KEY POINTS:
Physiotherapists have won a long battle with ACC, with a report saying they should be paid more.
The author, David Goddard, QC, also admonishes the compensation authority for its "heavy-handed" and at times "oppressive" approach to fraud investigations.
He says that a system that limits the number of treatments a patient can receive for different injuries should be overhauled.
Physiotherapists had called for an independent review into the way ACC funds the profession, following the introduction in 2002 of a new system of payments that saw physiotherapists receive a capped fee for treatment.
The report says physiotherapists provided 2.6 million treatments to ACC claimants in the year to June 2006, costing ACC $120 million.
Senior physiotherapists were concerned the system put financial goals ahead of patient ethics.
They opted to stay under the old system, where they received a smaller fee from ACC but could charge the patient a co-payment. Some then believed they had been unfairly targeted by ACC in audits and fraud investigations.
While Mr Goddard did not uphold the fear about patient ethics being compromised, he said payment levels under either system were not sustainable.
"This creates medium to long-term risks of quality and availability of physiotherapy services in New Zealand and unfairly transfers the cost of injuries from the community to the physiotherapy profession."
He raised serious issues in the way ACC staff had handled audits and fraud investigations. "ACC should make sure that there is good reason to suspect incompetence or dishonesty, and that other explanations do not exist that are equally or more likely to be correct, before dealing with physiotherapists or their patients or other third parties in a manner which suggests that ACC has such suspicions."
And while nothing in the evidence suggested anyone was inappropriately targeted in investigations, Mr Goddard said, there was a disproportionate appearance of senior physiotherapists in that process who had remained under the old system.
He said the issue in the review, however, that had received the most attention was ACC's system of treatment profiles.
The high numbers of applications for further treatment and high rate of approval "raise real doubts about whether the threshold for prior approval has been set at an appropriate level" and there was a strong case for ACC to develop a "more sophisticated approach".
Malcolm Hood, spokesman for the New Zealand Physiotherapy Trust, said the report was hard-hitting and a vindication for patients, although he said ACC's "world-class" reputation had been dented by the affair.
ACC chief executive Dr Jan White welcomed the report, saying some of the ideas were constructive.
Physio pay
Existing: Either $21.76 a treatment or $54.73 an hour from ACC, with co-payments from patients on top. Contracts worth about $103 an hour. No co-payments.
Proposed: Payments above $137 an hour and regular reviews. Or allowing providers to charge co-payments and increase payments by a lesser amount.
