Integration%20of%20Service%20Delivery%20to%20SASOG/GMG%20Members

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Integration of Service Delivery to SASOG/GMG
Members
March 2007
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AGENDA

• Welcome Introduction - Prof Franco Guidozzi
• GSK Overview - Sue King
• Proposed Integration of SASOG GMG Services
  - Dr Chris Archer
• Healthcare Analysis - Casper Venter
• Malpractice Insurance - Paul Lewis
• Proposal The way forward

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OBJECTIVES

• New legislative and economic threats facing
  Gynaecology Obstetrics / Private Healthcare
• Unify Gynaecology Obstetrics in South Africa
  under auspices of SASOG
• Improved Service Delivery contracted by SASOG to
  - GMG
• - HealthMan
• - E2 Solutions
• - Other

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1.Historical Background Analysis
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SAMA STRUCTURE
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Historical Background Analysis

• SASOG
• Representative Association
• Approx. 500 Members
• Focus on - Academic
• - Ethics
• - Medico Legal

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Historical Background Analysis

• GMG
• Before SHCJV
• Formation of GMG
• GMG representation on SASOG
• SASOG representation on GMG
• SAMA representation

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Gynaecology Management Group

• 10 years old
• Structured as a public company
• Functions as a Managed Service Organization (MSO)
• Membership of 250
• Funding from Member contributions and
  pharmaceutical sponsorships

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Why the need for change?

• Enormous challenges Threats
• Appropriate response from Private Practice
• Cannot leave it to SAMA
• Unity in the Gynaecology Community
• GMG will continue no debt
• Better representation for O G
• Unfair burden on GMG members
• Limited funding limits effectiveness
• Need to employ professional consultants

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2. Threats Facing Gynaecology Obstetrics in
Private Practice
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Government Initiatives - Legislative
Reforms originating from Government objectives

• Enabling legislation nearly complete
• Ensuring health care services for all
• Ensuring equity in the delivery of health care
  services
• Move to an integrated National Health System
  Social Health Insurance for the future
• Public Private Partnership initiatives are
  essential

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Private PracticeKey Legislative and other Issues
Facing Private Practice

• Medical Schemes Act of 1998
• National Health Reference Price List 2007
• Risk Equalisation Fund 2007
• Circular 8 of 2006 to be implemented 2008
• Management of PMBs, CDLs, DSPs
• GEMS, LIMS, REF
• Basic Benefit Package
• Amendments to Health Professions Act
• Increased Malpractice insurance costs
• Increased Litigation
• Hospitals taking control
• Lack of new students specialising
• NHRPL Processes
• Premier Plan
• DSP arrangement

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4.Proposed Integration of SASOG GMG Services
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Where should a PPU be situated?

• Inside SASOG?
• Outside SASOG?

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(No Transcript)
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5. Funding

• Member contributions
• Pharmaceutical interactions
• Grants
• Sponsorships

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PROPOSED FEE STRUCTURE FOR MEMBERS
1800 Full-time Private Practice 1200 1st
2nd year Full-time Private Practice 1200
Academic RWOPS 450 Full-time Academic 100
Registrars
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The Cost/benefit Relationship

• Costs
• GMG R2400
• SASOG R360
• GMG Value add
• R15,638 per month
• 651 return on investment

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6. Healthcare AnalysisGynaecology in
PerspectiveGovernment initiatives
LegislativeFunding Issues NHRPL 2007
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ECONOMICS OF HEALTHCARE
2000 R393
2001 R479
2002 R533
2003 R568
2004 R614
Average 15.52 p.a.
2005 R698
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ECONOMICS OF HEALTHCARE
1997 R20 254 968
1998 R23 669 446
1999 R28 747 153
2000 R31 159 571
2001 R36 977 784
2002 R43 238 412
2003 R48 635 737
2004 R52 210 917
1997 2005 168 Increase (20.94 p.a)
2005 R54 192 476
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Economics of Health Care 2001 - 2005
Billion
Admin Expenses 14.36 Medical Specialists 12.74
Clinical Support 13.96
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Medical Specialists
R/ Million
Year
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Economics of HealthcareBENEFIT PAYOUT (R000)
Hospital Increase - 95.73
- Average 19.15 Pharmaceutical Increase
- 15.53 - Average
3.12 Pharmaceutical 2004 2005 - (-9.72)
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MEDICAL SCHEME Financial Review Premium Income
2005
Total R25,135 million - 46.4
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ECONOMICS OF HEALTHCARE

• IMPACT OF CIRCULAR 8 OF 2006

Option 3
Supplementary Benefits
Option 2
Option 1
Non-PMB hospital other common benefits
Common Benefits
PMB Benefits
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• 7.
• Gynaecology
• NHRPL SUBMISSIONS TO CMS
• 2007

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NHRPL 2007

• RAND CONVERSION FACTOR (OG)
• Labour RCF R9.20 p.m.(Based on R729 405 p.a.)
• Overhead RCF R8.49 p.m.(Incl. equipment cost)
• ROI Rate R1.07 p.m.
• Total RCF R18.74
• Total RCF (Vat Incl.) R21.38 x 30 minutes
• 30 Minute Consult R641.60

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Gynaecology
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Total R731,553
Gynaecology
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SPECIALIST GROUPS RAND CONVERSION FACTOR

• SURGICAL Rand Conversion Factor (Incl. VAT)
• R
• ENT 19.54
• GYNAECOLOGY 21.40
• OPHTHALMOLOGY 24.26
• UROLOGY 19.11
• NEUROSURGERY 20.28
• ORTHOPAEDICS 22.38
• (AVERAGE) 21.16
• NON-SURGICAL
• PHYSICIANS 19.06
• PAEDIATRICS 19.49
• PSYCHIATRY 17.00
• (AVERAGE) 18.52

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TARIFFS THE WAY FORWARD

• Awaiting changes to the National Health Act
  submissions by 28 February 2007
• Chris Archer to re-do coding structure-
  logical/anatomical sequence- assign time-
  assign post-op time- assign complexity
• Obtain hospital data
• Cost studies to be re-done?
• Review equipment utilisation

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8.Service Offering to Members
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Service Offering to Members

• Academic
• Ethical
• CPD
• Medico Legal
• Healthcare Interactions
• Communication
• Commercial

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Service Offering to MembersHealthCare
Interactions

• HealthMan/GMG interacts and facilitates between
  various stakeholders in the health care market
• Private practitioners
• Regional National IPAs
• SAMA various Statutory Bodies
• Medical Schemes
• Administrators
• Managed Care Organisations
• Summary of Key offerings
• Coding relative value units
• Practice costs tariffs
• PMB disputes resolution
• ICD10 coding structures

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Service Offering to MembersCommercial Offerings

• HealthMan has established relations with a
  number of alliance partners that make their
  services available at preferential tariffs
• Alexander Forbes (Malpractice)
• Citadel (Wealth Preservation)
• Prosper Financial Services (Investments, Life
  Risk Insurance Employee Benefits)
• Medigro (Short Term Insurance)
• Sanlam (Bond Finance)
• Wesbank (Motor Vehicle Finance)
• VICIFIN (Bond Originator Commercial Finance)
• Absa (Credit card terminals)
• NuDebt (Debt collection via ACBs)
• Payroll service
• HealthFocus Practice Management system

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Service Offering

• Communications
• Website
• Design / build, maintain, host and secure see
  next slide
• Bulk E-mail with auto responses
• Bulk SMS service
• Outcome based registers
• Prescription pad facilitation
• Internet Access
• Dial up / ADSL
• Electronic Journals

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Proposal The way forward
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QUESTIONS