- Surgicom and Healthman
Secretarial, financial management, consulting and communication services are provided for Surgicom by Health Management and Networking Services (Pty) Ltd (Healthman) and its associate, E2 Solutions (Pty) Ltd. HealthMan is a privately owned healthcare consultancy specialising in the management and administration of specialist and healthcare networks. Their focus on promoting the professional and commercial interests of both specialist networks and healthcare practitioners, coupled with their extensive industry experience, quality service and industry contacts, make them the preferred choice in healthcare consulting.
HealthMan has focused exclusively on consulting to private practice since inception in 1996. Areas of expertise include network administration, legal support, healthcare research and financial modelling. HealthMan consultants play pivotal communication, representation and negotiation roles in their relations with key healthcare industry stakeholders: Networks, Funders (i.e. Medical Schemes and Managed Healthcare Organizations), Professional Associations, Hospitals, Pharmaceutical Companies and Suppliers. HealthMan was also responsible for NHRPL 2009 submissions for virtually all SAMA disciplines and has done most of the research work and support for the various legal challenges that have happened or are in progress.
Healthman’s client base includes the ENT, Ophthalmology, Paediatric, Psychiatry, Gynaecology and General Practitioner management groups as well as the Faculty of Consulting Physicians of SA (FCPSA), the Society of Neurosurgeons of SA, the Namibian Private Practitioners Forum and SAPPF. Healthman also represents various allied health professional groups including the Clinical Psychology Forum, the Radiography Management Group, the SA Society of Physiotherapy and the SA Speech Therapy & Audiology Association.
The HealthMan Management Team supporting Surgicom comprises:
|Casper Venter: Director
||Funder Relations & Project Management
|Ernst Ackermann: Director
|Mardi Roos: Director
||Network Support & Operations
||Coding Data Analysis
|Peet Kotzé: Associate Director
||Administration, Finance & Data
||Website & Communications
- SURGICOM, SAMA & SAPPF
Surgicom recognizes that one of its primary functions is to represent the private practice aspirations of members of the Association of Surgeons, who in turn is a sub-group of SAMA. We will continue to work with the Specialist Private Practice Committee (SPPC) of SAMA but also support SAPPF in their sterling efforts on behalf of private practice in this country. Their effectiveness is beyond question. Surgicom has been a full member of SAPPF since January 2014. SAPPF has a proven track record in dealing with many challenges, including skillful handling of three successful legal actions in respect of the RPL, PMBs and HPCSA’s initial attempt to determine ethical tariffs.
- WHAT DOES SURGICOM DO FOR SURGEONS?
- Surgicom strengthens the mutual organization of all surgeons who do any form of private practice, and through its associations with SAMA and SAPPF, enables surgeons to have a say in their destiny. We have successfully defended our interests against formidable structural opposition both around the negotiating table and in the courts. All surgeons have benefitted considerably. It is unfortunate that not all have contributed by becoming Surgicom members. Going forward it is unthinkable that surgeons can face an uncertain future without sticking together as part of an efficient cohesive organization. Surgicom is that organization.
- Surgicom provides a comprehensive range of advisory services through the HealthMan office and the Surgicom helpdesk. These include assistance with unresolved practice related queries, e.g. medical scheme problems, non-payment of PMB’s, rejections of accounts or specific codes, reversals of payments and assistance with forensic audits.
- Surgicom provides an informative and interactive website as well as a regular newsletter and email communications regarding important developments.
- Surgicom facilitates the consolidation of surgical claims data to negotiate coding and reimbursement with Medical Schemes.
- Surgicom assists with procedural coding (new procedures, unit values, SAMA and CPT coding, billing rules, ICD codes, PMB references) as well as billing policies, creditor policies and legal requirements. We are committed to participation in the new SACHI initiative. We continue to update relevant coding and meet regularly with the relevant funders and their administrators.
- Surgicom engages with the Department of Health, BHF, CMS, SAMA and the devices and pharmaceutical industry.
- Surgicom provides various commercial offerings such as credit card terminals, asset finance, PPS reviews and CPD point logging through the assistance of HealthMan and the Surgicom website.
- Surgicom, through the helpdesk, assists members with queries and complaints relating to the Consumer Protection Act and other areas of legislation as well as providing support and assistance to members who have been the focus of forensic audits and enquiries.
- Surgicom, through HealthMan, has an agreement with ABSA bank entitling members to a better rate on credit card point of sale terminals in the practice. Please contact HealthMan for further information- 011 340 9000.
- Surgicom members receive regular communications from HealthMan including their highly valued Private Practice Review as well as the annual Salary Review and various Healthcare Publications.
- THE GOVERNANCE PROJECT WITH DISCOVERY HEALTH
This pilot project was launched in July 2016 and is aimed at reducing managed healthcare hassle, enhancing quality of care and improving surgeon remuneration including the potential for a share of savings model in the future.
In the initial phase, clinical and financial data relating to five common areas of practice will be collected from participating Surgicom members, analysed, and presented back to them. The categories that have been chosen are appendicectomy, cholecystectomy, groin hernia, anal conditions and varicose veins. These procedures comprise approximately 41% of all general surgical procedures remunerated by Discovery Health Medical Scheme. 87% of the 540 general surgeons, who do at least some private practice, perform at least one of these procedures. Each participating surgeon will receive a confidential analysis of their profile with regard to these procedures and how this compares with national and regional norms.
Surgeons whose practice is confined to one of the areas outside of these five categories (e.g. specialist breast practice) will still be able to participate in the pilot, complete the discharge summaries and be paid. However they will not receive any data analysis in the first phase as the initial analysis is confined to these five procedures.
Members will be requested to adhere to agreed pathways of care but these represent standard treatment protocols and are not exclusive of new technologies. The analysis of outcomes (both clinical and financial) may identify certain outliers (both good and bad). By engaging with the individual surgeon, an attempt will be made to understand the reasons behind these particularly good or poor outcomes. A peer-mentoring committee comprised of Surgicom Board members will assist in this process where necessary.
Participating Surgicom members will be remunerated each time they log on to Discovery Health ID and by providing a quick and easy digital discharge summary for every “event”. These events are not confined to the five areas being studied but include every procedure (in or out of hospital), every endoscopy (in or out of hospital) and every hospital admission (with a procedure or not). The summary can be completed either on the web or using an app that will be provided for an ipad. The discharge summary can be sent to the referring doctor. In 2018, Discovery Health will remunerate each participating surgeon at a rate of R427.70 for completing the discharge summary via the HealthID platform. In future phases we will look at introducing further remuneration for surgeons in the form of a share-of savings model. Surgicom membership is a pre-requisite for participation in this pilot.
Surgicom is actively involved in all the coding bodies. We support CPT as a model for future coding structures. Our experience with the Medihelp - CPT contract places Surgicom as an important repository of CPT coding expertise. The South African Classification of Healthcare Interventions (SACHI) is a multi-party organisation that manages modernisation of coding in South Africa.
In 2015 Surgicom published a coding manual based on the 400 most frequently used general surgical codes.
In 2015 Surgicom established a new coding sub-committee under the leadership of Suresh Raidoo. Since then 27 new codes have been prepared for submission for incorporation into future coding structures.
Communication will be via email and the Surgicom website, with limited communication via sms, fax and post. Members receive a HealthView newsletter updating them on industry news on a monthly basis. Surgicom newsletters will be sent regularly. A Private Practice Review newsletter will regularly update news pertaining to practice i.e. codes, legislation, tariffs, etc.
Member meetings will be convened from time to time in the various regions at which matters of importance to private practice will be discussed.
- Experiences of Surgicom Members
We constantly receive feedback from our members who have benefited from Surgicom’s intervention in a dispute with a funder or hospital, a coding issue a forensic inquiry or simply obtaining good advice.
- Surgicom Membership
Please contact the HealthMan offices for a breakdown of the current Surgicom membership fee structure.
- Additional levies may be required from time-to-time in order to fund various legal challenges.
- New surgeons in their first year of private practice are entitled to one years’ free membership.
All surgeons that do private work are earnestly urged to join Surgicom. We thank the 297 General Surgeons who have already joined and supported Surgicom in the past.
If you have not yet joined Surgicom, kindly complete the membership application and ACB
(debit order) authorisation forms
and email back to email@example.com