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This year has been an exciting one with many changes developing and a disappointing one. Let's not dwell on the negative but move straight into the summary of the years activities.
Firstly the private practice unit at South African Medical Association has become a body which has increased its involvement in negotiations with Government, in the Department of Health, with the Council for Medical Schemes, and with funders (BHF and individual funding organizations).
The stance of the PPU has been to constructively engage rather than confront in an effort to bring better working conditions and fair remuneration to doctors. This has been through the Worth of the Doctor forum, the establishment of accurate cost of practice figures (successfully done by the ENT and psychiatry groups so far), negotiations around the NRPL and CON, the rationalization of codes for services rendered, the cross referencing of local coding with the CPT4 codes.
Further it must be appreciated that Government is trying to get affordable healthcare to all citizens by way of making medical care more affordable and accessible. These aims are noble and well intentioned. Reference to this was in the The Freedom Charter of 1955, reaffirmed in the Constitutional Principles for a Democratic South Africa and finally entrenched in our Constitution,
" Everyone has the right to have access to:
- healthcare services including reproductive healthcare
- sufficient food and water
- social security, including, if they are unable to support themselves and their dependents, appropriate social assistance."
The casualty of this process may well be private practice. In order to prevent this we have to embrace the goodness of these proposals and work with government to achieve these aims. By this manner we can hopefully end up in a win/win situation and also have an increasing say in the practice and distribution of medical (cardiological) care. The enemies are disease and poverty not Government and in the bigger picture they must be addressed to ensure a future for all South Africans. Constructive engagement is the way to go forward.
Specifically in the domain of cardiology we have started the cost of practice survey with a varied response. It is imperative that accurate figures are produced to allow a fair fee to be developed. If we do not support this then our fees will be set for us based on perceived worth and funding constraints. Healthman is the company we appointed and should they contact you please give them as much information as possible. It is confidential and, if you wish, anonymous. Generic information will be generated and will not trigger audits of practices.
Secondly coding has become a big issue. Adding a new code has to be fully rationalized and supported by relativities, time usage, equipment costs and degree of complexity. Much of this work has been done already by Stanford University resulting in the CPT coding system. All new and old codes are being cross referenced to the CPT system to ensure a fair fee with appropriate relativities. It has been suggested, and is being considered to change cardiology coding to the CPT4 system as opposed to adjusting all our existing codes to bring them in line with CPT4 relativities etc. This obviously needs input from the cardiology group at large, if we are to have a say in the fee structure and value.
The certificate of need continues to be a distant threat but don’t lose sight of it.
We also need data. Without accurate statistics, in medicine in general and in our own discipline we cannot negotiate or plan for the future. It must be emphasized that with data areas of weakness can be addressed, training implemented, quality maintained and fees negotiated. To this end both the cath lab data project and introduction of ICD 10 coding should help considerably.
Issues of credentialing are becoming important with funders with regard to certain procedures. We as a society must ensure that adequate guideline are in place and sufficient peer review takes place for members to know where they stand in relation the practice of cardiology. These matters are being dealt with by the Education and Ethics and Guidelines committees.
I would encourage you all to contribute as much as possible to the PPC and to the South African Heart Association over the next year. Much needs to be done but it needs input to be able to reflect accurately the sentiment of the cardiology community of South Africa.
A Stanley
Chair: Private Practice Committee, SA Heart
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Annual Report of the Full Time Salaried Practice Committee 2005
Committee Members:
Prof AF Doubell (Chairperson)
Dr E Brice, Dr J Brink, Prof P Manga, Dr D Schutte, Prof K Sliwa
The committee met (teleconference) twice during the year – on the 14th February 2005 and the 1st August 2005. The following matters were addressed:
- Training in Cardiology and Cardiothoracic Surgery.
- Education Subcommittee for Heads of training institutions.
- The SA Heart Cathlab Registry.
- SA Heart, the Journal of the South African Heart Association.
- Appointing foreign cardiologists.
- Waiting lists in State Hospitals.
Training in Cardiology and Cardiothoracic Surgery.
The three year training program in cardiology was finally accepted by the College of Medicine of South Africa (CMSA). Following the endorsement by CMSA, the Health Professions Council of South Africa (HPCSA) finally accepted the three year training program for cardiology.
Despite a possible surplus of cardiothoracic surgeons in the country, the state sector is still finding it difficult to attend to the needs of the indigent population. The committee undertook to convey these discrepancies to the HPCSA.
Education Subcommittee for Heads of training institutions.
The Committee for Heads of training institutions, a sub committee of the Education committee, carries the responsibility for implementing the training regulations referred to above. This sub committee did not meet last year and the Full Time Salaried Practice Committee lobbied the Education Committee to ensure a meeting in 2005. A meeting has been scheduled for the 16th of October. Issues identified that will be discussed include: consistency regarding training posts (training in consultant vs. registrar posts), logbook requirements, final logbook certification before CMSA issuing the Certificate in Cardiology, accreditation of training centres and the hosting of cardiology examinations.
The SA Heart Cathlab Registry.
The Committee views the registry as an important initiative of SA Heart with significant potential benefits to academic units. The progress with the development was monitored. The initiative has gained momentum over the second half of this year and will be ready for launching at the SA Heart Congress in October.
SA Heart, the Journal of the South African Heart Association.
SAHeart will be issuing its 7th quarterly publication at the October congress. The Journal has been well received and has maintained a high standard. To date the Journal has focussed on reviewing selected topics by invited authors. The editor has initiated a drive to draw original papers for peer reviewed publication and members are urged to submit their research work to SA Heart.
Appointing foreign cardiologists.
A number of academic units are understaffed and in specific cases the appointment of foreign cardiologists may assist in alleviating the problem. However, bureaucratic red tape often delays and hampers such appointments. HPCSA was urged to find more efficient ways of fast tracking such appointments. A new mechanism has indeed now been implemented by the HPCSA to assist in this regard.
Waiting lists in State Hospitals.
Lengthening waiting lists for cardiac surgery is a problem in many state hospitals. It is recognized that multiple factors impact on surgical lists and clear solutions are not evident. However, the committee felt that most of the Provincial Health Departments were aggravating the problem by not acting decisively to improve the situation and the committee undertook to bring this to the attention of the authorities and to apply pressure to ensure that the situation is corrected.
Anton Doubell
Chairperson: Fulltime Salaried Practise Committee, SA Heart
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Annual Report of the Ethics & Guidelines Committee 2005
Guidelines are time consuming and expensive to produce. Sponsorship from vested interests can lead to allegations of bias and lack of objectivity.
At the last AGM it was agreed that the SA Heart association will seek Affiliate Membership of the European Society of Cardiology and follow and recommend the Guidelines of the European Society.
The Constitution of the European society has been duly amended and we await the ratification of our membership.
The committee had one telephonic conference during the year under review.
Now that special interest groups have incorporated into SAHA it will be important to have these groups to contribute to modifications of Guidelines to suit the South African situation. Several pocket guidelines are available from the European Society and members should avail themselves of these.
Abdul Mitha
Chairperson: Ethics and Guidelines Committee, SA Heart
Annual Report of the Education Standing Committee 2005
The Education Standing Committee has dealt with a number of issues, mainly by e-mail. These include requests from HPCSA for advice regarding eligibility of individuals for registration as cardiologists, and endorsement of meetings.
A face-to-face meeting of elected members of the Education Committee, together with the subcommittee of the heads of training units, is to be held during the SA Heart/CASSA Bergrhythms congress in the Drakensberg in October. Issues to be discussed include cardiology training, examinations and travel grants for trainees.
A new committee will be elected before the SA Heart AGM. My term has come to an end, as I will not be standing for re-election. I would like to thank my fellow committee members for their support and input.
Rob Scott Millar
Chairperson: Education Committee, SA Heart
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