• 29 Jul 2016

    SpesNews Volume 133

    NEW MEDICAL SCHOOL

    After years of campaigning, government has given the green light for the establishment of a much-welcomed 10th medical school in South Africa. This announcement was made last Saturday by the vice chancellor of the Nelson Mandela Metropolitan University (NMMU), Prof Derrick Swartz.

    The decision in favour of the university was given on July 6th, when the minister of higher education and training, Blade Nzimande requested NMMU to proceed to create a new medical school by 2020. Minister Nzimande also purportedly indicated that the NMMU had to expand its existing portfolio of health sciences programmes in ten different health professional categories. 

    The creation of a new medical school is most warmly welcomed and should offer some relief against the extreme disparity currently existing between the number of doctors per population when South Africa is compared to countries such as China and the UK.

    SA estimates of the present doctor:population ratio has been pegged at 27,000 doctors for a population of roughly 50 million. In contrast, the UK is sitting with 120,000 doctors for a population of about 60 million. These figures are obtained from the World Health Organisation.  Presently the existing South African Medical Schools produce about 200 doctors per year per medical school (around 2,000 doctors per year in total). According to the NMMU, the Eastern Cape, with a population of 6.56-million, is faced with huge healthcare and socio-economic challenges. With only one medical school located in Mthatha (at Walter Sisulu University), the province produces a 100 doctors per year from an annual intake of a 150 students, in addition to a small number of specialists.

    The Department of Higher Education provided R72.3 million to NMMU over a three year period - starting in 2014, to set up, among other things, new pre-medical programmes to allow for multi-entry-options towards the MBChB degree.

     

    THE INAPPROPRIATE USE OF Z-CODES

    By this time, the use of ICD-10 codes should be enshrined in the minds of health professionals of all levels. Not only is the submission of ICD-10 codes to schemes a legal requirement, it is also compulsory for reimbursement and essential for demographic and other analysis. Medical schemes often run continuous claim monitoring systems and consequently base forensic audits on the results of the reports generated by these. One area of concern identified is the use of Z-codes (such as Z76.9, etc.)

    ICD-10 codes are alphanumeric codes that are used to convey disease, injury and/or afflictions. The use of these codes are governed by a strict set of rules defining the use, format and chronological order of the codes and code sets.

    Coders are expected within the South African context to always code to the highest level of specificity (maximum number of digits – usually 5) and to always code accurately and appropriately. This implies that I should use a code to its highest level of specificity, but it should also be relevant (applicable) to the condition being coded for. Z-codes, unfortunately obscure huge amounts of information when used inappropriately or carelessly. Not only does it make disease budgeting more difficult, it also complicates the identification of specific diseases and hinders the development and implementation of proactive measures to these silently developing potentially catastrophic diseases.

    ICD-10 codes are expected to be included in all scripts and referrals and extensive ICD-10 code validations will ensue. Incorrect or inappropriate use of ICD-10 codes often lead to the rejection of claims, misallocations of benefits being claimed for, increase (unnecessary) financial burden on patients and cancellation of PMB responsibility by medical schemes.

    ICD-10 training can be booked through DUXAH at events@duxah.co.za.  The SpesNet ICD-10 online browser can also be used to validate ICD-10 codes and is a valuable resource.   

     

    GEMS PNEUMONIA AND GASTROENTERITIS MANAGEMENT

    GEMS indicated that, after discussions with SAMA, the use of the Z-codes will be closely monitored and meticulously assessed.

    GEMS further sent through communication regarding the management of Pneumonia and Gastroenteritis. From the communication, it becomes apparent that the number of admissions for the management of these two conditions have escalated significantly. The concern raised from the scheme’s side is that the increase in the admission number may obscure elements of fraud, waste or abuse.

    Essentially what this means is that GEMS will scrutinise the claims for these more meticulously and may also at some stage request motivation for the chosen treatment of the condition alongside all supporting documents.

    In what appears to be an ever increasing demand for additional practice administrative burdens, it becomes ever more important to examine and implement technology based practice automation and management solutions to support the practice in meeting these requirements. Not only should the solution be robust, reliable, efficient and accurate, it also has to be future proof. In a bid to promote the time specialists spend in clinical consultation and management, SpesNet regularly embarks on the assessment and development of technology that can facilitate these processes. Kindly speak to your SpesNet consultant for more information on available options that could assist.

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