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Australia's approach to musculoskeletal injury care and reimbursement demands rethink: Report

Smith+Nephew (LSE:SN, NYSE:SNN), the global medical technology business, today announces a new report examining musculoskeletal injury care and reimbursement in Australia that urges health payers and providers to resolve system-wide challenges hindering positive patient pathways from primary settings through to recovery.


The Economist Impact - Musculoskeletal Injuries in Australia Report outlines the growing number of meniscal injury (MI) and rotator cuff (RC) injuries in Australia. It seeks to find solutions to ensure patients in Australia access better care for acute soft tissue injuries, and that a multi-party solution is adopted to address risks and gaps in current practices care looking at diagnostic techniques, referral mechanisms, and cost considerations of different reimbursement and/or compensation schemes.



Smith+Nephew Senior Director, Sports Medicine, Ella Post says that these injuries impact individuals, the health system and workplaces and that patient pathways need to be simplified and streamlined to ensure best-practice diagnosis and treatment.

“Our health system is experiencing heightened demand for surgical interventions for meniscal and rotator cuff injuries related services causing what we believe is a concerning and growing public health challenge in Australia. We know that access to care is dwindling, as elective surgery queues are getting bigger, and pathways are inconsistent between different clinicians and providers.

We believe it will take an all-of-system approach to ensure that Australians experiencing these injuries get the care they need, when they need it and at the quality they deserve.”

Key recommendations of the report include:

  • Increase awareness of the burden of MI and RC injuries

  • Simplify and streamline patient pathways

  • Recognise and provide support for the different roles played by healthcare professionals, especially GPs, along the patient pathway

  • Improve elements of the health system, including better access to and use of clinical data

  • Review costs and existing compensation/reimbursement schemes for MI and RC injuries

Musculoskeletal disorders are the biggest contributor to years lived with disability worldwide (approximately 17%)1. If left unresolved, MI and RC injuries can lead to severe difficulties in performing activities of daily living, work-related disruption, social withdrawal, and emotional distress.

While it is recognised that the impact of musculoskeletal injuries is vast, and serious work-related claims for these injuries are on the rise, the report outlines the lack of data available to inform and guide clinical decisions and referral patterns.

“Many of these recommendations hinge on knowing more through better communications and data sharing. Setting up a centralised registry for MI and RC injuries would help to quantify the cost of lost productivity and reduced physical function and better inform and guide clinical decisions and referral patterns, improving the quality and timeliness of care delivered,” says Post.

The report suggests that the Australian Government does not recognise these injuries as a health priority and says that critical policy changes are needed to minimise morbidities caused by untreated meniscal and rotator cuff injuries.

Kieran Fallon, Professor, Musculoskeletal, Sport and Exercise Medicine, Australia National University Medical School says that report also found that GPs and allied health services play a critical role in ensuring an outcomes-focused patient journey with the patient pathway for these injuries varying significantly depending on GPs’ referral decisions.

“What I really like to see in terms of pathways is much better education of our GPs in two things. One is in clinical orthopaedic examinations. And second, in their access to the new and enormous amounts of data that’s coming out in this area.”

References

1. Cieza A, Causey K, Kamenov K, et al. Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2021;396(10267):2006-2017.


ENDS


About Meniscal injuries and rotator cuff injuries

  • Musculoskeletal injury refers to damage of muscular or skeletal systems, usually due to a strenuous activity and includes damage to skeletal muscles, bones, tendons, joints, ligaments, and other affected soft tissues.

  • Meniscal tears are one of the most common work-related injuries, with associated risk factors such as kneeling, squatting or crouching, crawling, lifting/carrying/moving, standing up from a kneel, stair or ladder climbing, and driving.

  • Over the last 20 years, the prevalence of shoulder pain in the general population aged <70 years grew 20% while the lifetime of prevalence of shoulder pain has increased to 67%1.

  • Knee and ankle injuries constitute 13% of the total medical consultations, out of which 11 % are caused by meniscal tears2.

About the reportMusculoskeletal Injuries in Australia: Current Challenges and Opportunities is an Economist Impact report, sponsored by Smith+Nephew. The report examines the different care pathways that exist for patients with musculoskeletal injuries, particularly meniscal and rotator cuff injuries, in Australia.

This research combined an evidence review, an expert panel meeting, and several in-depth interviews. The following individuals (listed alphabetically) contributed their views, insights and time for this report:  

  • Alison Thorpe, Director, Perth Shoulder Rehabilitation; Researching Clinician, Curtin University 

  • Hugh Seward, Sports Physician, WorkSafe Victoria 

  • Kieran Fallon, Professor, Musculoskeletal, Sport and Exercise Medicine, Australia National University Medical School 

  • Mark Jacobs, Injury Management Consultant, Brisbane  

  • Mark Phillips, Manager, Clinical Services Team, Recovery, Planning & Performance Division, WorkSafe Victoria 

  • Paul Dale, Director, Policy, Medical Technology Association of Australia 

  • Peter Choong, Sir Hugh Devine Professor of Surgery, University of Melbourne  

  • Sarah Griffin, Director, MedTechnique Consulting 

  • Scott Willis, National President, Australian Physiotherapy Association 

  • Tamika Heiden, Principal & Founder, Research Impact Academy 

  • Tania Pizzari, Associate Professor, Physiotherapy, La Trobe University 


Additional quotes from contributors to the report


Quoted in the Economist Impact report, Mark Jacobs, Injury Management Consultant, Brisbane, said: “Every injury is different. No two RC injuries are the same. The cuff tear might look the same, but the person that it’s attached to is very different, and that’s where people get lost.”


Identifying the global challenge posed by MSDs, Alison Thorpe, Director, Perth Shoulder Rehabilitation, and Researching Clinician, Curtin University, commented in the Economist Impact report, “The Global Burden of Disease Study ranks MSDs as one of the biggest expenses to healthcare systems around the world.”


Quoted in the Economist Impact report, Hugh Seward, Sports Physician, WorkSafe Victoria, said: “There’s a time pressure to come to a diagnosis quickly because you’ve got a full waiting room. You’re limited to probably 10 minutes in your schedule to make the diagnosis, and sometimes the pain complaint for a shoulder or knee is not the only thing that’s presented in that 10 minutes.”


Quoted in the Economist Impact report, Sarah Griffin, Director, MedTechnique Consulting, said: “The way Medicare is set up, there are a lot of perverse incentives that can actually steer people away from the most appropriate care, especially for people who don’t have private health insurance, or can’t afford to go to a private physiotherapist. For them, it might actually be quicker to go to a surgeon because the surgeon is covered under Medicare. Those incentives that are built in may actually direct people to potentially inappropriate and more expensive care.”    


Quoted in the Economist Impact report, Peter Choong, Sir Hugh Devine Professor of Surgery, University of Melbourne, said: “The internet is probably the dominant source of information for most patients before and after seeing their healthcare provider. However, the literature tells us that neither patients nor providers are able to discern the quality of information that is available on the net.”


Identifying the challenge of RC injuries in Australia, Tania Pizarri, Associate Professor of Physiotherapy at La Trobe University, commented in the Economist Impact report, “RC injuries in Australia pose a significant burden, with about one in four people experiencing shoulder pain at some point in their lives, and about one in three people presenting with injuries or pain being referred further for physiotherapy. 50% of these patients would still be in pain six months after their first episode, indicating the chronic nature of these injuries.”      

Neeladri Verma, manager for Health at Economist Impact and editor of the report, says:"Musculoskeletal disorders are a major cause of disability and lost work time in Australia, and knee and shoulder conditions are an important part of this burden. This study is very timely given the issues the market faces, and we hope our research findings provide insight into the steps we could be taking to improve the care pathways and catalyse meaningful change for Australians living with these conditions.”


References

2. Ackerman IN, Page RS, Fotis K, et al. Exploring the personal burden of shoulder pain among younger people in Australia: protocol for a multicentre cohort study. BMJ Open. 2018;8(7):e021859.

3. McGaughey I, Sullivan P. The epidemiology of knee and ankle injuries on Macquarie Island. Injury. 2003;34(11):842-846


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