President’s Report 2016

Today marks one year since I have been president of this society. It has been a steep learning curve but I have been blessed with a highly efficient and helpful EXCO and Secretary and I must thank them for all the assistance that has been afforded to me.

The Society under my guard has reached the crossroads in many respects, financially, the way we approach funders and important role players, the insurance industry and in terms of transformation to make us an allinclusive institute.

Financial Status.

Up until the last financial year the society existed as a non taxpaying entity and MANCO, the business arm of the Society was VAT registered and paid VAT on behalf of the society in terms of the congress surplus. We considered ourselves a tax exempt entity, however, more recently SARS has beginning to look into the tax affairs of Societies, and there seemed to be some ambiguity in our status. SARS is now beginning to take a less lenient stance on Societies. The precedent has been set when they looked into the financial affairs of the CMSA. We have now decided to make the Society more tax compliant and to come in line with all the rules and regulations of SARS relating to organisations like ours. This has primarily done to protect the assets of the society in the event of an investigation. The Societies auditing and financial services was therefore moved to Integritas who are now expertly dealing with getting our house in order. On the 26 July 2016 the Society was entered into the register and met the requirements of a Non profit organisation (NPO 173-221). As of September 2016, the Society was registered with SARS as a Taxpayer. All our financials have been brought up to date and all that remains now is for us to apply for a tax exemption certificate.

SAPPF.

One of the advantages of being a member of the ENT Society is automatic membership of SAPPF. SAPPF’s have been involved in many activities that bring value to our practices both private and public.

Various parties including Healthman have been asked to tender for Private practice cost studies by SAMA. Once the outcome of this process is known and if Healthman is awarded the tender then we as a society will be in position to cooperate. It is prudent for us review costing studies as this was last done in 2008. These cost studies will be essential if an Independent Regulated pricing committee for health is necessary.

As far as the NHI white paper, SAPPF has responded to data inaccuracies and unsubstantiated comments and is now on record should the NHI progress. NHI alternatives models were discussed by SAPPF in view of experiences of the rest of the world.

Regulation 8. The Genesis case has been eventually withdrawn by the scheme and have agreed to pay some of the costs. A huge amount was spent defending 3 failed appeals by the scheme.

Very few of the societies were invited to discussions on the Health Market Inquiry and on advice of Webber Wentzel Attorneys SAPPF did not do another presentation.

SAPPF was also involved in discussion on new codes and RVU’s and it was noted that simply using CPT values will put us at a huge disadvantage, another reason why cost studies need to be updated so that we can then work out costs, skill levels and time spent to come up with suitable unit values. We have withdrawn coding crosswalk to CPT4 or next year awaiting the outcome of the competition commission. No new codes will be accepted this year.

The issue of PMB’s being ignored was also addressed by SAPPF and it has been decided to address these on an ad hoc basis with CMS.

HEALTH OF MEDICAL AID SCHEMES.

This took a further knock in 2015 and a net operating loss of R1.219 billion was realised according to CMS. The industry’s net healthcare result is a deterioration on the R456 million deficit reported in 2014 and the R1.55 billion surplus of 2013, and is part of the reason many schemes are implementing 10-15% premium hikes in 2017, e.g. Discovery 11.2%, Bonitas 11.9%. The average increase the previous year was 8.8%. All of this in the face of decreasing benefits across the board. Schemes have been drawing on their investment income to pay members’ claims which is not a sustainable activity. The net surplus of all schemes was R2.5 billion down on R3.4 billion of 2014. The biggest deficit was reported by Bonitas followed by GEMS. All of this in light of membership of all the schemes remaining static. The average solvency of the medical schemes was down by about 1%.

MEMBERSHIP FEES:

Recently we received many complaints regarding the fees you have to pay for membership of the society. This came predominantly from the doctors working in the public sector. We have taken this complaint very seriously, and placed a moratorium on fee increases until resolution was reached. It must, however be borne in mind that the membership fees that we pay is one of the least in the medical profession in view of what services we get from the various services and benefits that one derives. Eventually it was decided to implement a three tier system as follows:

This will only be implemented next year as all have been invoiced already.

HISTORY BOOK:

After 3 arduous years, the much anticipated book on the history of the ENT Society has now reached completion. The book is an extensive chronicle of the proceedings of the society over the past few decades of its existence, and required a lot of research and hours of interviews. The book will be available free of charge to members of the society from the Aspen stand. We would like to thank Stefaan Bouwer and his daughter Tamara Lombard for all the many many hours that they put in to bring this book to completion. It has cost the society more than we had initially budgeted to reach this stage, but I think that it was well worth it when you consider the result. A special tank you to Aspen for paying for the printing and publication.

The digital online book will be available for future updates and as a record of the proceedings and activities of the society going forward.

ACADEMIC DEPARTMENTS:

I am glad to report that the academic departments appear to be in a healthier state than was the case last year with very few exceptions. The challenges that face the departments have not changed but the personnel running the departments have worked tremendously within their frameworks to improve the services required of them. The threats identified are the decreasing number of beds and theatre time allocated to ENT and financial allocations. This will be an ongoing problem and we encourage the heads of departments not to give up on this fight.

The ENT Society would like to honour and thank Professor PC Modi for all the work and efforts in running the department at Wits, despite all the trials and tribulations that he encountered over the years. Your dedication and commitment is roundly applauded by the society. He is now at point of retirement and has been replaced by a very competent and able Dr Dipuo Masenge who will be the new Head of Department at Wits. We wish him all strength and support in his new endeavour.

It is also very encouraging to note that outreach is being established throughout all the academic departments. We would like to acknowledge the tremendous work done by Professor Fagan in establishing the Open Access Textbook that is available online. The site has recently reached a million downloads. This is the highlight of the outreach programme as it is a 24hour teaching tool.

We would like to congratulate Professor Fagan for being recently elected the chairman of the international advisory board of the AAOHNSF for 2 year term. He will be the only Non American serving on the board of directors of the AAOHNSF.

The number of publications coming out of the academic institutions is increasing and the quality of these papers is being recognised.

REGISTRAR COMMITTEE:

The registrar committee continues to grow. The chairperson of the committee is now Dr Mahlatse Ramatabane and we wish him all the best in the future. The Society views the registrar committee as a very important cog in the wheel. They have had a very successful registrar training week at which 40 registrars attended and benefitted tremendously. Future coursed of this nature is planned. An ENT master class is planned for in Cape Town on the 29 April 2017.

CONGRESSES:

The Local Organising committees of our congresses continue to astound us at the quality and effort they put in year after year. This is despite the paucity of fund that available to them. We however, encourage them to continue in this vein as our annual congresses remain the flagship of the Society. We also recognise that the format of our future congresses will change to accommodate the changes in technology and consideration of the demands of the newer ENT surgeons.

The 2017 congress will take place in Port Elizabeth in collaboration with the Nordic Society.

The 2018 congress will be in Cape Town and will incorporate with the World Audiology Congress. We wish Professor James Loock all the best with that arrangement.

The 2018 Congress will be in Durban.

As far as IFOS 2021 is concerned, we have given our full support to the Moroccan bid and sent in a motivation for their bid as we feel our allegiance lies with an African bid.

ETHICAL PRACTICE:

The promotion of ethical standards among medical organizations increases public support for the medical profession. If the public has trust for the medical community because it knows that the community will act in its best interest, generous donors may fund research projects that lead to advancements in medical science. Other initiatives carried out by the medical community may also receive public support in terms of participation or simply in terms of consent. In short, a medical organization that can be trusted to act ethically is one that will generally be looked upon favourably by the public. We therefore encourage our members to be vigilant and continue to practice your profession and maintain the highest degree of ethical practice. We remind you that most of the complaints that we receive from the public are related to over-servicing. We endeavour to always protect our members provided that you practice within the framework that we consider to be appropriate.

JOURNALS: One of the most tangible benefits of belonging to the Society is the online access to ENT Journals. We have gone to great lengths to secure sponsorships for you to have access to 3 of the most read ENT journals. We encourage members to make more use of this facility.

TRANSFORMATION:

The Society has never been more committed to transformation than it has until now. It recognises that the fact that change needs to be initiated sooner rather than later and we intend putting active processes in place, from this conference onwards to ensure that we see that transformation is effected so that it becomes an all inclusive society representing the demographics of the community to include on the basis of gender, ethnicity and race. We accept that this process has been a little tardy and would like to put into gear mechanisms to accelerate it. At this AGM, a position on the EXCO comes up for resignation and re-election. We urge all members to vote wisely to assist the Society to fulfil its goals in this regard. The EXCO also recognises the necessity to invoke the need to co-opt people onto the EXCO, based on our constitution, if necessary. In addition, to make the Society even more inclusive, I would like to limit the duration of service of a member to 2 terms, and to introduce a rotational basis of office so that more members can get the chance to serve as EXCO members. Each term of office is a 3year period, and that member needs to resign and that point to either be replaced or re-elected. Until now we have not placed a restriction on the number of times a member