Hundreds joined the NDIS pricing workshops, sharing solutions and concerns. The workshops were intended to produce a comprehensive report on pricing reform, but that report remained unreleased until a Senate vote forced a partial release.
Instead of the full recommendations, the government issued a ‘snapshot of concerns’ that provided zero insight into the proposals made by experts like Sarah Collison and her industry colleagues. For many in the disability sector, the process now feels like little more than a tick-box exercise.
In a sector already grappling with burnout, workforce shortages, and the daily realities of supporting Australians with disabilities, transparency should be a cornerstone. Yet, as Occupational Therapist Sarah Collison shared in an exclusive interview, the National Disability Insurance Scheme (NDIS) pricing reforms feel anything but open.
Having participated firsthand in the Independent Health and Aged Care Pricing Authority’s (IHACPA) workshops on NDIS pricing, Collison described them as “one of the most robust” she had seen, with facilitators who “genuinely listened, asked thoughtful questions, and dug deep into the complexity of delivering allied health services.”
But what followed? A snapshot of concerns released on 15 September 2025 offered stark revelations about inequities while remaining silent on the full recommendations.
Collison, the founder of Verve OT and Verve OT Learning, has built her career at the intersection of clinical practice, professional development, and systems change. With over a decade leading teams and training thousands of therapists, she knows the scheme’s pressures intimately. Her insights, drawn from those workshops and her frontline experience, reveal a process that started with promise but veered into opacity.
“It just seems to be an all too common occurrence,” Collison said, “with these sort of consulting and then everything sounds like it’s going well and then at the end it’s just like, yeah, we’re going to do our own thing that sort of suits what we were going to do anyway.”
A genuine dialogue
The IHACPA consultations, launched in June 2024 following the NDIS Review’s call for independent pricing oversight, promised a fresh approach. Over 35 workshops across 11 locations, from Darwin to Perth, gathered input from more than 750 sector members, 455 submissions, and an online questionnaire.
The resulting snapshot, titled Exploring opportunities for pricing reform: A snapshot of what we’ve heard, laid bare the cracks: pricing fails to reflect service delivery costs, especially in remote areas. It fosters inequities, erodes quality, and stifles innovation.
Participants and providers alike voiced a desire for “transparent processes and models that are predictable and allow for long-term planning,” alongside “quality and safe supports that encourage innovation” and “sustainable services no matter where you live or how complex your disability,” all according to Collison.
Collison, selected after registering interest, attended sessions that exemplified this engagement. “The workshops were really well run,” she recalled, “in that they were facilitated by multiple members of the team of IHACPA.
There were breakout rooms where we spoke about specific issues, specific challenges, barriers that we have identified. There was really robust discussion amongst the attendees… agreement, some disagreement, but it was very respectful.”
The facilitators, she added, “asked a lot of questions to really try to unpack what the issues were and to get really good insights.” She left feeling it was “genuine collaboration and co-design.”
That authenticity made the aftermath all the more jarring. The full IHACPA recommendations, likely “rigorous, independent, and evidence-based,” as Collison described, were shelved. Instead, the government formed a hand-picked “Independent Pricing Committee,” whose review paved the way for the latest price guide cuts. No sector submissions, no feedback opportunities, no consultations.
“They’ve received that report. They’ve kind of pushed it to the side and then gone, actually, we’re going to do a different independent pricing review now,” Collison said. “They handpick those three individuals, and then based on that, provide a report that then influences what the price guide did.”
The snapshot release after the Senate vote offered only a fraction of the intended recommendations. Collison explained, “It was meant to be a full, comprehensive report reflecting all of the workshops and expert insights, but what was released was just a snapshot of concerns. It gives you nothing about the recommendations we actually made.”
Fellow professionals in the sector have echoed these frustrations, with sentiments highlighting a lack of transparency. “Everything is missing, all the important stuff,” Collison said, calling for the press to uncover the “actual recommendations made, not the watered-down ones.”
Inequities on the ground
The snapshot’s warnings are not abstract; they are etched into Collison’s daily work at Verve OT, where her team conducts functional capacity assessments, assistive technology evaluations, home modifications, and Specialist Independent Living (SIL) and Specialist Disability Accommodation (SDA) assessments.
Even in metro areas like Sydney, the half-hour travel cap bites hard.
“We can go 10 kilometres and it takes us an hour, but we can only charge half an hour for that,” she explained. “And that does make it really hard to be able to continue to see clients in those areas.”
Outreach to regional hubs like Griffith amplifies the strain. “We travel to Griffith every kind of six to eight weeks, and we do a number of assessments. And there are a lot of areas down there as well, where we’re limited to the half-hour cap. And then as soon as we go beyond that, there’s no payment that’s coming through.”
With recent cuts halving travel allowances further, therapists’ costs, fuel, time, and wear and tear do not pause. Add a six- to seven-year price freeze amid rising superannuation, mileage reimbursements, NSW Health salaries, rent, electricity, and more, and the maths does not add up.
“Every other cost that we face as a business has continued to increase. I don’t think you have to be a financial genius to understand that at some point, the total number of all those costs is going to exceed the total revenue that’s coming in, if that revenue doesn’t change,” Collison said.
Remote participants fare worse, with travel distances up to 700 kilometres inflating costs and depleting plans in months. Providers in these areas struggle to attract and retain staff, leading to burnout and unsafe ratios.
“Definitely doesn’t make sense,” Collison said, “it’s sabotage. There is no way for it to be a successful system.”
What lies hidden?
Based on workshop discussions and the snapshot’s unflinching critique, Collison suspects the withheld recommendations called for bold shifts, likely including price increases.
“My impression is that it probably recommended an increase in pricing,” she said. “Now whether that was a change in the pricing model, potentially moving away from fee for service to outcome-based modelling, or whether it actually just identified that the rate that’s currently being paid is no longer sufficient and actually needs to be increased. I suspect that whatever the model looked like that was recommended, it’s probably going to be that it was an increase, because otherwise, why else would the government keep withholding it?”
This sidestep, she argues, undermines co-design. “It really kind of just brings into question how genuine the government is about co-design and collaboration and genuinely listening to the sector.”
For OTs, a female-dominated field, it stings deeper. “It also does feel gendered,” Collison said. “If you look at the primary workforce for health, for aged care, for disability, it is all heavy female dominated. You wouldn’t see this in the construction industry or finance.”
Echoing aged care’s playbook, where Royal Commission funding calls morphed into co-payments, Collison sees short-sighted savings trumping sustainability. Capacity-building supports like OT, she emphasises, “can actually directly influence cost saving in other areas.”
“By cutting capacity building and reducing our hourly rates and preventing us from actually being able to deliver services is only going to cost the scheme more in the longer term. Capacity building is kind of a long-term game plan. We need time and patience to actually be able to see the full impact.”
Eroding quality, fuelling burnout
The snapshot spotlights how pricing squeezes overheads, staff training, and innovation, ripples Collison sees in her Verve OT Learning programs. “We do a lot of training, obviously, and very much it’s about ethical and transparent billing,” she said.
Under fee-for-service, OTs bill hourly, not by outcomes, yet must evidence gains in independence. “It’s difficult for us to be able to show outcomes immediately. We need to make sure that if we are delivering services under that fee-for-service model, that we are assisting our participants to build capacity. Otherwise, there’s a concern that it’s throwing money for the sake of it and not actually getting good outcomes.”
But with businesses “starting to feel squeezed,” training and supervision, key to quality, become casualties. “Some of the things that will be squeezed out will be things like training and supervision and support, all of those things that ensure that a quality service is actually being provided,” Collison said.
New graduates face complex caseloads without guidance, harming participants and therapists alike. Australia’s OT workforce, already short-staffed, sees burnout soar.
“We have a really high rate of burnout in our profession, and we have a workforce shortage that is only worsening. If we continue to place pressure on therapists and we start cutting things as a way to save money, we’re just going to see more and more of them leaving the sector,” Collison explained.
Solutions and advocacy
Diversify income, rethink service delivery, and prioritise long-term viability. “There’s a real need to look at how we work, to look at how we deliver services, how we potentially diversify income streams so that we are not solely relying on the NDIS,” Collison said.
The message to providers and participants is clear. “You don’t have a role in shaping the sector,” she lamented. Recent reforms, like the Evidence Advisory Committee, lean academic but sideline lived experience. “I’m not sure how reflective that is of the sector. How do we ensure that we capture their voice about what works and what doesn’t work?”
Practitioners must step up as advocates, weaving justification into assessments. “We are spending a lot more time, really, particularly in our assessments and reporting, trying to really advocate, why something is needed? Why is it required? What is the outcome? What is the benefit that’s going to be provided?”
It’s a “fine line,” Collison said, as OTs are funded supports, but their frontline view is unmatched. Yet, this medico-legal rigour fuels burnout. “It almost feels like it’s a battle now, and you almost approach it knowing that it’s going to be fought back. Another factor leading to burnout and to stress amongst the profession. And also, obviously, burnout and stress for participants that are constantly battling these things as well.”
Sector professionals emphasise that “transparency matters more than convenient silence,” with calls for Freedom of Information requests to unlock the report. Sustained pressure from advocacy groups could force its release, “especially if withholding it looks like a cover-up,” Collison said.
A call for real partnership
As NDIS costs balloon and reforms accelerate, such as Thriving Kids or plan exclusions, Collison’s core belief endures: “Empowered practitioners create better outcomes.” The hidden IHACPA recommendations, buried under “public interest immunity,” symbolise a deeper malaise: cost-cutting over quality care and safety for participants.
Yet, in sharing stories from Nhulunbuy to Hobart, the snapshot proves the sector’s wisdom is vast. Releasing the full report is not just transparency; it is a lifeline for sustainable, equitable services. For Collison, the path forward demands transparency.
“If we actually opened up and had a more holistic view about this, we may not get the savings the government wants right now, but we might get more long-term sustainable cost savings.”
Until then, OTs like her will keep advocating for an NDIS that is navigable, not overwhelming. “Why is this so hard to take the time to actually do genuine co-design and to actually genuinely collaborate?” Collison asked. The silence may speak volumes, but voices like hers ensure it is not the final word.
