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FCPSA Progress Letter

1 March 2011

Dear Colleagues

Re: Progress in Faculty of Consulting Physicians of SA

Over the past year I have had the opportunity at meetings, conferences and social events, to make contact with many of you and it struck me again that so many of you are still oblivious as to the purpose but also achievements of this association in the past.

Why should you bother? What benefit will you see in your practice? Is it again money disappearing into a black hole?

Hopefully as you read further you will hasten to join formally and to pay your contribution without which we are dead in the water.

1. Reference price list

As you might have read in the press, the court case which we participated in as one of several associations to challenge the validity of the reference price list in its present form was won by ourselves and more so, we were awarded costs by the presiding judge.

At no time did we ask for this issue to progress to the courts. This simply happened after numerous meetings with the assigned colleagues of the Department of Health (DoH) ended in a stalemate. The societies tried to the last day before the case was finally heard, to achieve some kind of compromise, but to no avail. This was very unfortunate as the last thing we want to do is to antagonise the DoH.

At present we are still at a stalemate which has now involved the coding structure as well. Each medical aid now has their own price list which is really confusing and has caused major hassles with the various software programmes. Our attempts to engage with the minister of Health have been unsuccessful so far and SAMA has continued their discussions independently, despite SAPPFs best attempts at an amicable solution.

SAPPF is reviewing and responding to the latest proposals by the Council of Medical Schemes on the determination of prices in the private sector.

We have stated on numerous occasions and in various forums that we understand the Funders cannot adjust our fee structures in the short term, but it is a matter of principle for them to concede that we are grossly underpaid for services rendered and unfairly so. This concept is also not accepted by the DoH as I see it. Some colleagues unfortunately exploit the situation and do overcharge which creates a very unfavourable environment for negotiations to take place.

We are presently trying to negotiate some practical solutions in the interim with a clear objective to achieving a more fair remuneration structure phased in over the next five years.

2. Tiered Consultations

The concept of tiered consultations, especially for the consulting disciplines, remains a priority. We are also discussing the feasibility of a "discharge day" code which will allow fair remuneration of the inevitable prolonged consultation at the time of discharge of a patient. Although the concept has been considered by some funders, we are far away from them implementing this.

3. NHI and our role as physicians

Although exact details of the proposed NHI have not been clear, we fully support the principles of equitable healthcare whilst at the same time understanding that those who can will fund their own healthcare at a standard agreeable to them.

Many Specialists, who have been helping out at no cost in the public sector, were asked to leave the public sector over the last few years. This is regrettable because we need to harness all the academic ability we possibly can and not waste such a limited resource.

We will make ourselves available to assist with teaching and training of junior Doctors because they are the lifeline of medicine in South Africa. I have suggested that we involve junior registrars at our academic meetings in future to improve their exposure and also give them the opportunity of interacting with senior colleagues.

We need to find ways to use our expertise to attract young colleagues to our specialty and to make it an attractive career. This responsibility rests on our shoulders.

4. Clinical Governance

It has become a crucial issue to ensure good clinical governance amongst ourselves. No fingers should be pointed at us. We have to ensure ethical behaviour from every single specialist in private practice.

We have requested from the Funders details of any physician in whatever subspecialty or general physician to be able to speak to these colleagues to avoid tainting the entire profession. To date, no cases have been reported.

Does this mean that we are squeaky clean? I do not think so, but still it is not as widespread as the press would like to report.

5. Coding

The SAMA Doctors Guide to Billing (DBM) has been released in electronic format for 2011 but the new codes were not finalised as per SAPPF recommendation. Approximately 600 codes were assessed by the SAPPF / SAMA committee for validation. SAMA had a meeting with the Competition Commissioner (CC) to clarify the issue of anti- competitive behaviour in producing a guide to billing. They did this without informing the SAPPF. From their communication it is still not clear what the CC position is on this issue. SAPPF has also met with the CC and will be making a submission in the next four weeks.

We had a great meeting with the Funders on a new coding system late in 2010 and hope to find a positive response from the DoH on this initiative to compile a new South African procedure coding structure which will be able to better describe our procedures and consultations and avoid incorrect billing. This is also under scrutiny by the CC and will have to be acceptable to them before we can proceed. We seem to be the only profession who cannot determine a structure to act as guide to billing. Time will tell.

Once this is in place, the fee structure will be the next step, an issue which will need to be considered by the Competition Commissioner to avoid any possible pitfalls to be interpreted as anti-competitive behaviour.

6. Physicians Conference

There will be a Physicians Conference on an annual basis. Members of the FCPSA will be invited first as we want to reward those colleagues who have supported this crucial endeavour financially but also by their commitment to the issues at hand.

We are able to host this conference through an ongoing educational grant from Pfizer. Without them it would not be able to happen.

7. CMS and PMBs

We have spent several days at the council for Medical Schemes to discuss the PMBs and the code of conduct of providers, funders and the CMS themselves. In 2009 we were involved with designing updated algorithms for 10 PMB conditions, and the second group will be assessed in October / November. These meetings are crucial as we are able to bring evidence based medicine to the table to motivate appropriate revisions of the PMB algorithms.

During 2010 a further round of meetings focussed on cardiology, oncology and vascular diseases. So far the 2009 changes have still not been implemented so 2010 will probably be even further delayed. At the same time it is crucial that we participate to ensure there are evidence based guidelines of best practice and not just what the public sector can afford!

There has also been a discussion on a discharge summary to be done for hospitalized patients to ensure an accurate record exists as well as ensuring more accurate ICD 10 coding. This is in the process of being implemented in Netcare Hospitals and I would encourage colleagues at other private hospitals to do the same.

I was elected by the Board of Directors to serve as CEO again in 2011. We include herewith, the list of the Directors for your information.

Region Directors Discipline Email
S Gauteng Dr Adri Kok Specialist Physician adrikok@vodamail.co.za
  Dr Hendrik Vermooten Specialist Physician hvermooten@mweb.co.za
  Dr Nivesh Sewlall Pulmonologist sewlalln@medicine.wits.ac.za
  Dr Hilary Carman Dermatologist hilaryc@wol.co.za
N Gauteng Dr Elsa van Duuren Rheumatologist evduuren@mweb.co.za
  Dr Wiebren Duim Neurologist neuro@duim.co.za
KZN Dr SABS Abdool-Gaffar Pulmonologist docsabs@mweb.co.za
  Dr Andrew Ramdass Specialist Physician ramdassas@ispace.co.za
  Dr Aslam Amod Endocrinologist amod.trials@telkomsa.net
N Cape Dr Joseph Mynhardt Specialist Physician joseph@mynhardtkim.co.za
Free State Dr Freek Bester Specialist Physician fcjbester@bestgib.co.za
W Cape Dr Roy Spammer Specialist Physician rspammer@mweb.co.za
  Dr Hilton Kaplan Endocrinologist hkmd@ct.stormnet.co.za
Mpum/Limp Dr Frans Theron Specialist Physician theroninterniste@gmail.com

If you have not yet joined FCPSA and SAPPF, please complete the Membership Application and ACB authority and fax it to 011 782 0270. I look forward to your support but especially your willingness to become a member and so support the issues that affect your practice every single day.

Please do not hesitate to contact us should you have any questions.

Kind regards

DR ADRI KOK
FCPSA: CEO

MBBCh (Rand) Dip PEC (SA) FCP (SA) MMed (Int. Med) FACP BTheol
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