MONDAY, 30 MARCH 2020

How can you continue to care for clients – FAQs?

Can I do small outdoor group sessions?

Unfortunately the answer is no. National Cabinet agreed last night to limit both indoor and outdoor gatherings to two (2) persons only – that means ESSA members can only work one-on-one with a client (i.e. one AEP and one client) in an outside setting. Bootcamps are now reduced to two persons, including the trainer.

Yesterday’s new advice replaces ESSA’s guidelines last week to conduct outdoor exercise classes with no more than two others (three people in total including an instructor).

Does the two-person rule apply to health clinics?

No, health and allied health clinics are deemed essential health services. Please continue to observe the one person per four square metres rule and hygiene requirements. More than one Accredited Exercise Physiologist (AEP) and admin staff can work in a clinic at any one time.

We have no specific guidance on clients and carers but consider that clients and carers are exempt from the two-person rule.

ESSA encourages clinics to have clients wait in their cars to decrease the number of people in the waiting rooms.

ESSA does not believe/recommended indoor group/personal training classes can be classified as essential health services.

The ONLY exceptions are for:

- AEP providing group exercise classes for Medicare Item 81115 for type 2 diabetes group services

- Those ESSA accredited professionals who are registered as personal trainers with the National Disability Insurance Scheme (NDIS).

Stricter Home Confinement Directions (Stay at Home Rules)

Nationwide restrictions were announced yesterday 29 March 2020 to further contain the spread of COVID-19. Across the nation, you are no longer able to leave your principal place of residence except for, and only to the extent reasonably necessary to accomplish, the following permitted purposes. All states and territories have implemented measures like these with New South Wales also imposing restrictions on visiting people in their homes. 

• to obtain food or other essential goods or services;
• to obtain medical treatment or other health care services;
• to engage in physical exercise, either alone or in the company of no more than one other person; or in the company of a family group who ordinarily live in the same household;
• to perform work on behalf of an employer that is engaged in an essential business, activity or undertaking, and the work to be performed is of a nature that cannot reasonably be performed from the person’s principal place of residence;
• to visit a terminally ill relative or to attend a funeral, subject to any applicable restrictions under other relevant Public Health Directions;
• to provide assistance, care or support to an immediate member of your family;
• to attend any Court of Australia or to comply with or give effect to orders of the Court; or
• to attend a childcare facility, school, university, or other educational institution, to the extent care or instruction cannot reasonably be obtained in the person’s principal place of residence.

A person who leaves their residence for a permitted purpose may be accompanied by members of their household or, alternatively, by no more than one person who is not a member of their household.

You will be fined if you are not observing these new stay at home rules which apply to everything you do apart from going to work. Remember, you are delivering essential health services if you get challenged.

Reflect on What Essential Services You Should be Providing

Make an individual assessment of your clients to determine if it is essential to book a face-to-face appointment. If a face-to-face appointment is not deemed essential, talk to clients about moving services to telehealth to support the government's social distancing rules. Consider what advice vulnerable populations have been told by Governments as below:

Vulnerable Populations

National Cabinet’s strong advice is for self-isolation at home to the maximum extent practicable for Australians:

· over 70 years of age;

· over 60 years of age who have existing health conditions or comorbidities;

· indigenous Australians over the age of 50 who have existing health conditions or comorbidities.

Consider the example of Dale Ischia who closed her practice in Victoria last week for clients recovering from cancer.

Can I see people at home?

Yes, provided you observe the NSW Health guidelines on community-based and outpatient health services including home visits (please use these a best practice guide even if you work in another state):

Please note, the limit of two people does not apply to family units.

Again, only continue to operate essential services at clients’ homes at your own discretion.

Can I re-purpose a large commercial gym and see clinical clients 1:1?

Definitely not. All large commercial gyms should be closed and should not be used or repurposed for any reason, including filming. Fitness Australia is calling on State Governments to relax large gym closures to allow use of facilities to create digital content only.

ESSA is NOT advocating for large gyms to be open for any purpose. If you want to do any filming and do not have access to a large gym, we suggest you film outdoors in your backyard.

New Telehealth Medicare Item Numbers

Four new temporary item numbers were released last night on 29 March 2020 to assist in containing COVID-19 and enable AEPs to continue to provide healthcare services safely.

A service may only be provided by telehealth where it is safe and clinically appropriate to do so.

ESSA encourages you to provide the very best telehealth services to clients. We will be advocating for the continuation of these items beyond 30 September 2020. However, the success of our advocacy will be contingent on how well you and other allied health professionals deliver those services.

The new temporary MBS telehealth items must be bulk billed and are for non-admitted patients.

Exercise physiologists have access to four new item numbers:

Service Descriptors:

Category 8 - MISCELLANEOUS SERVICES – ITEM 93000

GroupM18 - COVID-19 Allied Health Telehealth Services

Telehealth attendance by an eligible allied health practitioner if:

(a) the service is provided to a person who has:

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(b) the service is recommended in the person’s Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person’s chronic condition and complex care needs; and

(c) the person is referred to the eligible allied health telehealth practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d) the service is provided to the person individually; and

(e) the service is of at least 20 minutes duration; and

(f) after the service, the eligible allied health telehealth practitioner gives a written report to the referring medical practitioner mentioned in paragraph (c):

(i) if the service is the only service under the referral—in relation to that service; or

(ii) if the service is the first or last service under the referral—in relation to that service; or

(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;

to a maximum of 5 services (including any services to which this item, item 93013 or any item in Part 1 of the Schedule to the Health Insurance (Allied Health Services) Determination 2014 applies) in a calendar year.

Where the service is bulk-billed.

Fee: $63.25 Benefit: 85% = $53.80

End Date for services: 30-Sep-2020

ITEM 93013

Phone attendance by an eligible allied health practitioner and the rest of the descriptor is the same as above.

New Medicare Provider Frequently Asked Questions:

Please read this before contacting ESSA.

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB

What Provider Number do I use?

During COVID-19, AEPs are able to use the usual Provider Number that is attached to your clinic, even if you are conducting tele-health sessions from your home or a self-isolation location, other than the usual clinic location.

Do I have to bulk bill the new temporary MBS telehealth items?

Yes. It is a requirement that all the new MBS items are bulk billed, meaning the client assigns the MBS benefit to the provider. As bulk billed services, providers cannot charge an additional fee for these items.

How much do I charge for telehealth under other compensable schemes?

What you charge is as always for Non-Medicare telehealth, is at your own discretion.

Whatever you set your fees at; remember you need to be able to sustain these fees for the duration of the COVID-19 pandemic. Set them too low and you may not be able to sustain the delivery of services.

What online platforms can I use?

No specific equipment is required to provide Medicare-compliant telehealth services. Services can be provided through widely available video calling apps and software such as Zoom, Skype, Physitrack, FaceTime, Duo, GoToMeeting and others. Free versions of these applications (i.e. non-commercial versions) may not meet applicable laws for security and privacy.

Exercise professionals must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. More information for ESSA professionals on various platforms is available on our COVID-19 home page.

We will have information from the NBN tomorrow on some usage tips and guidance you and your clients.

Please remember that ESSA’s Tele-Practice Policy Statement applies to all ESSA professions including Accredited Exercise Physiologists (AEPs), Accredited Exercise Scientists (AESs), Accredited Sports Scientists (ASpSs) and Accredited High Performance Managers (AHPMs).

All ESSA exercise professionals need to meet the requirements of our ESSA Telepractice Policy Statement and be able to satisfy all the requirements listed in our telehealth check list. Both documents are available here: https://www.essa.org.au/Public/Coronavirus_(COVID-19)_Telehealth_Updates.aspx

The Australian College of Rural and Remote Medicine (ACRRM) has some freely available guidance on its website which may be of use at:

https://mycollege.acrrm.org.au/search?query=telehealth&collection=acrrm-meta-public

What about telehealth for T2D group items?

No new items have been developed for T2D group items.

Can I use a phone service even if the patient and I have the capacity/equipment to videoconference?

Videoconference services are the preferred approach for substituting a face-to-face consultation. However, in response to the COVID-19 pandemic, providers will also be able to offer audio-only services via telephone if video is not available. There are separate items available for audio-only services.

Do clients continue with existing CDM plans or do they need new ones?

Clients continue with existing CDM plans.

Workers Compensation Schemes and Private Health Insurance funds

ESSA continues to work with state and territory-based workers’ compensation schemes and Private Healthcare Australia to favourably influence existing rules, item descriptors and item codes of these various stakeholders to fund the provision of AES tele-services throughout the COVID-19 pandemic. ESSA has highlighted the evidence-based clinical effectiveness of AEP services for Australians. Our progress is to date with key stakeholders:

We continue to work diligently with state and territory Health Departments advocating for the best interests of our members and your communities. Rest assured; we will continue to update you daily as details are confirmed.

Repaying the NDIS one-off advance payment for registered providers

If you missed the opt-out date of last Friday (27 March) and received the lump sum payment in your account automatically, you can make an immediate repayment to the NDIA if you want. Contact the NDIA National Contact Centre and ask for an invoice to be issued for the repayment.

Aged Care - Free webinar on the current situation for people in aged care regarding COVID-19

Free recorded webinar (45 minutes) available from Older Persons Advocacy Network (OPAN), Aged & Community Services Australia (ACSA) (a peak agency of aged care providers), and the Aged Care Quality and Safety

Commission and St Andrews Village in Canberra covering:

· What's known at the moment and what is still emerging?

· What aged care providers are doing to get ready and respond.

· Information about restricted visitation to aged care homes.

· What's being done to prevent social isolation during restricted visits and how to maintain contact with loved ones.

· How to access aged care advocacy and other support.

· What can be done to prevent COVID-19?

· How to keep informed about what's happening in aged care? View here: https://vimeo.com/399761986

Resources to help with Managing Employees

Two resources have been developed to help you with downsizing and standing down employees, and redundancies at this difficult time on the ESSA Business Network (EBN) and our COVID -19 Business Owners page.

Want More details on COVID-19?

The Australian Government released yesterday:

- A WhatsApp channel that can be accessed by entering aus.gov.au/whatsapp
- Coronavirus apps available on Apple  and Android 

Mental health support

Mental health resources

ESSA Board Director Dr Simon Rosenbaum has developed a list of free resources for exercise practitioners regarding the mental health impacts of #COVID19. He has a team of people helping him. Give him some feedback on twitter @simon_rosenbaum

More Australian Government funding

An initial $74 million will be provided to support the mental health and wellbeing of all Australians.

The Government’s digital mental health portal, Head to Health, will be a single source of authoritative information and guidance on:

· how to maintain good mental health during the coronavirus pandemic and in self-isolation

· how to support children and loved ones, and

· how to access further mental health services and care.

Light Relief – Coffee

Find out what your coffee order says about you!