LATEST MHS WEB TALK
(Last update was: Monday, June 13, 2005 10:44:56 AM )

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1. DISPENSING UPDATE
The NCD are working on the papers for an appeal regarding the new dispensing laws.

They need to speak to a practice with more than one doctor, who dispenses in the main practice as well as from a different, satellite practice. They need to know what the doctors were required to pay for their application and the licenses.

If you are a doctor who has successfully applied for or know of someone who has applied for a so called "locum's license" please inform the NCD.

Confusion over dispensing law
The draft regulation that forced doctors to acquire dispensing licences came into effect on July 3 after a controversial court battle between the National Convention on Dispensing (NCD) and the Department of Health. The Council for Medical Schemes said that they were obligated by law to protect the rights of the public to ensure that properly recognised institutions treated them. Medical schemes were also by law only allowed to pay out to doctors who were properly registered. Medical schemes, however, had only received a list of those doctors who had applied for dispensing licenses and those who had already qualified in this category after the laws had been implemented. The Discovery Health managing director Barry Swartzberg said it would take a while to implement and check who were the licensed doctors. In September, Discovery was processing all claims, and was still seeking clarity on many issues.

2. SINGLE EXIT PRICE
The Cape High Court dismissed an application aimed at overturning the medicine-pricing regulations, saying it will benefit the South African consumer. The regulations will come into effect immediately. This means that the professional fee for pharmacists to dispense medicine will remain at a maximum of R26. The maximum professional fee for doctors is R16. In order to give providers time to update their systems, Medscheme will only start implementing the new Single Exit Price and the professional fees from 1 September 2004. Sovereign Health will implement the new pricing system from midnight, Friday 27 August 2004. Leave to appeal is being sought.

3. NEARLY 10 000 HEALTH PRACTITIONERS TO BE ERASED DUE TO NON-PAYMENT
The Health Professions Council of South Africa (HPCSA) is to erase 9 650 practitioners from the register for failure to pay their annual fees by 1st April 2004. These practitioners will be erased from register with effect from 31 August 2004, unless they pay their annual fees immediately. Practitioners who would like to find out about their registration status are urged to contact HPCSA on (012) 338 9300 / 9301.

Sources: 
GWYNETH PEERS for NATIONAL CONVENTION ON DISPENSING
Anusha Manilall Sovereign Health
Dean Mewse , Solutio Health Risk Management.
SAPA, 27 August 2004
Chriselda Lewis, Sowetan, 04 August 2004
Health Professions Council of South Africa

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ICD 10 Coding (2004/06/14) - You will receive Bankmed’s benchmarks for the period January 2003 to December 2003 via mail in the near future.  These benchmarks are also available on our website, where you can drill down to view the detailed transactions.  Click here to log in: www.mhs.co.za/loginmhs.asp, if you have previously registered alternatively, click here to register: www.mhs.co.za/register.asp.  If you’ve forgotten your password, send us an e-mail to: webmaster@mhs.co.za for assistance.

A comprehensive user manual is the latest feature on our website!  Just log in with your user name and password, and on the left side bar menu you will find the link – User Manual.

The following doctors won Sportman’s Warehouse gift vouchers on our website: Dr WA Botha and Dr ACP Coetzee.  Thank you for your feedback and participation!

As you are aware, a committee is currently discussing the International Classification of Diseases (ICD) 10.  We support their efforts and therefore include the following communiqué:

INTERNATIONAL CLASSIFICATION OF DISEASES (ICD) 10 CODING

POSITION OF THE COUNCIL FOR MEDICAL SCHEMES

1.            IMPORTANCE OF CODING

The Council for Medical Schemes and the National Department of Health support the implementation of ICD 10 in the public and private health sector. This is a diagnostic standard that has been adopted by the National Health Information System of South Africa (NHISSA) and is currently accepted by most parties as the coding diagnostic standard of choice.

ICD 10 Coding is important in that it allows for easy storage, retrieval and analysis of information for patient care, research, performance improvement, and planning and facility management. It also enables fair reimbursement for health care services provided and communicates in a predictable, consistent and reproducible manner. In addition, coding enables reliable communication about healthcare data among many participants in the health care industry.

It is indisputable that benefits provided by medical schemes can be most appropriately managed if those medical schemes have access to sound diagnostic data.  Accordingly,

3.            FORMATION OF AN IMPLEMENTATION TASK TEAM

The Council for Medical Schemes, the Department of Health and industry stakeholders formed a task team whose primary objective was to develop a strategic plan for the successful implementation of the ICD 10 in the public and private health sector.

4.            STRUCTURE OF THE TASK TEAM

The task team is the main decision making body and its functions entail the following:

·        oversight responsibility and monitoring capacity

·        industry readiness

In addition to the task team; there are three sub-committees:  operational, technical and training subcommittees.

Operational sub committee:

The operational sub committee is responsible for the following matters:

• Identification and recommendation of training institutions or consultants.
• Licensing issues
• ICD 10 coding manuals
• Privacy and Confidentiality
• Assessment of public and private sector readiness

Technical sub committee:

The technical sub committee is responsible for the following matters:

• Minimum training standards for ICD 10 coding
• Coding level
• Non diagnosing providers – scope of practice
• Primary vs. secondary diagnosis

Training subcommittee

The operational sub committee is responsible for the following matters:

• Minimum training standards
• Certification

Further Information

For more information please contact Patrick Matshidze at 012 431 0514 or e-mail at p.matshidze@medicalschemes.com

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Prizes and PMB's (2004/02/29) - We wish everybody a happy New Year, may this year bring you prosperity and happiness!

The latest Bankmed and NMP benchmarks for the third quarter of 2003 have just been released – so keep a lookout in the post, or logon to our website: www.mhs.co.za/loginmhs.asp!  If you have not registered just click here: www.mhs.co.za/register.asp and we will contact you with your user name and password. We have a competition on our website at the moment, so just complete the Doctor Feedback Competition form, and you could be eligible for fun prizes! Visit our website before the 27^th of February to participate!

The following doctors won the 3 prizes for the feedback competition in December: Dr WV Boyd won a picnic basket at the Spier wine estate in the Western Cape, Dr TJ van Wyngaard won a picnic basket at the Van Gaalen Cheese Farm in Gauteng, and Dr JM Rabinowits won a case of wine! Enjoy your prizes! Thank you for your participation and feedback! With regards to medical news, PMB or Prescribed Minimum Benefits have received a lot of attention in the media, so here are some of our thoughts on the topic:

Prescribed Minimum Benefits
(Dr Heather Rens)

Prescribed minimum benefits (PMB’s) are not new. They were first introduced in 2000 and at that stage centred around the provision of hospital cover for acute conditions. These regulations have been expanded to include 25 chronic diseases. The composition of the list is interesting in that the prevalence of the diseases varies greatly from relatively rare but high cost diseases to very frequently encountered disease complexes.

In the experience of many schemes and administrators this list accounts for a high proportion of members currently managed via chronic benefits. For these 25 chronic diseases schemes are obliged to pay for all non- hospital expenses and no co-payment should be incurred where care is provided by a designated service provider (DSP).

We include a list of the 25 chronic diseases for easy reference:

Addisons disease           Crohn’s disease                       Hyperlipidaemia

Asthma                          Diabetes insipidus               Hypertension

Bronchiectasis                Diabetes mellitus Type 1      Hypothyroidism

Cardiac failure                 Diabetes mellitus Type 2      Dysrhythmias

Cardiomyopathy             Multiple sclerosis                Epilepsy

Chronic renal failure          Parkinson’s disease           Glaucoma             

Coronary artery disease    Rheumatoid Arthritis          Schizophrenia

COPD                             Haemophilia                       Ulcerative colitis

Systemic Lupus Erythematosus

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