2015 Tariff compilation
CPC/Qualicare welcomes all of its members back from their 2014 recess. This newsletter compilation which is dedicated primarily to the various offerings for 2015 made by funders in return for your consulting of their patients.
It is essential however, that you understand the following:
- Each practice is required to set it’s own tariffs with it’s patients, as there is no “NHRPL” in place.
- Neither Qualicare nor IPAF plays any part in negotiating these tariffs with medical funders, but merely compiles the offerings of the various medical aids and places them in an easily accessible format for you.
- You are neither compelled, nor advised to accept, or reject any of these tariffs and it is your individual prerogative to decide on tariffs, once having obtained your patient’s consent in this regard.
- Neither Qualicare nor IPAF accepts any responsibilities related to any errors or omissions in this compilation or for any losses you may incur as a result of information on the tables.
2015 CRYSTAL BALL OVERVIEW
2015 promises to be an exciting but challenging year with more and more funders requesting IPAF to form family practitioner networks for them. The purpose of these networks, in the eyes of the medical funders is to save on “downstream” cost.
You and we all know that family practitioners have not been responsible for the cost blow-outs experienced by large numbers of medical funders when looking at their expenditure on hospitals and specialists in 2013/14.
The costly habit of direct referral to specialists, by patients by-passing the FP, and open access to emergency units, run for profit by private hospitals and often actively supported by our fellow family practitioners who could no longer be bothered to cover their practices after hours, are the direct causes of the perilous situation.
But you, as a family practitioner are only able to curtail downstream costs when the funders have the guts to put their money where their mouth is.
By this we mean that they not only need to empower FP to save downstream costs, but they need to understand and quantify the worth of the FP in the healthcare delivery system of private medicine in SA. In order to save downstream costs funders, advised by IPAF, and lead by the example of Medscheme (especially GEMS) and Discovery as well as Polmed, Bankmed (and others in the pipeline), have brought in GP nomination for 2015. This means that patients will need to nominate the GP of their choice, and stick to that practitioner for between 6 -12 months at a time.
Should the patients fail to make this nomination, the participating funders will automatically allocate a FP to a patient based on their consumption of medical aid funds and pattern of consultation with FP for the preceding year.
Most GP nomination will be in full force by the end of March 2015. This will hopefully bring to an end patients deciding who their specialist should be and indeed whether they need a specialist or not.
The FP is thus put back into the “driving seat” of the healthcare delivery system in the private sector.
CPC/Qualicare will continue it’s upskilling programs throughout 2015, and reminds you that during 2014 we ran courses on ABPM monitoring, spirometry, antibiotic resistance, end of life care, as well as an extensive 20 lecture open day, to ensure that your skills remain honed and relevant. To enable you to take over coordinating patient care once again.
We now need to concentrate on the abuse of emergency units by patients who have found this loophole to bypass their FP and force the hospital admission, thereby having the encounter paid from the funders risk pool. This is a priority for 2015.
As you resume your rightful place as Conductor of the Medical Orchestra in 2015, please ensure that you pay close attention to our mass emails, visit CPC/Qualicare our website (www.docweb.co.za), consult the IPAF website(www.ipafoundation.co.za), attend our open day, as well as our upskilling workshops for 2015 and finally ensure that your practices and waiting rooms are clean, modernised, efficient and effective to enhance the doctor patient experience.
We are determined to preserve and maintain the position of the FP in this country. We will oppose hospitals attempts to employ practitioners into a vertically integrated HMO type arrangement, up to the highest level, as we firmly believe that our current FP healthcare delivery model is the best for this country, both private and public.
We are determined to expand the Private Family Practitioner model to cater for state patients and are directly involved in negations with provisional and central government to facilitate this stance.
We wish you a productive and rewarding 2015 and remind you to make the fullest use of CPC\Qualicare and all of it’s offerings in 2015.
Tony Behrman & QC Team