SpesNews Volume 119
Social Media in the spotlight
The HPCSA is investigating Professor Tim Noakes for “unprofessional conduct”, this after he posted a message on a social media network that a mother should wean her baby with a low carbohydrate, high fat diet. The complaint against Prof Noakes was brought by The Association for Dietetics’ president, Claire Julsing-Strydom. Depending on the verdict of this hearing, certain changes in social media conduct would probably be necessary and practices utilizing social media should please assess whether its application is aligned with the various acts and ethical guidelines.
POINT of SALES services
SpesNet would like to urge practices utilizing any Point of Sales services to please verify you are in total alignment with the contracted fees charged. In the event of disagreements, this should be escalated to SpesNet and the specific financial institute within a period of 30 (thirty) days otherwise the statement would be considered as correct and accepted.
CMS CIRCULAR 37 of 2015
“Request for Proposal for Low Cost Benefit Option (LCBO) design.”
The CMS introduced the principle of the LCBO in Circular 9 of 2015. While it is busy with developing industry guidelines that will outline the scheme requirements for the implementation of these, the LCBO is expected to include a minimum set of predetermined benefits at its core.
Circular 37 was published as a request for stakeholders to engage with the CMS around the successful implementation of the framework – the request being submission regarding the benefits as well as the pricing for the LCBOs. With the envisaged R200 - R400 per member per month premium for these options, the CMS proposes 2 option categories that are being planned: Option A and Option B. What is important to note is that the specialist referrals in Option A is limited to None and for option B, One per beneficiary per year. The circular makes pertinent mention that the thresholds are arbitrary and reflects no expectations of its final health value proposition. The circular furthermore mentions that “…it is envisaged that subject to the merit of each business case, Council will consider granting medical schemes an exemption from certain sections of the Act in terms of Regulation 8 of the Act.”
CMS PRESS RELEASE 7 of 2015
“CMS and Registrar part ways”
In 2014 the CMS launched a forensic investigation into the alleged irregular activities of the then Registrar, Dr M Gantsho following allegations made by Mr Themba Langa, former curator of Medshield Medical Scheme, around a bribe amount of R3 million. Dr Gantsho’s term effectively expired on 30 June 2015 and the Minister of Health did not reinstate his contract of employment. Medshield Medical Scheme also launched a High Court application against Mr Langa, Dr Gantsho and Alumni Trading 264 (Pty) Ltd for the repayment of R10 million. This is the amount Medshield purportedly acquired the “Medshield” trademark from Alumni. The matter has also been reported to the Hawkes.
Is your Practice Management Processes optimally aligned to ensure maximum income? (part 1)
In order to minimise risk and improve revenue in private practice, a regular needs analysis should be conducted to evaluate and see whether new business processes and/or systems need to be implemented in the practice.
There are 3 key factors to consider to reach optimal practice income: Staff, Business positioning and Quality process management. We kick off our focus on practice on staff in this SpesNews issue and this feature will continue in the subsequent issues of the SpesNews.
It is important that all Staff needs to have a good understanding and solid knowledge of the following:
Job descriptions – well defined, understood and accepted, leaving no room for misinterpretation
Key Performance Indicators (what will their job function be evaluated on?). Performance must be measured and evaluated (daily/weekly /monthly) and tasks need to be meticulously specified. To achieve optimal efficiencies that translate to great income it is preferable that the staff get incentivised based on their measured achievements.
Coding knowledge (ICD10/RPL) – basic training is essential and access to intelligent search engines a must
Healthcare Industry orientated knowledge: Knowledge of Medical Schemes rules, regulations and tariffs – access to intelligent search engines is a must.
Competent staff to optimally use all functionalities of the Practice Management System (to optimise HR time and eliminate human error).
DISCOVERY HOSPITAL DATA
If Discovery releases its patient satisfaction survey and hospital performance data later this year, it could have profound effects on the hospitals patients choose to be admitted to. The information has purportedly been communicated to the hospitals and is expected to also lead to better hospital patient care and management. Specialists practicing at “lower” rated hospitals run the risk of a decreased patient number as patients would probably opt for management in a better rated hospital. Time to engage the hospital manager?