Primary Health Reforms: How will they affect Pilates?

What are the changes?

The Australian Government recently announced significant changes to Private Health claiming as part of their Private Health Reform Package. These changes come into affect on the 1st of April. We agree with the Government that participants in private health (who also include us!) need to have clearer information about what their health funds include and how they are covered. However, Pilates classes have also been swept up in these reforms. The Government have informed our governing bodies that Pilates classes can no longer be claimed through private health funds unless we comply with a host of restrictive practices, including not advertising our classes as Pilates, and only providing Pilates as part of physiotherapy treatment. However, as much as they concede that Pilates based exercises can form part of physiotherapy rehabilitation, we are unable to mention Pilates in our case notes and invoices if the patient is claiming from their health fund.

We face a strong risk of being audited, and forced to repay any rebates, as do you as patients, if there is any evidence that Pilates was provided in a class situation.

Auditing has begun, even before the changes

Other physiotherapy clinics have already been audited by Private Health insurers before the reforms have even begun. Several private health funds have also rung patients from other clinics to ask them about the treatment that was provided in their classes. Despite the best efforts of the Australian Physiotherapy Association, the best concession they could wrangle from the government was that Physiotherapy was physiotherapy, regardless of what tools were used. However, we still are prevented from using the term ‘Pilates’ if we want to offer our patients the benefits of this low impact exercise.

Our response

We strongly feel that these changes undermine our professional practice and clinical judgement, and also the value of Pilates as a form of rehabilitation and strengthening. Our Pilates classes, like most others in allied health clinics around the country, have been run strictly to guidelines, our patients assessed individually, given individual programs according to their health needs and our class numbers strictly capped. Our therapists have achieved a high level of training in Pilates based approaches. We do not prescribe Pilates unless it is clinically indicated.

We continue to offer Pilates classes!

After much consideration and concern, we have decided to keep our Pilates classes but sadly, due to these reforms, we will no longer offer health fund rebates on our classes from April 1 2019. This means that we can continue to provide this valuable service, to advertise it as Pilates, we remove the risk to our clinic and patients of having to pay back benefits paid for the classes, and the intrusion of the health funds into our patient’s medical records.

The best news is that we are now able to include more people in our classes – capped at 8 patients per class for the moment – and therefore greatly reduce the price. Our classes have been full for a while so this opens up some more spaces. Winning! So while you might not be able to claim Pilates classes on your private health fund, we will still continue to provide you with individual care in our classes and you can still get the benefits of this wonderful exercise program.

If you want to be assessed for our classes, please give our office a call on 38053223 so that we can make an appointment for you with one of our physiotherapists.