The June 1st, 2016, revisions to the Statutory Accident Benefits Schedule will change how rehabilitation therapy is covered. But how will it affect rehabilitation clinics on a business level, and what will clinics have to do to adjust?
Many of the basics of how rehabilitation clinics work will not change – the clinic will still require a license from the Financial Services Commission of Ontario (FSCO) in order to accept money directly from insurance companies, and individual therapists will still need to be certified by professional organizations. However, the scaling back of coverage, both in terms of money provided for therapy and the time allotted for that therapy, will have its own impact, and clinics will need to strike a new balance between the needs of their patients and financial sustainability.
Scaling back of coverage
The monetary reduction of coverage across all levels by itself creates a problem – with less money available in statutory benefits, patients become more likely to run out of money for their therapy, and for it to happen faster. This can be a serious issue when it comes to more specialized and complicated forms of therapy, particularly as many of them are not covered by OHIP, leaving patients without the ability to pay their bill once the insurance money runs out. With this additional danger, clinics will need to revise their policies on how to handle patients whose insurance coverage is about to end – regardless of whether this means referring them to additional sources of funding, providing service for debt management, or creating a transition program to help them at the end of their treatment.
The reduced time frame for rehabilitation of non-catastrophic injury – lowered from 10 years to 5 years – will have little effect in the first five years, but a considerable impact after, causing clinics to increase their intake to maintain revenue from long-term patients. However, this should happen without any need for policy changes as clinics will be filling their openings as they open up.
Of far more importance is the new oversight by insurance companies regarding miscellaneous products and services. While this will not impact most medical treatments and therapy, it will have an impact on non-traditional services such as acupuncture and massage therapy, which patients and clinics will now have to demonstrate to the insurance provider as essential to recovery. This means that a number of non-traditional services may no longer see funding from settlements, leaving the patient – who may be in no financial condition to pay for out-of-pocket therapies – to foot the bill. As a result, clinics may need to re-evaluate the services they offer outside of those specified in the Statutory Accident Benefits Schedule, especially regarding whether they will continue to offer those services.
Likewise, the new definition of "catastrophic" may change what can be funded in more borderline cases. Patients who are marginally ambulatory yet still completely incapacitated, or who are suffering from severe chronic pain, may no longer fall under the category of "catastrophic," resulting in reduced funding for treatment. How clinics handle this new situation will depend on the expense to the clinic of these treatments – although in an ideal circumstance, a balance can be struck that ensures that patients receive the therapy they need, it may become necessary to reduce the therapy provided in cases where there is an unsustainable overhead cost.
The changes to the Statutory Accident Benefits Schedule will require clinics to re-evaluate how they do business, and how their treatments are funded. This may require clinics to seek additional sources of funding, or change the therapies they provide and how they provide it. With enough care and compassion, hopefully a balance can be struck between ensuring that patients receive the therapy they need, and the sustainability of the clinic.
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