Private Practice Review November 2017 View this email in your browser

PRIVATE PRACTICEREVIEW

NOVEMBER 2017

A summary of breaking news and general

information regardinghealthcare in the public

and private sector,published in the media

CONTENTS: Food for Thought

View on Special News View on Government

View on New Products Financial View

View on Medical Schemes Special Views

Special Notices

FOOD FOR THOUGHT

Sparks fly at 100%

ban on smoking plan

One hundred percent smoke-free public spaces; the removal of smoking areas inrestaurants and clubs; totally uniform packaging for all cigarette and vape brands,adorned with warnings and pictures of diseased organs; the removal of all smokingadvertisements, including for e-cigarettes and vapes: These are the key propositionsby Health Minister Aaron Motsoaledi as his department fights to amend the TobaccoProducts Control Amendment Act in a bid to lower smoking rates countrywide.

One organisation likely to fight against the amendment is the Free MarketFoundation. Director Leon Louw has spent years fighting against tobacco legislation,claiming it is an attack on the personal freedom of citizens, an affront to the dignity ofsmokers, and an infringement of consumer rights.

National Health Insurance will require 'trade offs'

Judge Dennis Davis; Tax Committee Wayne Duvenhage; OUTA

LNHI ‘will require trade-offs’ reportedBusiness Day on 14 November.

Uncertainty around how SA’s NationalHealth Insurance will work, is cause forconcern, according to a new report bythe Davis Tax Committee (DTC), whichemphasised the need for properconsultation before the health insurancescheme is implemented.

The committee, chaired by Judge DennisDavis, released six reports on variousaspects of tax administration.

''The magnitudes of the proposed NHIfiscal requirement are so large that theymight require trade-offs with otherlaudable NDP (National DevelopmentPlan) programmes such as

expansion of access to post-schooleducation or social security reform,"according to the report dealing with NHI.

In reaction on the DTC press release theOrganisation Undoing Tax Abuse (OUTA)also expressed its concern over the risksassociated with the poorly planned NHIplan.

“Despite clear evidence that SA cannotafford NHI, and that the ability toeffectively manage and administer theNHI will be seriously challenged, MinisterMotsoaledi is pressing ahead with thisirrational plan in the face of mountingopposition.

"Thus far the scheme is based on 'sellingan idea' without sufficient publicparticipation, and adequate analysis ofthe technical elements andcomplications that will hinder thesuccessful implementation and long termmanagement of the system and yes, itwill fail to achieve its objective much likethe e-Toll scheme did,” said OUTA’s CEOWayne Duvenage.

* Read more in the November SAPPF Newsflash on the Davis Tax Committee

Pressing ahead with NHI implementation - Institute for Race

Relations Rreport

Dr. Anthea Jeffery

“The government is busily pressing These proposals would widen individual

ahead with implementing its proposedNHI system,” wrote Dr Anthea Jeffery,Head of Policy Research and author ofthe Institute of Race Relations (IRR) reportin the November issue of @Liberty policybulletin.

“However, it still does not know what theNHI will cost, how it will be financed, howthe supply of health services can beramped up to match increased demand,how the enormous administrative burdenwill be met, or how the corruption thenew system will foster can be curbed.”

The government has effectively ignoredthe report by the Davis Tax Committee.

The @Liberty report describes severaleffective and affordable alternatives tothe NHI which have been generated bythe IRR and others.

choice and give people access to soundhealthcare at affordable prices.

The government has generally ignoredthese practical alternatives. Instead, DrMotsoaledi has repeatedly accusedcritics of the NHI of wanting to retain anunfair system and deprive South Africansof the benefits of universal healthcoverage (UHC).

“This accusation is false,” the IRRresponds. “Critics are not opposed touniversal health coverage, but rather tothe inability of the NHI to achieve it.”

*The Institute for Race Relations

produces, disseminates, and promotes

the new ideas that South African policy

makers need in order to promote the

investment and economic growth that

will draw poor people into jobs and build

a more prosperous South Africa.

New policy on intellectual property a foolish step

The standards of intellectual property rights (IPRs) are improving in most countriesacross the globe, but SA seems to be bucking the trend according to proposed newlaws and regulations, wrote Jasson Urbach, a Free Market Foundation director, in The

Star, 9 November 2017.

According to the latest Biopharmaceutical Competitiveness and Investment Survey,SA ranks poorly compared with other countries when it comes to biomedicalinvestment attractiveness.

“If the Department of Trade and Industry’s Draft IP Policy is translated into law, theresulting abrogation of patent rights will become a further major barrier to investment,especially so for the innovator pharmaceutical companies whose new medicinesprovide the product pipeline on which all generics manufacturers depend,” saysUrbach.

“The Draft IP Policy takes SA in the wrong direction. Robust IP protections will fosterinnovation and attract committed investors who can drive economic growth andhuman development. Without them, we will never make the transition from aresource-based economy to one based on knowledge and ideas.”

VIEW ON SPECIAL NEWS

Downside of the digital era According to the 2017 Old MutualCorporate Disability Monitor, whichsurveys disability trends in SA and thedriving factors behind them, 42% ofcorporate businesses said that enquiriesfrom their employees about disabilitycover had increased and 43% of overallrespondents (who were corporatebusinesses, intermediaries, reinsurers andassessors) reported that the nature ofdisability claims had changed.

A primary cause of disability claims, ispoor lifestyle (70%) - including poor diet,not enough exercise, drinking, smoking,substance abuse and obesity - and stressin general (54%); 70% of respondentsstated that the economy has an impacton the number of disability claims;

41% of respondents believed that

financial stress led to psychologicalstress, which then results in physical

problems. When asked which disabilities haveincreased, 71% of all respondents saidpsychological disorders; 70% saidcancer; 24% said muscular-skeletalissues;16% said cardiovascular illness;and 13% said HIV.

App for rural doctors Ophthalmologist, Dr William Mapham, ata small eye clinic in Swaziland, inventedan app providing rural doctors with a setof digital tools - such as a vision test - toassess a patient. The case is thenreferred to the specialist on Vula’s on-call system. Typically, response time isabout 15 minutes. The app hasexpanded into specialties includingorthopaedics, dermatology, burns, HIV,family medicine, internal medicine,neurosurgery, ENT, cardiology andoncology.

SA has biggest HIV scheme Less than 20 years ago there were only90 people in SA that were on treatmentfor HIV. Now SA has the biggest life-saving treatment programme in theworld, with more than 4-m people ontreatment, according to the latestUNAIDS report.

According to research a person livingwith HIV who is adhering to ART is up to97% less likely to transmit HIV.

Visit the UNAIDS website to view thereport.

VIEW ON GOVERNMENT

Sugar tax approvedThe bill providing for the implementation of a taxon sugary beverages - the health promotionlevy - was passed by the National Assembly on21 November.

A task team will monitor the implementation ofthe health promotion levy to assess its effect on

job losses. It will also look at a range ofgovernment programmes to provide support tothe industry.

Securing a place for SA'snext generation doctors

Health crisis takes centrestage in Gauteng budget

According to Health Minister AaronMotsoaledi three provinces - Gauteng,the Western Cape and KwaZulu-Natal -are to blame for the shortage of juniordoctor posts.

Motsoaledi said the lack of placementsfor those needing to complete theirmandatory internships and communityservice has become an “annual ritual”and warned that he will take guiltyprovinces to court if it continues. On 23November about 160 junior doctorsacross the country had still not beenallocated internship or communityservice positions. This figure was downfrom about 316 just days earlier andcomes little more than a month beforethe country’s junior doctors are expectedto take up internship and communityservice posts at the beginning ofJanuary.

The HPCSA accredits certain publichospitals and clinics in each province tohost internship and community servicedoctors based on their training capacity.

Province are responsible to find themoney to pay for these posts.

100 medical students from 2016 were

placed only in September. In addition,about 800 students from Cuba will be

seeking internships in 2018.

The health department received thebiggest budget adjustment of R1.23-bn inthe Gauteng Medium Term Budget PolicyStatement presented in the legislature.

Gauteng Premier David Makhura hasannounced a high-level interventionteam to coordinate a recovery plan forthe ailing Gauteng department of health.

Critical inadequacies in the capacitiesand capabilities‚ and competencies torun the provincial health system‚ hadclearly been exposed by the LifeEsidimeni tragedy.

At the end of October‚ the province was

able to pay 1 721 service providersinvoices amounting to R416-m.

The health department is now working ona payment plan till the end of the year.

* Michael Sachs‚ the NationalTreasury’s head of budget whorecently resigned‚ is to join theOffice of the Premier of Gauteng asthe deputy director generalresponsible for performancemonitoring and evaluation.

FINANCIAL VIEW

Netcare hit bySA marketconditions

Mediclinicrevenue flat incurrency terms

Foreign boostfor LifeHealthcare

Market conditions in bothSouth Africa and theUnited Kingdom placedpressure on Netcare’sability to grow, whilefunder-led demandmanagement initiatives inboth countries impactedits results, according togroup CEO Dr RichardFriedland.

Results for the year endedSeptember 30, show thatGroup Revenuedecreased by 9.6% to

R34 125-m from R37 729-m, with the

decline being attributableto currency conversion.

Mediclinic has reportedrevenue that was flat inconstant currency termsfor the six months endedSeptember 30 2017.Revenue was up 10% to£1 405-m. Underlyingearnings before interest,taxes, depreciation, andamortisation (EBITDA)were up 5% to £232-m - adecrease of 5% inconstant currency terms.

* Mediclinicscrapped its bid toacquire theremaining 70.1% ofUK-listed SpireHealthcare Group.Mediclinic acquireda 30% stake in Spirein 2015.

Life Healthcare’s enlargedinternational businessaccounted for nearly aquarter of group revenuein the year to end-September, from just 7%previously.

The private hospitaloperator bought 94% ofUK-based AllianceMedical Group inNovember 2016 andincreased its shareholdingin India’s Max HealthcareInstitute in August 2017 to49.7%. These deals helpedthe group to growrevenue by 27% to

R20.8-bn in its 2017financial year. However,normalised earnings pershare fell by 45%.

VIEW ON NEW PRODUCTS

US approves first pill with digital tracking device

United States regulators have approved the first pill that contains a digital trackingsensor to alert doctors and caregivers as to whether a patient is taking a medication

as scheduled. The pill, called Abilify MyCite (aripiprazole tablets with sensor), isdesigned for patients with schizophrenia, bipolar disorder and depression. A patientingests the pill, and a sensor inside the pill activates when it reaches the stomachfluids, sending a message to a wearable patch. This patch then transmits theinformation to a mobile app.

VIEW ON MEDICAL SCHEMES

Hospital groups stiflingaffordable day hospitals

Discovery Health ID app isempowering the patient

The big private hospital groups arerestraining the growth and developmentof independent day hospitals by usingtheir resources and muscle, according toCarl Grillenberger, CEO of AdvancedHealth.

He said approximately 75% of the acutehospital sector is controlled by a handfulof groups.

He said 13% of surgical procedures areundertaken in day clinics, while thepotential is closer to 70%, as per globalnorms.

The Discovery HealthID application is aworld-leading electronic health recordthat gives our members and treatingdoctors (with patient consent) a full viewof their medical history. This improves thedoctor’s ability to diagnose and treat,and empowers members to track theirtreatment. In October Discoverylaunched DrConnect, a healthinformation platform providing memberswith free access to a curated library ofover 5.5-bn medical questions andanswers provided by a network of over105 000 doctors worldwide - a far bettersource of accurate medical informationthan “Dr Google”.

CMS Circulars

The following Circulars were published by the CMS in November. Visit www.medicalschemes.co.za for more info.

67 of 2017 70 of 2017

Publication of the Draft HealthcareUtilisation Annual Statutory ReturnData Specification Documents

68 of 2017

Managed Care and AdministrationOrganisations Accredited by the

Council Exco

69 of 2017 Adjustment fees payable to Brokers

with effect from 1 January 2018

Proposed Levies for MedicalSchemes 2018/19

71 of 2017

Benefit definition meeting onnutrition in the Palliative care setting

72 of 2017

Confirmation of the amalgamationof Discovery Health Medical

Scheme (DHMS) and the Universityof the Witwatersrand Medical AidFund (Witsmed): 1 January 2016

SPECIAL VIEWS

From Healthbridge:

Collections are one of the most critical functions of any business, yet for manymedical practices, it often goes unmeasured.

Many medical professionals don’t have a clear picture of how well they are doing inthis critical area, and don’t realise the effect on their cashflow and profitability.

Fortunately, there is a report known as an Age Analysis, which provides a useful

snapshot. It shows a breakdown of how old your patient accounts are – also knownas Accounts Receivable (AR), or money owed to a practice.

The Age Analysis groups accounts into 30-day increments of elapsed time (30, 60, 90,120 days). All invoices aged over 120 days fall into the inclusive AR >120 daycategory.

We investigated the financial health of a sample of private GP practices across SouthAfrica by aggregating their age analysis data, as at the end of April 2017.

Clickon the button below to find out what we discovered.

Button

From EthiQal:

SPECIAL NOTICES

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