President’s Report 2014
Amendment of the Constitution of the Society
Since the inception of the current constitution in 2005, a number of scenarios changed which impelled the necessity to amendment of several clauses in the constitution.
The amendments constitute the following:
- removal of all clauses referring to the Society’s subordinate relationship with SAMA,
- removal of clauses representing the description of the Society’s transitional arrangement with MANCO during its inception. MANCO became a fully functional subsidiary of the Society invalidating the need for the relevant clauses,
- removal of clauses referring to the stipulations of the transitional period applicable to adoption and institution of the original constitution,
- addition of clauses describing classes of membership, specifically pertaining to the retired members of the Society.
- amendment of the time frame to nominate eligible candidates for the office of member of the EXCO,
- and, more detailed description in the formation of a quorum.
Senior members of the Society previously awarded Honorary Membership will in future be awarded Emeritus Membership, once the age of 70 is reached and the members are in good standing, thus forming a new category. Honorary Membership will be reserved for Non-Member individuals whom the EXCO regards worthy to be rewarded with the accolade. Emeritus members will enjoy all the privileges of ordinary members, with the advantage of subscription fees being waived and congress registration fees set at 50% of the fee charged for ordinary members.
Contracts with Medical Schemes
A number of medical scheme funders such as Bankmed, Bestmed, Bonitas and others launched preferred or designated service provider (DSP) contracts which they persuaded doctors to sign, in exchange for guaranteed payment agreements, as well as the assurance that patients will be channeled to the contracted doctors. As a result hospital managers encouraged specialists to sign the medical scheme contracts to enable the hospital being considered for DSP assignment by the funder. It is unlawful however for hospital groups to approach doctors to sign these contracts.
Several funders (e.g. GEMS) offer remarkably low remuneration rates, probably in an attempt to contain PMB expenditure. In exchange they offer to channel patients towards DSP’s, and admitted to continue doing so even if a DSP proves to be clinically ineffective or financially non-compliant. Similarly there are funders whose remuneration schedules only offer the basic rate.
Medical funders in the past confronted doctors to engage in preferred provider contracts, which in essence initially resulted in dividing the doctors or specific specialist groupings. In 1997 SANLAM Health and Southern Health (Anglo- American) attempted to coerce doctors into signing contracts that would’ve proved to be detrimental to individual doctor’s practices. At the time many doctors were in a vulnerable position as they were in a process of establishing their new individual private practices, yet all specialists united to resist signing contracts from multinational companies, eventually leading to the closure of SANLAM Health and Southern Health in 1999. This incident serves as an example of what can be achieved when doctors unite against medical funders who are offering unfavourable remuneration schemes.
The signing of funder contracts offering low benefits not only results in other schemes defaulting downward, but also nullifies the bargaining or lobbying power of the coding committee due to a lower benchmark.
Medical schemes argue that they can control cost by offering lower benefit values. Remarkably the schemes are also lacking the ability to accurate profiling, which potentially may increase cost. Like all other specialist groups, members of our Society will therefore have the option to either unite in solidarity with other members, or break rank to pursue each own’s individual routes to a destination of nihility. Success and strength unquestionably lie in unity. A united front will eventually force the schemes to negotiate with specialist groupings to manage cost. The more the members who break rank, the less incentive there will be for medical schemes to consider improved remuneration rates.
Low remunerating contracts are not in the interest of the profession, or its independence or its dignity. Threats to limit hospital resources, to reduce patient volume, to complicate payments, and the likes should be viewed with skepticism, though it may become a reality if there is a breach in unity.
The Competition Commission’s inquiry into Private Health Care in South Africa necessitated submissions from all stakeholders in the private healthcare industry. SAPPF’s submission (of which the ENT Society is a member) inter alia centres around the following:
- value of the private health care sector to the South African economy,
- why a two-tiered system developed (public and private sector),
- the history of the development of the private health care system,
- the implication of practice cost studies on the benchmarking and regulation of tariffs, as well as the ruling by Judge Ebersohn in 2010,
- autonomy of doctors and the prevention of doctors being employed by private health institutions,
- financial position of medical schemes in terms of the CMS report,
- management of coding with reference to global practices,
- management of the remainder of regulatory issues,
- reflection on the reasons behind the global trend of private health care inflation exceeding normal inflation.
Understandably actions like these require legal representation implying enormous financial layouts.
Prescribed Minimum Benefits
Funders who utilize a system of engaging DSP’s, will reimburse PMB’s at a negotiated rate, which in most instances represents only a few percentage points more than scheme rate. The funders concerned will reimburse doctors who did not register as DSP’s at the basic scheme rate. GEMS contracted governmental hospitals as DSP’s regardless of the implicated hospitals’ ability to accommodate the extra private patient load or to provide an adequate and acceptable service. GEMS will therefore reimburse all PMB claims by private practitioners at the basic scheme rate. The Council of Medical Schemes (CMS) refuse to investigate further complaints on PMB’s until the Competition Commission has completed its inquiry.
The ENT list of PMB’s have been revised and updated and is by no means a complete list. The list can be downloaded from the secure section on the ENT website. Members are requested to notify the administrative office of any omitted codes that may possibly qualify for inclusion on the ENT PMB list.
New Coding and Guidelines Manual
Chris Joseph and Stefaan Bouwer revised and updated the Coding and Guidelines Manual. Through the generous support and sponsorship of Aspen a ring binding file has been compiled to allow easy replacement of updated contents. Copies are available through the distribution process of Aspen.
Certificate of Need
The implementation of the dormant Certificate of Need has been postponed. Although it seems that the Department of Health (DOH) has lost energy in the effort, the idea has by no means been shelved. SAPPF in collaboration with other stakeholders such as SAMA and SADA will be writing to the Minister of Health as well as the President requesting removal of sections 36 – 40 of the National Health Act. Evidently these actions will also require funding, as legal representatives will certainly be involved.
Hosting of Congresses
A survey launched amongst members and the trade at the beginning of 2014 to determine delegate’s preferences to the venue of the annual congresses, showed a propensity for the coastal towns of Cape Town, Durban and Port Elizabeth, as well as for Johannesburg and Sun City. The current format of assigning congresses to weekends with extension into the first two days of the week also enjoyed overwhelming support. The effects of a globally shrinking economy certainly impact on the activities of the Society resulting in a decline in the quality and quantity of sponsorships. This may perhaps necessitate higher registration fees, utilization of cheaper venues and a modification in the composition of the congresses.
The rotation of congress hosts for the next 6 years will be as follows:
- 2015: Durban
- 2016: Pretoria
- 2017: Port Elizabeth
- 2018: Stellenbosch
- 2019: Johannesburg
- 2020: Bloemfontein
Complaints from Patients
The EXCO from time to time receives complaints from patients concerning the behavior of colleagues. Appreciably the EXCO are obliged to respond to such correspondence. We would like to emphasize however that all matters are dealt with in confidentiality and good faith, in an attempt to settle the issue amicably. On occasion colleagues indicated that they do not desire the presence or involvement of the EXCO upon which the EXCO has no alternative than to inform the patient to deal with the matter at their own discretion.
Status of Academic Institutions
The facilities as well as the functional operation of teaching units at a number of academic departments remain of concern. Perturbing aspects are as follows:
- Reduction in provincial hospital budgets resulting in a smaller number of available beds and reduction in availability of operating time. This adversely affects the quality of training.
- Dwindling ancillary services such as anaesthetics, radiology services and nursing services.
- Under-equipment of clinics and operating rooms, as well as the compelling use of malfunctioning or outdated equipment, adversely affecting the range of procedures that can be performed.
- Availability of consultants:
- Insufficient number of consultants being appointed.
- Unavailability of consultants due to abuse of the RWOPS system. That RWOPS system should probably be abandoned at institutions where it is ill policed.
Finding an achievable and sensible solution seems to ever elude the decision- making fraternity.
The EXCO is considering the establishment of fellowships in head and neck surgery and otology in collaboration with private institutions, linked to private hospitals. Inceptive meetings were held with Discovery to establish a contingency plan for possible involvement in taking this project forward.
The previous issue of Society memorabilia such as the official ties and cufflinks came to an end a year ago. New ties and cufflinks had to be designed and manufactured, a project which consumed a tremendous amount of time and energy as a number of unforeseen obstacles had to be bridged. New silk ties were manufactured in Croatia, and a locally produced scarf for the ladies is also introduced. Silver plated cufflinks, opposed to the previously gold plated cufflinks, are now in use. All these items are now available through the administrative office of the Society.
The writing of the history book on the Society is progressing well through the tremendous effort of Stefaan Bouwer and Tamara Lombard. We urge all members of the Society to provide whichever information, material and photographs they may possess to the authors to compile as factually accurate a history book as may be possible.
We continuously invite and encourage all members of the Society to forward any suggestions that may be benevolent to the sufficiency and functionality of the Society.
DR JACQUES VILJOEN
CAPE TOWN: 19 OCTOBER 2014