NASA has tried to complete a practice cost analysis since 2009. Most of you should have received e-mails from Prof Eastman in this regard in the last 12 - 18 months. Thank you to everyone who took part and submitted their expenses to the independent consulting agency - Healthman. For more information about Healthman go to www.healthman.co.za.
Not enough submissions were made to the agency and the analysis cannot be completed. We've only had 29 submissions from 69 full-time private neurologists and these submissions will soon be outdated.
Why do we need a practice cost analysis?
Since the NHRPL fell away in 2003/4 there has been no formal supervision to medical billing. Neurologists have perforce been billing independently to each other. This has not presented a problem to date, but times are changing.
All other specialities have banded together and conducted practice cost surveys. This outlined their costs and allowed them to understand in greater depth where their deficiencies lay. For example they identified their ever increasing medical insurance fees needed to be included into their rates. They were also able to justify increases in general fees.
Without a cost analysis we cannot generate a complete picture of private practice in South Africa and we are stuck with medical aid rates that are 13 years out of date. Inevitably it's a complete disservice to our patients who pick up the shortfall of the actual cost.
Neurology in the big picture:
Four years ago the majority of specialists walked out of SAMA and the South African Private Practitioners Forum (SAPPF) was formed as a result. One of the major reasons for withdrawing from SAMA was the problematic coding process. At the time NASA was approached by the SAPPF to join, but we decided at an annual general meeting not to take them up.
The SAPPF went on to represent almost all specialists and have been dealing with the coding crisis and NHI for small associations. This kind of representation and experience is something NASA lacks. Dr Duim has worked hard to represent neurology in one of the subcommittees, but since NASA pays no membership fees we are not formally represented and our interests are not looked after.
Coding was in a mess long before the formation of the SAPPF. Recently the Competition Commission has further complicated matters in the coding process and created more confusion and disorder.
In response to these progressively urgent problems, a meeting was called between the Competition Commission, government, funders and specialist bodies (including the SAPPF and BHF) on the 10th of July 2013. For whatever reason, government and the Competition Commission did not attend the meeting. Despite this a few resolutions were made. It was decided a new body is needed to run coding and decide on the monetary value of each code. This body would of necessity be an independent non-profit organisation and representative of all stakeholders. Currently, neurology is not formally represented on any level in these proceedings. My deepest concern is that we will continue on our non-partisan path and eventually fall prey to our own inertia.
- We need to get involved and engage with these issues to protect ourselves. At the most basic level this means completing the practice cost survey as soon as possible.
- We need representation on the SAPPF. This will cost each NASA member R1000 per annum.
- NASA membership fees need to be reviewed. Currently membership fees stand at R200 per annum and is way out of line with other professional associations. The majority of speciality associations pay between R3000 - R6000 per year for membership. This creates a robust body that more than adequately looks after its members.
- We need to create an active membership that engages with all these issues in a pro-active way or we will remain sitting ducks in a rapidly changing environment.