Annual Report of the Private Practice Committee 2006

Members: Drs A Stanley, C Corbett, J Harrisberg, R Kleinloog  &  A Snyders.

This year has been an interesting one and a frustrating one! The following are highlights of the year:

Practice cost studies: These were completed after a great deal of cajoling. Unfortunately we had a limited response (approx 20 responses) and these were used. A wide range of costs were reported and various actuarial deductions were made. The spreadsheet of the cost analysis and proposed structure is available on the website or on request. The DOH has however not finally decided on which system, if any, to adopt. The reason for the change is that they require a system that is accurate, defendable and based on the true cost of supplying the service.

NHRPL: The publication has been delayed as the DOH has taken over this function from the CMS and certain regulations have to be in place before they can be published. SAMA had been excluded from the process and lodged an appeal as to the legality of the process. This was accepted by the DOH. They delayed publishing until the regulations are in place. However the legality of the NHRPL is also being questioned. AND if the NHRPL is illegal then the suggestion by CMS that the 2006 NHRPL be used with a 4.9% increase is also challenged. The DOH have said that the regulations would be ready within possibly two weeks and thereafter there will be a three month period for comment by interested parties. SAMA will have its cost based billing system ready and submissions will be made. If the NHRPL is illegal then what should be used for next year?

SAMA proposes - to challenge the legality of the NHPRL process; - that the guide to billing, The Doctors Billing Manual be published with the HPCSA guide as well as a column which practitioners can populate with their fee as estimated using their own practice costs; -to lodge a complaint with the competitions board re indirect price-fixing by industry.

Medical funders: Funders continue in their quest to cut costs while still providing their shareholders a handsome profit. Some contact has been made with the medical advisers group and hopefully this will be productive. The proposed increase is CAPIX added to last year RUV. The funders have to publish the benefits offered in different products by 30th October 2006.
           
CPD:  HPCSA says it is launching the new system and will be built on trust. Practitioners must keep a record of activities completed.

All in all an exciting year but cardiologists need to stick together and be willing to work together towards a better deal and more effective dealings with the Department of Health and funders.

Anthony Stanley
Chair: Private Practice Committee

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Annual Report of the Full Time Salaried Practice Committee 2006

Members:  Prof P Manga (chairperson), Prof F Smit, Dr J Hewitson, Dr M Makotoko, Prof K Sliwa, Dr E Brice.

Training regulations:  Changes to the adult cardiology curriculum, which were adopted at the SA Heart meeting in Drakensberg, have been formally accepted by the College of Medicine and have been included in the new regulations for Adult Cardiology training. A similar change as recommended by the paediatric cardiology group is currently pending. Unlike adult and paediatric cardiology there is no single unified exit examination for cardiothoracic surgery. It is going to require a combined effort of various university bodies as well as the Cardiothoracic Society and the Cardiothoracic Special Interest group of SA Heart to formalize an agreement for a single exit examination for cardiothoracic surgery.

Staffing:  This is a perennial problem affecting every public hospital or academic institution in South Africa. It was suggested that a study group be formed to get an overview of the current and projected work loads not only for adult cardiology but also paediatric cardiology and cardiothoracic surgery. It was felt that only a proper human resources audit in both the public and private sectors will convince the Health Department of urgent staffing deficiencies for the various cardiological services in the country. It was also agreed that such a survey will be somewhat a costly exercise and thus it will have to be funded by SA Heart. A proposal for this funding will be put forward at the SA Heart Annual General Meeting on the 30th of October 2006 in Cape Town.

Cardiothoracic  Surgery:  It was highlighted again that Cardiothoracic Surgery  was going through extremely difficult periods at some training institutions. The proposed cardiological survey will help at addressing some of the problems experienced by Cardiothoracic surgical units with regards to resources. However, there were local issues at play at some of these centers and these needed to be resolved locally and possibly the Cardiothoracic Society could help in this regard.

Pravin Manga
Chairperson: Fulltime Salaried Practise Committee

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Annual  Report of the Ethics & Guidelines Committee 2006

Members: Dr AJ Dalby (Chair), Dr MJ Bennett, Prof R Essop, Dr RH Kinsley, Dr N van der Merwe.

During this year the Committee has been engaged in the publication of the European Society of Cardiology’s Guidelines which have been adopted by SA Heart Association.  This capacity was granted to SA Heart Association when it was accepted as an affiliate member of the ESC.

Last December, various Societies and individuals were approached to review various Guidelines.  They have been requested to produce a written commentary which, where necessary, adapts the Guideline to local circumstances or indicate advances in practice norms that require its modification.  The table at the foot of this report indicates the names of those Societies and individuals who have accepted this task as well as the E&G Committee members who facilitate the process.  Thanks go to all concerned.

To date, the Heart Failure Society and LASSA have produced commentaries respectively on Acute Heart Failure and Chronic Heart Failure, and Cardiovascular Disease Prevention, which have been published in tandem with the ESC texts as supplements to SA Heart.  Especial thanks go to Prof K Sliwa-Hahnle, Dr E Klug and Prof F Raal for the energy they put into the project.

The Committee has informed the Department of Health and the Board of Healthcare Funders of its acceptance of the ESC Guidelines and indicated to them that the full text of  these Guidelines are to be found at escardio.org/knowledge/guidelines

This year the ESC produced updated Guidelines on Chronic Stable Angina and on Atrial Fibrillation.

SA Heart members should be aware that a total of 33 Guidelines or Statements are presently to be found on the ESC website.  The reprinting of these by SA Heart Association is expected to take some years.  Therefore, members are advised to access Guidelines either directly through the ESC website or via the link from SA Heart Association’s website.

Dr AJ Dalby
Chairperson: Ethics and Guidelines Committee

 Annual Report of the Education Standing Committee 2006

Members: T M Mathivha (chairperson), J Brink, A Cilliers, T Mabin, P Mntla, J Patel.

I  have taken over from Prof Rob Scott Millar as the chair of the Education Committee. The Education committee had two meetings in the past year - 16/10/2006 and 25/01/2006 (teleconference). The following issues were discussed:

A. Matters pertaining to the cardiology Certification programme

1. Log book requirements - changes to the logbook requirements were suggested and these have now been implemented through the College of Medicine regulatory processes.
2. Training - use of the private sector technical experts in training is encouraged where such expertise is not available on site (i.e. electrophysiology and percutaneous interventions).
3. Certification examinations - the frequency of examinations remains twice a year to allow unsuccessful candidates to sit again for the examinations after six months.The committee is exploring the possibility of introducing an MCQ examination format as part of the evaluation in the future.

B. Grants and fellowships

Names of members awarded scholarships and grants should be made known to the committee on a regular basis.

The education committee will meet face-to-face on 29/10/2006 to discuss all matters pertaining to training and other matters of interest.

Food for thought: Currently there are 30 HPCSA accredited adult cardiology training posts nationally - however due to the shortage of supervisors only 18 are filled. (Unfortunately I do not have total numbers for paediatric cardiology and cardio-thoracic surgery).

Tshimbi Mathivha
Chairperson: Education Committee

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