strategy to understand and enhance private audiology
TRANSCRIPT
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Strategy to Understand and Enhance Private Audiology Practice in South Africa
October 2017
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The Pillars of Private Practice
The Practitioner
The Profession
The Practice
The Medical Scheme
Environment
The Regulatory
Environment
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Regulatory Challenges Facing Private Practice
???
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National Health Insurance Overview
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NHI Structure
Private Hospitals and
specialists
Private Doctors
NHI Authority
(Revenue collection, negotiation, purchasing)
NHI Fund (Pooling)
Primary Care Clinics
Medical Scheme contributions
Medical Schemes
Complementary Services
General Taxes New Payroll Tax
4% Increase
Central
Hospitals
Districts (CUP)
Community Outreach Workers
District Hospitals
Provinces
Hospitals
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Phases of the NHI
• Phase I - 2012 to 2017 • Health System Strengthening Initiatives • Moving Central Hospitals to National Sphere • Establishing NHI Fund
• Phase II – 2018 to 2021 • Purchasing of Services • Mobilising of Additional Services • Establishing NHI Fund + Management & Government Structures • Population Registration • Amendments to Medical Scheme Act
• Phase III – 2022 to 2025 • Mandatory Prepayment • Contracting Private Hospitals and Suppliers • Finalisation of Medical Schemes Amendment Act
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Projected Private Sector Expenditure
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
0
50
100
150
200
250
300
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Private Spend Projections
Spend % of GDP
283
NHI Budget (R256 Bil)
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Davis Tax Commission: Current Concerns Focus on Funding the
NHI
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General Consensus on Funding of NHI
• GDP Growth much lower than NHI Projections • Tax base narrow • Unemployment too high • Service Basket needs to be defined NHI not the correct model for UHC in South Africa • Is unaffordable in current economic climate • Costing needs to be done before further implementation
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Single NHI Fund
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CMS Strategic Plan
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CMS Roadmap to NHI
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HPCSA Regulatory Issues
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SPECIALIST / GENERAL PRACTITIONER SURVEY RESULTS
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Employment of Doctors
• HPCSA Sanctioned GP employment by Life Healthcare in Casualty, ICU and Maternity
• SAPPF Requested Research Report from Econex • Included Survey of Doctors • 20% response rate – 620 doctors • Research and questionnaire to Inform SAPPF position
statement on doctor employment
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Corporate Employment?
18
In general do you think doctors should have the OPTION of being employed by hospitals?
In general, and if the contract terms are agreeable, would YOU consider being employed by a hospital?
57% 43%
Yes No
45% 55%
Yes No
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Most cited advantages and disadvantages
19
22%
57% 55% 52%
42% 39%
0%
10%
20%
30%
40%
50%
60%
Advantages
1%
87% 77%
62% 59% 48%
0%10%20%30%40%50%60%70%80%90%
100%Disadvantages
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HPCSA – Global Fees
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HPCSA – Global Fees
• HPCSA issued Press Release on Global Fees in April • Currently still awaiting the Final Position statement Concerns: • Business models (rule 8) • No fee sharing (rule 7) • No subcontracting / professional appointment (rule 18) • Medicines and devices: no involvement in marketing,
advertisement or manufacturing (rule 23) • Possible exploitation (rule 22)
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Competition Commission Health Market Inquiry
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May 2014 Draft Statement of
Issues
June 2014 Receive Comments on
Draft Statement
July 2014 Consider Comments on
Draft Statement
August 2014 Publishing of Guidelines
Timelines
October 2014 Written Submissions
February 2015 Analyse and Publish
Submissions
Aug 2015- June 2016 Research and Analysis
26-29 January 2016 Conduct Pre-Hearings
16 Feb – 9 June 2016 Conduct Public Hearings
5 Aug 2016 Provisional Report and
Recommendations
15 December 2016 Publish Final Report
and Recommendations
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HMI Schedule for 2017
• 28 February - Analytical Report of Prescribed Minimum Benefits • 28 February - Supplier induced demand in private healthcare Report • 1 March- HMI Facilities Analysis report • 1 March- HMI Practitioner Analysis Report • 1 March- HMI Funder Analysis Report • 15 March - Profitability Analysis on Private Healthcare Funders • 15 March - Profitability Analysis on Private Healthcare Facilities
• May - June 2017 – Further Public Hearings
• 20 October 2017 – Tariff & Coding Submissions • 30 November 2017– Provisional Report & Conditional Recommendations • TBC - HMI Final Report and Recommendations
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The Audiology Landscape
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First Need To Understand The Revenue Model
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Discovery Audiology Code/Revenue Distribution (2016):
R 310 Million Claims
79%
7%
14% Hearing Aids
Procedures andEquipmentConsultations
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Top 10 Codes (2016)
Code
Descriptor Claims Numbers
Unique Practices
Amounts
1 1830 Global Hearing Aid 19 122 269 244 746 366
2 1011 Audiology consultation. 16 - 30 mins 44 042 245 8 683 732
3 1825 Repairs to hearing aids 5 978 161 5 689 822
4 1013 Audiology consultation. 46 - 60 mins 12 230 222 5 488 976
5 1012 Audiology consultation. 31 - 45 mins 12 482 236 4 044 688
6 1100 Pure Tone Audiogram (Air conduction) 37 030 305 3 587 542
7 1580 OAE (Oto-acoustic emissions) 25 900 141 3 506 222
8 0020 Report writing 11 178 496 2 974 992
9 0301 Material 7 070 70 2 209 226
10 1105 Pure Tone Audiogram 24 518 290 2 116 494
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Practice Cost studies
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Why do the Cost Study Now?
Studies now being done for Specialists, GPs, Optometry & Physios
A request from the Comp Comm – Health Market Inquiry
Need a tariff structure to possibly replace HA mark ups?
Need to review Equipment Codes
Scheme Rates are too low for Professional Fees
Price Control a threat
Insight Actuaries Appointed
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Practice Cost Model Following elements to be included
1
2
3
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Overhead Distribution 2008 & 2016
Financial Survey – O & G
-
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2008 2016 2016
Standard Equipment
Sundry Expenses
Finance and Insurance
Management &AdministrationPremises
Personnel
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Challenges for the Future
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Challenges for Audiology Practice
• Professional Fees are under remunerated • Reliance on Hearing Aids to keep Practices Financially viable • Price Regulation for Private Practice – Mark Ups on Hearing Aids? • Competition Commission probe into Private Healthcare • Change in HPCSA Ethical Rules to improve competition in Healthcare • Health Professionals Employment by Corporates • Multi Disciplinary practices across various Professional Boards • HANC Coding System for Hearing Aids v NAPPI Codes • Fraud & Waste in Audiology – Forensic Reviews
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The End of Business as Usual