|
This year was again occupied with practice cost studies and trying to get a realistic based on which to determine cardiology fees. It was again difficult to get adequate and ongoing input from individual practitioners. We still only have a 20% return. A rough list was submitted based loosely on the American system and the existing DB. Trying to reach an equitable unit value is difficult. The high cost of equipment remains problematic in that some practices use high end equipment and others prefer the second hand market. This leads to obvious inequities.
Billing:
The DBM will be published later these year due to delays in the DOH publishing the NHRPL. The manual will include all the different lists for comparison and guidance.
Certificate of Need:
No further information is available but it is a continued worry as to the final outcome of this piece of legislation.
Department of Health:
There is ongoing effort to maintain links with and exert influence on the DOH,. This has mainly been driven by the SAMA board. There is some disquiet in that the medical practitioners may not be receiving the strongest representation at this level. The PPC has formed a section 21 company whose aim will be to more completely represent member interests while maintaining strong ties with the parent body. Hopefully this will be a more agile organ in terms of member interest and exert more appropriate influence on the DOH.
ICD10:
Still no consensus has been reached regarding patient confidentiality and the ICD codes. In general it is felt that not enough is being done to safeguard patient interests. The other issue is the quality of information being generated by the use (or misuse) of codes to inlock patient benefits. Initial statistics should be made available in order to highlight these deficiencies.
PMB and benefits:
An interesting court decision was made regarding the payment for PMB conditions at the HPCSA rate. This will lead to an amendment to the regulations in the near future.
Fee structure:
This is ongoing and report-back from independent actuarial companies regarding the most suitable fee structure for South Africa are about to be released. The DOH is keen on an Australian based system because of the linked DRGs. It is imperative that , we, as practitioners influence this process. The PPC is very active in this regard.
DOH Indaba:
This was held earlier in the year and private practice and the private hospital groups were subjected to a fair amount of denigration. Perceived as too expensive for South Africa, the HPCSA spokesperson Advocate Mkhize recommended that the minister should not just rock the private practice boat but capsize it! Interesting.
Membership of medical schemes:
Trend is towards people buying down i.e. choosing the lowest scheme. How will the different groups deal with this? This will impact on office based practice and to a degree on hospitalization. This is a concern regarding the affordability of appropriate care e.g. chronic medication for chronic conditions.
Finally, the emergence of the Specialist advocacy group has weakened the profession as a whole by further fragmenting and dividing the profession. At this time we should be united in trying to maintain our autonomy as a profession. We are rapidly becoming a toothless gaggle of internecine groups. If a member makes a legitimate challenge he is not supported by the group but a ‘colleague’ will step over him and supply the service and meet the conditions demanded by the funders. This principle of divide and rule, as ably applied by all our detractors, will result in the demise of professional autonomy.
Anthony Stanley, Chairperson
top of page
Annual Report of the Full Time Salaried Practice Committee 2007
Committee Members: Prof P Manga (chairperson), Prof F Smit, Dr J Hewitson, Dr M Makotoko, Prof K Sliwa, Dr E Brice
Training : Problems with training in almost all training programmes (adult & peadiatric Cardiology and Cardiothoracic Surgery) exist to some degree. The perennial problem of staffing, equipment and other resources at academic hospitals have been highlighted in the past but there does not appear to be an easy solution in sight. Many training units have used the private sector to fill in gaps. The committee believes that the public-private partnerships should be encouraged especially in areas which strengthen training.
Staffing: Last year the committee proposed 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. The committee is in the process of drawing up a format of a database to be used for this survey. Once the format of the database is finalized it is hoped that SA Heart would fund the survey. It was felt that only a proper human resources audit in the public sector will convince the Health Department of urgent staffing deficiencies for the various cardiological services in the country.
Cardiothoracic Surgery: Cardiothoracic surgery is still going through difficult periods at some training institutions. It is hoped that the proposed survey will help highlight some of the problems experienced by Cardiothoracic surgical units with regards to resources.
Cath Lab Registry: Very few of the cath labs in the public sector are on line. It is hoped that as SA Heart continues its rollout more of the labs would be involved in the registry. Prof Francis Smit is principally involved with the surgical registry and hopefully that rollout would occur soon.
Pravin Manga, Chairperson: Fulltime Practise Committee, SA Heart
top of page
Annual Report of the Ethics & Guidelines Committee 2007
Committee Members:
Dr AJ Dalby (Chair),
Dr MJ Bennett,
Prof R Essop,
Dr RH Kinsley,
Dr N van der Merwe.
Activity: During the year under review, the attempt to publish the ESC Guidelines, accompanied by the commentary of local experts was abandoned due to the high cost. As the full text of all the ESC Guidelines are to be found at escardio.org/knowledge/guidelines, all interested parties should obtain access through the SA Heart website link to the ESC.
This year the ESC has produced updated Guidelines on:
- Valvular Heart Disease
- Diabetes, Pre-Diabetes and Cardiovascular Disease
- Endomyocardial Biopsy
- The Universal definition of Myocardial Infarction
- Cardiac Pacing and Cardiac Resynchronisation Therapy
- Arterial Hypertension
- Cardiovascular Disease Prevention and
- Non-ST Elevation Acute Coronary Syndromes
Based upon a number of published international opinions, SA Heart issued a statement on the duration of clopidogrel therapy after acute coronary syndromes and after coronary stenting which was distributed to the National Department of Health and the funders of private medical care. While a positive response was obtained from the majority of funders, Medscheme’s committee chose to reject the recommendation and have indicated that they await SA Heart’s response to their decision.
Assisted by Prof FJ Raal of LASSA, I held a meeting with Discovery to discuss the need for more aggressive lipid-lowering therapy in secondary prevention and in diabetics. The use of carotid IMT to identify atherosclerosis was accepted as was the use of ultrasensitive CRP to decide upon therapy in patients with borderline LDL cholesterol levels. Discovery undertook to review their LDL target in secondary prevention.
I have also assisted the committees concerned with CT Coronary Angiography and the SA Heart Cath Lab Registry.
In Vienna I represented the Association at a meeting of Affiliated Societies with the ESC President.
Dr AJ Dalby, Chairperson
Annual Report of the Education Standing Committee 2007
Committee members:
T M Mathivha(Chairperson),
J Brink,A Cilliers,T Mabin, P Mntla, J Patel
The education committee had two meetings in the past year - 29/10/2006 (Face to face meeting with the heads of training institutions) and 12/09/2007
(Teleconference). The following issues related to several areas of activities were discussed:
A. Matters pertaining to Education and Training
1. Cardiology Certification Program -
Introduction of Multiple Choice Question format - The possibility of introducing an MCQ type examination as part of the written component is not feasible at present due to lack of infrastructure .Creating a question bank is a cumbersome process and there are also security concerns to be considered.
2. Accreditation of new training sites - Greys Hospital ( Pietremaritzburg) is now recognized as a satellite training site for adult cardiology with linkage to the Inkosi Albert Luthuli Central Hospital.
3. There is a greater need to formalize and strengthen the public-private partnership that currently exists. This will go along way in ensuring that the technical skills and technology support that may be lacking in the tertiary public institutions is easily accessed for training and skill acquisition purposes.
B.Travel Grants and Research scholarship recipients
Dr S Khan -- Research scholarship (2006) R50,000.00
Dr J Hewitson -- Travel Grant (2007) R10,000.00
Dr V P Vaghela -- Travel Grant (2007) R10,000.00
Dr Tibazarwa -- Travel Grant (2007) R10,000.00
The education committee will meet face to face on the 23/11/2007 to discuss all matters pertaining to training and other matters of interest.
Food for thought:
Total numbers of HPCSA accredited training posts:
Adult Cardiology 28 (2 vacant)
Paeds Cardiology 7 (no vacant posts)
Cardio- Thoracic surgery approx. 36 (Figures incomplete)
Tshimbi Mathivha
Chairperson: Education Committee
top of page |
