Next year , patients will HAVE to again get used to seeing their FP FIRST, BEFORE making an appointment to see a specialist. Failure to do so will result in massive co-payments by the patient to the specialist, and even total rejection of the specialists account.
Once referred, the patient will be obliged to return to their FP for ongoing monitoring and continuity of care. And Specialists will be required to write discharge letters to the referring FP to assist him in doing so.
There will be no more popping your kid in to the “Paed” or “ENT” for a snotty nose, visiting the Gynae for a routine Pap smear, or seeing a “Orthopod” with a casual sore back.
The medical schemes and their administrators’ errors of the past 12 years,( based on greed and avarice to have as many numbers of lives paying subs and under administration at any cost) , have come home to roost and prove that open access to specialists, and hospicentric health plans, have merely served to force the cost to a medical scheme, into stratospheric proportions without commensurate improvement in quality of care.
Research by GEMS has shown that the cost to that scheme of patients seeing Specialists direct is massively higher than seeing their regular FP first. And GEMS will no longer put up with this!!!
They are leading the challenge, as the second largest medical scheme in RSA, with just short of 2 million lives. They will be working closely with IPAF leaders to redesign their offering to bring in what they call “Care Coordination” through the Family Practitioner.
Medscheme Administrators have fully identified with this new scenario, and will be assisting GEMS in their new challenge. The changed benefit designs will resonate with the Family Practitioner as access to the FPs will be markedly improved and enforced, through DSP arrangements with the profession.
FPs will be integral in managing preventative benefits, as well as screening of high risk patients on a 6 monthly basis.
Bankmed too has for a long time advocated this change in thinking and must be credited with the planting of the seed of preventative care into the mind of the industry and the profession. The concept has been further expanded upon by GEMS, and Medscheme and no doubt the clarion call will be picked up by all progressive thinking schemes in their 2014/15 benefit designs.
Those schemes which do not believe that specialist and hospicentric care will herald the death knell of the medical aid industry are, unfortunately living in the past and will see their reserves gradually dry up!
Gone will be the days when patients call in after 6 months on treatment to renew a prescription for a chronic medication and hold a gun to your head if you ask them to come in for a check up.
Dedicated preventative benefits too, will be written into the plan designs to empower you to contact every one of your high risk patients, from diabetics, to hypertensives, from cardiacs to lower back pain sufferers, to come in for their 6 monthly assessments, in terms of their plan design.
Pap smears , HBA1c’s, PSA’s, breast examinations and mammography, eGFRs, HIV screening, etc will be paid for from risk pool , and in GEMS further FP consultations will be available from their RISK pool even when other funds are deleted.
Limits on the number of primary care consultations will be significantly relaxed.
Colleagues, before you book a trip to Bali to celebrate, remember that none of this will automatically fall into your laps.
Schemes want the same from you as they did from specialists, namely highest quality for lowest cost (within reason). They want to know and will be able to measure that their beneficiaries are well looked after, that you know what you are doing , that your surgeries meet basic standards of accreditation, that you are up to date with your CPD, and that patient are comfortable visiting your practices.
Patients will be asked to nominate ONE Family Practitioner annually, and stick to him/her wherever possible. Emergency arrangement will, of course, be in place as will consultations away from home and nearer to a patients work.
YOU will however need to win the hearts and minds of your patients to nominate you as their preferred doctor.
IPAF has devised an accreditation form which will possibly serve as the basis for a scheme to say that you are acceptable to it and to the industry. The form is included in this newsletter, and you are encouraged to fill it in and return it to CPC/Qualicare, if you have not done so before.
IPAF has already received completed forms from over 2000 FPs who have completed it when filling in certain of the IPAF contracts to which it has been attached in the past.
Comfortable waiting room chairs, fresh magazines, clean fish tanks, friendly well trained receptionists and practice assistants, clean toilets with soap , water and disposable paper towels, clean linen on your diagnostic couches, nice smelling passages, newly painted walls inside and out, fresh flowers, neat desks in your consulting rooms, well dressed staff and doctors, with up to date computers, refrigerators for cold chain management, etc .
BUT most of all YOU NEED TO BE UP TO DATE WITH TRAINING. CPC/Qualicare runs clinical update courses all year. We are currently running a spirometry course, as well as a course in the use of Ambulatory Blood Pressure Monitoring devices. We provide you with free glucometers, clinical lectures, and stationery, as well as all your ethics points for the year and most of your CPD.
All you need to do is make yourselves available, attend our courses and read your newsletters and spend time with your Qualicare consultants when they call.
Colleagues, you are about to be restored to your rightful place in the HCDS of RSA.
RISE TO THE OCCASION AND ASSERT YOURSELVES
THIS IS YOUR TIME!!