workers and in delivering pain management treatment

Pain education programs are 8-10 hour multidisciplinary group education programs designed to provide skills that focus on a transition to self-management for injured workers with persistent pain. Pain education programs are conducted as an outpatient public hospital service, do not involve individual treatment and must meet the same criteria as a PMS for consideration by the WorkSafe.

Guidelines

What can the Agent pay for in relation to Network Pain Management Programs and Pain Management Services?

The Agent can pay the reasonable costs of NPMP and PMS:

• required as a result of a work-related injury or illness
• that are reasonable, necessary or appropriate in the circumstances
• where the program or service is objectively safe and effective
• in accordance with WorkSafe’s policies/guidelines
• approved by WorkSafe under Victorian workers compensation legislation

The Agent considers it reasonable to fund only one NPMP or PMS for a worker unless there is appropriate clinical justification provided for a subsequent program.

The Agent can pay the reasonable cost of travel for a worker to attend an NPMP or a PMS where:

• prior approval has been provided by the Agent
• the need for travel has been clinically justified by the worker's treating medical practitioner

Who can provide Network Pain Management Programs and Pain Management Services?

A NPMP can be provided by a multidisciplinary team who has agreed to meet specific service standards, established by WorkSafe. For more information please refer to the Network Pain Management Program Providers' List.

PMS can be provided by a multidisciplinary team comprising of medical practitioners and allied health providers who are approved to provide health services by WorkSafe.

What information does the Agent require to consider paying for Network Pain Management Programs and Pain Management Services?

Network Pain Management Programs The NPMP provider must submit a 'Network Pain Management Program: Assessment Request' form to the Agent for consideration of a NPMP for the worker. If approved, the NPMP provider can proceed with the assessment of the worker and, if the provider and WorkSafe deem the worker appropriate, a Network Pain Management Program may be initiated.

Pain Management Services

The provider must submit a request for an assessment to the Agent including details of the medical practitioner referral received. If approved, the PMS provider can proceed with an assessment.

Following the assessment, the PMS provider must submit a report outlining the key assessment findings and recommendations for the management of the worker. The provider must provide adequate clinical justification in support of any recommendations that the worker engage in an inpatient or outpatient PMS program. If approved, the PMS provider can undertake the pain management program.

Pain education programs

The provider must submit a ‘Public Hospital Pain Education Request’ form to the Agent for consideration of a pain education program. Pain education programs can only be conducted by a public hospital as an outpatient PMS.

When will the Agent respond to a request?

Within 10 working days of receiving the NPMP or PMS request, the Agent will advise whether:

• the request has been approved
• the request has been denied
• further information is required to make a decision

Where further information is required, the Agent will advise whether the request has been approved or denied within 10 working days of receiving the additional information.

A NPMP or PMS request may be reviewed by the WorkSafe Clinical Panel to assist in making decision on the request. The Clinical Panel may contact the requesting provider to seek further information and/or discuss the proposed treatment prior to making a recommendation to the Agent about the request. The Agent will respond to the request when they have received the Medical Advisor's recommendation.

Will the Agent consider paying for concurrent treatment?

A worker can continue to receive treatment from their treating medical and/or mental health practitioner during their participation in a NPMP or a PMS in line with any current approval that is in place.

The Agent will not pay for physical treatment (including physiotherapy, hydrotherapy, chiropractic services, osteopathy, remedial massage or acupuncture), or occupational therapy concurrently while a NPMP or a PMS is being conducted. This is because physical treatment is included as part of a NPMP or a PMS.

If an injured worker requires a Certificate of Capacity during the period in which a NPMP or a PMS is being conducted the Agent can pay for the services provided by a medical practitioner, physiotherapist, chiropractor or osteopath necessary to complete the certificate. For more information please see the Certificate of Capacity policy.

What fees are payable for Network Pain Management Programs and Pain Management Services?

The Agent will pay fees for NPMP at the agreed rate for providers who have met specific service standards established by WorkSafe.

The Agent will pay fees for PMS where clinically justified by a worker's treater. Fees will be paid in line with the reasonable costs of medical and allied health services up to the maximum amount detailed in the fee schedules for public hospitals, private hospitals, private and allied health services.

In relation to Network Pain Management Programs and Pain Management Services, what won’t the Agent pay for?

• treatment or services for a person other than the worker
• treatment or services provided by a health professional not registered and approved by WorkSafe under Victorian workers' compensation legislation
• treatment or services subcontracted to, or provided by a non-registered provider
• procedures such as surgery, spinal injection procedures, radiofrequency neurotomy/denervation or implantable pain therapies as part of an NPMP or a PM Service
• treatment for a condition that existed before the worker’s work-related injury or illness
• where there is no objective evidence that the service is safe and effective
• provided by single discipline providers
• fees associated with cancellation or non-attendance
• treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent
• treatment or services provided by telephone or other non face to face mediums, including telephone consultations between providers (including hospitals) and/or workers
• any fines, fuel costs, toll charges, travel insurance or motor vehicle hire associated with travel costs

Further information

Contact the relevant Agent, email [email protected].