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News

At their meeting held in Johannesburg on June 28th, 2013, the NASA Executive elected Lawrence Tucker to the office of president. The office of secretary has been left open. Dominic Giampaolo was elected vice president and treasurer, while Dali Magazi, Dave Anderson and Wiebren Duim were elected respectively to the newly created portfolios of education, private practice and ethics. (LMT)
It is anticipated that the number of ethical issues referred to NASA for consideration will continue to increase, as has been the case in the past few years. It is for this reason that your NASA Executive Committee has unanimously decided to create an Ethics Portfolio. This portfolio will be headed up by Wiebren Duim.

In the past, referrals have come mostly from the Health Professions Council of South Africa (HPCSA), the Board of Health Care Funders (BHF), individual medical aids (such as Discovery), patients, and so on. Matters referred for consideration of the Ethic’s portfolio will include, but will not necessarily be confined to, any issues relating to medical malpractice, bringing the neurology profession into disrepute and the review of unusual billing practices. It is anticipated that when such ethical issues are referred to NASA in the future, the head of the Ethics Portfolio (Wiebren Duim) will set up an appropriate NASA ethics subcommittee to consider the particular issue, which subcommittee will consist of NASA executive committee members and other co-opted NASA members depending on the nature of the issue.

The NASA Executive Committee has approached Professor Roland Eastman, Professor Pierre Bill, Professor Vivienne Fritz, Professor Amed Bhigjee and Dr Johan Smuts who have all agreed to be co-opted and serve on the NASA Ethics subcommittee, should this become necessary in the future. These NASA members were chosen based on their respective experience and/or expertise. (LMT)
Your NASA Executive Committee (ExCo) has elected Dave Andersen to head up the newly formed NASA Private Practice Committee. It is clear that there is a great deal of work to be done in this portfolio

The NASA Executive Committee has identified the ongoing project to calculate representative running costs of South African specialist neurological practices as the most pressing issue requiring attention under this portfolio. This is especially important because accurate assessments of specialist neurology practice costs will materially affect the future estimated monetary value of neurology procedures codes and, in particular, assist in establishing fair and equitable charges for specialist neurological consultations.

To this end, a private consulting firm, Healthman, was some years ago appointed by NASA to undertake a study in order to determine average costs of running a specialist neurological practice. The process has been long, fraught and costly for NASA, with few useful results. Information from approximately 40 practices is required before Healthman will be able to determine representative specialist neurological practice running costs. Professor Eastman has kindly agreed to continue assisting the NASA Committee with this issue and the Committee has unanimously agreed to co-opt him to the Private practice Portfolio.

With respect to neurological procedure codes, these still remain problematic and require NASA attention. Review and refinement of these codes will require involvement of SAMA and/or the SAPPF. (LMT)
However, your NASA ExCo is of the opinion that a substantial increase in NASA subscription fees will be necessary next year.

NASA ExCo is carefully studying the potential benefits and related costs of joining the South African Private Practice Forum (SAPPF). SAPPF represents, lobbies for and negotiates on behalf of a large proportion of South African medical and surgical specialists; and in particular those belonging to the smaller disciplines such as neurology.

SAPPF has a track record of significant successes including their legal action which led to the setting aside of the National Health Reference Price List (NHRPL). Membership of SAPPF amounts to R1,000-00 per NASA member at present. Therefore, if NASA decides to join SAPPF, then NASA fees will increase by at least this amount (i.e. to at least R1,200-00) next year. (LMT)
This meeting has been running for the past 11 or so years and has become very popular with the registrars. It is organised by Profs Carr and Heckmann, together with Dr Sue Tager of the Donald Gordon Institute. The meeting is not aimed as a crash course to prepare candidates for the College examinations. Rather, it is designed to provide the opportunity for South African Neurologists with particular specialist interests to discuss their field of expertise.

In the past, the meeting has been largely funded by Sanofi, but more recently the Donald Gordon Institute and NASA have also contributed financially. In 2012 NASA donated approximately R 70,000-00 and has committed itself to providing up to R30,000-00 for this year’s meeting which will be held in Johannesburg in November.

The organisers of the Registrar Teaching Weekend point out that this meeting is not restricted to registrars only and that NASA members in private practice are welcome to attend. For further details contact Sue Tager (sue.tager@mediclinic.co.za). (LMT)
In order to qualify as specialist neurologists in South Africa, candidates now have to obtain an MMed research qualification, as well as be successful in both the College of Neurologists’ part one and part two clinical examinations. A University MMed qualification in neurology alone no longer qualifies a doctor to practice as a specialist neurologist in this country. Consequently, the College of Neurologists has been put under pressure to examine more candidates every year. Each year the College draws up a list of potential examiners and a significant proportion of these potential examiners are neurologists in private practice. The NASA ExCo would like to encourage members to act as external examiners for the College of neurologists, if requested to do so. In turn the College has agreed to minimise negative impacts on such neurologists’ private practices by, for instance, inviting examiners from the same city in which the examinations are taking place. (LMT)
NASA has tried to complete a practice cost analysis since 2009. Most of you should have received e-mails from Prof Eastman in this regard in the last 12 - 18 months. Thank you to everyone who took part and submitted their expenses to the independent consulting agency - Healthman. For more information about Healthman go to www.healthman.co.za.

Not enough submissions were made to the agency and the analysis cannot be completed. We've only had 29 submissions from 69 full-time private neurologists and these submissions will soon be outdated.

Why do we need a practice cost analysis?

Since the NHRPL fell away in 2003/4 there has been no formal supervision to medical billing. Neurologists have perforce been billing independently to each other. This has not presented a problem to date, but times are changing.

All other specialities have banded together and conducted practice cost surveys. This outlined their costs and allowed them to understand in greater depth where their deficiencies lay. For example they identified their ever increasing medical insurance fees needed to be included into their rates. They were also able to justify increases in general fees.

Without a cost analysis we cannot generate a complete picture of private practice in South Africa and we are stuck with medical aid rates that are 13 years out of date. Inevitably it's a complete disservice to our patients who pick up the shortfall of the actual cost.

Neurology in the big picture:

Four years ago the majority of specialists walked out of SAMA and the South African Private Practitioners Forum (SAPPF) was formed as a result. One of the major reasons for withdrawing from SAMA was the problematic coding process. At the time NASA was approached by the SAPPF to join, but we decided at an annual general meeting not to take them up.

The SAPPF went on to represent almost all specialists and have been dealing with the coding crisis and NHI for small associations. This kind of representation and experience is something NASA lacks. Dr Duim has worked hard to represent neurology in one of the subcommittees, but since NASA pays no membership fees we are not formally represented and our interests are not looked after.

Coding chaos:

Coding was in a mess long before the formation of the SAPPF. Recently the Competition Commission has further complicated matters in the coding process and created more confusion and disorder.

In response to these progressively urgent problems, a meeting was called between the Competition Commission, government, funders and specialist bodies (including the SAPPF and BHF) on the 10th of July 2013. For whatever reason, government and the Competition Commission did not attend the meeting. Despite this a few resolutions were made. It was decided a new body is needed to run coding and decide on the monetary value of each code. This body would of necessity be an independent non-profit organisation and representative of all stakeholders. Currently, neurology is not formally represented on any level in these proceedings. My deepest concern is that we will continue on our non-partisan path and eventually fall prey to our own inertia.
Bottom line:
  1. We need to get involved and engage with these issues to protect ourselves. At the most basic level this means completing the practice cost survey as soon as possible.
  2. We need representation on the SAPPF. This will cost each NASA member R1000 per annum.
  3. NASA membership fees need to be reviewed. Currently membership fees stand at R200 per annum and is way out of line with other professional associations. The majority of speciality associations pay between R3000 - R6000 per year for membership. This creates a robust body that more than adequately looks after its members.
  4. We need to create an active membership that engages with all these issues in a pro-active way or we will remain sitting ducks in a rapidly changing environment.
(DA)
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