PrivatePracticeReviewJanuary-June2020 Viewinwebbrowser

NOTICEPrivatePracticeReviewpresentsthereaderwithasummaryofthemostrelevantbreakingnewsinthelocaland

globalhealthcareindustry,asobtainedfrommediasources,includingthepublicbroadcaster,independenttelevisionbroadcasters,independentnewsagencies,newspapers,radioandnewssites.HealthManstrivestoquotethe

OriginalSource.HealthMancompilesthisinformationtoprovidethereaderwithabriefoverviewofthemostrecenteventsanddevelopmentsastheyarereportedinthemedia.TheviewsandopinionsexpressedinPrivatePractice

ReviewarethoseoftheauthorsofthemediasourcesanddonotnecessarilyreflecttheviewsoropinionsofHealthMan,itsdirectors,employeesandassociates.

InthisNewsletterAsummaryofnewshighlightsinthehealthcaresector:

January-June2020

FoodforThoughtNewsonGovernmentSpecialNews

NewsonMedicalSchemesCMSCircularsSpecialNotes

IntheJuneissueofSAPPF'sHealthView:AsummaryofFoodforThought,FinancialView,PharmaceuticalViewandGeneralHighlights:1January-30June

FOODFORTHOUGHT

CoronawillchangeSA'seconomyforever

“Whetherthepandemic,andthemassivejoblosseswillhelpfocusthemindsofcivilservantsamidgovernment’scrucialbidtoreduceitswagebill,remainstobeseen,”

wroteHelenaWasserman,News24(3April2020).

Abouthealthcare,Wassermanwrote:"LoftyplansforanewSouthAfricannationalhealthsystemwillprobablyfallvictimtonew

post-virusrealities.Therewon’tbeanymoneyleftforit.Butinitsplacecouldcomemuchtighterpublic-privatecooperationasgovernmentandcompaniesseemtowork

closelytogetherinthefightagainstthepandemic."

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NowistherighttimeforSAtoembracetelemedicine

“TheCOVID-19coronavirusoutbreakhasnecessitateda‘businessunusual’approachforhealthprofessionals,asmanyarenowdoingconsultationswithpatientsonlineorbytelephone,”wroteVuyoMkizeinCityPress(19April2020).Doctorsareturningtotelemedicine-alsoknownastelehealth-tohelplimitthefoottrafficintoconsultingrooms.

“Whilethegeneralresponsetotheguidelinesamendmentallowingfortelemedicinehasbeenpositiveamonglocalpractitioners,thecouncilisstillconductinganenvironmentalscantofindlastingsolutionsforSA,whichhasawidehealthcaredeliveryresourcegap,”saidPriscillaSekhonyanaHPCSAspokesperson.

Scrappingprivatehealthcoverisaviolationofrights

“Inthenext12months,hundredsofthousandsofSouthAfricansaretobestrippedoftheirprivateinsurancecover.NoprivateprimaryhealthinsuranceproductswillbeallowedbeyondMarch2021,”wroteJassonUrbach:directoroftheFreeMarketFoundation-BusinessDay,16Apr2020.

“Thisshockingmanifestationofgovernmentmeddlinghasforcedshort-terminsurerstocanceltheirclients’valuableaccidentandhealthpolicies,adverselyaffectingthelivesofthousandsofindividualswhoareinpossessionoflifeandillnesspolicies.Poorandmiddle-incomeSouthAfricanscannotaffordthisformofsocialengineering,wheretheyareforcedtosuffertheconsequencesofill-informedgovernmentdecisions."(UrbachhassubsequentlyresignedasdirectoroftheFreeMarketFoundationandhas

immigratedtotheUK(4June2020).HealthManwisheshimwell.)

Otherdiseasescannotbeputonhold"Hasthepandemictakenoverpatientpriorities,asthegreaterbattleistofightitatthispointandfortheforeseeablefuture?"askedThoneshanNaidoo,CEOofMedshieldinBusinessDay(3June2020).“Doctorsmightstartcounsellingagainsttreatmentsthey

wouldnormallyrecommend,andnodoubtseesomepatientsdiesooner;notbecauseofCOVID-19,butbecausetheyarenotabletotreattheirpatientsastheynormallywould.

"Whataboutpatientsneedingsurgery?Howmanybedswillbeavailableforsurgeryandintensivecarerecoveryduringthiscrisis?”

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SPECIALNEWS

RopingintheprivatesectortoassistincaringforCOVID-19patients:

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FollowingconfusionamongprivatehealthcareprofessionalsontheirroleinassistingtheDepartmentofHealth(DoH)incaringforCOVID-19patientsinprivatefacilities,

MedBriefAfricaco-editor,MarietjievandenBerg,askedtheDoH’sDrNicholasCrisptoaddresssomeoftheissues.Sheasledquestionsregarding:theDoH’splanstoutilisetheprivatehealthcaresector;scopeofpracticeissues;remunerationfordoctorstreating

statepatientsinprivateinstitutions;utilisationofretiredhealthcareprofessionals;assistancewiththeprovisionofPPEsforprivateinstitutions;andlimitationsonelective

surgery.

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NEWSONGOVERNMENT

Ramaphosabecomesa‘wartimepresident’“OnMondaynight(23March)PresidentCyrilRamaphosabecameawartimepresident.

AndheshowedSouthAfricansthattheonlywayhomeistounitearoundasinglepurpose,andthatistodefeattheCOVID-19disease,”

wrotePieterduToitinFin24(24March2020).“Ramaphosa'saddresswillrankasoneofthemostconsequentialbyanydemocratic

headofstate,andoneofthemosthistoricofanySouthAfricangovernmentleader.Itsetthetoneforanationaleffortwhicheverycitizenwillfeelcompelledtoheed."

Alothassincechanged...

COVID-19willpermanentlychangeSA’shealthcarelandscape

“TheCOVID-19outbreakhasalreadydonemoreintwoweekstoacquirepublicsectorpatientaccesstoprivate

facilitiesthan10yearsofNationalHealthInsurance(NHI)planningandpilotprojectshavedone,”wroteDrJohann

SerfonteininMedBriefAfrica(1April2020).Thisisaclearindicatorthatpoliticalwillwasthelacking

elementinmakingprogresswithNHI.

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"BetweentherecentcreditdowngradebyMoody’sandtheeconomicdecimationfollowinginthepathoftheworldwideCOVID-19epidemic,anyNHIplanshavenowprettymuchbeenscupperedforthenextdecade.TheSouthAfricangovernment’slendingcostsandinterestpaymentswillincreasebyasmuchas50%duetothedowngrade,leavingafiscalholethatleavesnohopeforataxfundedNHI,"wroteSerfontein.

“Iamsuretheprivatesystemwillpitchinwhereitcantotryandstemtheflood-tide.ThatiswhenourrealbattleagainstCOVID-19willbegin-thecommunalbattleforsurvivalofthemostvulnerableinoursociety.Foronce,IhopeIamwrongaboutthesituationandthatgovernmentwillmiraculouslymanagetoavertthisimpendingcatastrophe.”

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Covid-19responseispreparingcountryforNHI,saysPresCyril

Ramaphosa

“Thegovernment’sresponsetotheCOVID-19pandemicisabuildingblocktowardsSA’shealthcarefutureundertheNationalHealthInsuranceprogramme,”accordingtoPresCyrilRamaphosa.-News24(1June2020).

Thegovernment’srelianceonaprivate-publicpartnershiptodealwiththecoronavirusoutbreakadequatelypreparedthegroundfortheNHI,saidRamaphosaduringavirtualforummeeting,organisedbytheSANationalEditors’Forum(SANEF).

"HecalledtheNHIthesilverliningtothisunprecedentedhealthcarecrisis."

WhileRamaphosaremainsoptimisticabouttheNHI,tensionsbetweengovernmentandtheprivatesectoroverCOVID-19havebeensimmering.Privatehealthcareprovidershaverecentlyrefusedgovernment’sofferofaflatrateofR2493perdiemfortheirCOVID-19services(excludingextracostslikeintubation,iftheytreat“stateresponsibility”patientsinprivatefacilities).SomedoctorsareconcernedthattheagreementswillbeusedwhentheNHIbecomesareality.

SAinaNationalStateofDisaster

OnMarch15,PresCyrilRamaphosadeclaredaNationalDtateofDisasterandannouncedmeasurestocontainthespreadofCOVID-19,includingtravelrestrictionsonforeignersfromhard-hitcountries,abanonmassgatheringsofmorethan100people,andtheclosureofschools.OnMarch23,athree-weeknationalshutdownwasannouncedaspartofinterventionstocombatthespreadofCOVID-19.SouthAfricanswerenotallowedtoleavetheirhomes,unlessforessentialpurposesOnApril21,anextraheannouncedthatanextraR20-bnwillbeinjectedintothenationalhealthbudgettoshoreupitseffortstoslowtransmissionofCOVID-19andrampupitscapacitytocareforthesick.

OnApril23,asmartlockdownalertsystem(fromMay1)todeterminemovementrestrictions,basedonhowthevirusisspreading.ThecountrywasplacedunderLevel5,requiringanationwidelockdown.OnMay1,thecountrymovedtoLevel4,whereessentialservices,includingsomebusinesses,wereallowedtoresumeoperationsunderverystrictconditions.OnJune1,SAmovedtoLevel3withthegovernmentintroducingahostofnewregulations.Itimpliedtherelaxationofthecurrentlockdownrules,withmorethan8-mpeoplebacktowork.Meanwhile,governmenthasextendedtheNationalStateofDisasterwithanothermonthuntilJuly15.

'Just207criticalcarebedsand350ventilatorsaddedtopublichospitalsduringlockdown'

“SAhealthauthoritieshaveaddedanywherebetweenzeroand207newcriticalcarebedstoexistingpublichealthcarecapacityduringthenationallockdown,butthetruenumberremainsunclear,”reportedNews24(7June2020).

"Thedepartmentsaidthisweekthat2309criticalcarebedsallocatedtoCOVID-19patientsnationally,andmorethan13000fieldhospitalbedswereaddedtothetotalcapacityduringthelockdown.

AsofJune1,193Covid-19patientswereinICU,92wereonventilators,92wereincriticalcareand1531wereadmittedtogeneralwards,healthdepartmentspokespersonPopoMajatoldNews24.AsofJune3,therewere2719highcareandICU(criticalcare)bedsinthepublicsectornationally,and7676overall,ofwhich4957bedsareintheprivatesector.AccordingtoapresentationtoParliamentbythenactingdirector-generalatthedepartment,DrAnbanPillay,onApril10,therewere2512criticalcarebedsavailableinthepublicsector."Inotherwords,aftersubtractingthenumberofcriticalcarebedsavailablenearlytwomonthsagofromthenumberavailablenow,only207bedshavebeenadded."

HighCourtsdeclarelockdownrulesinvalidandunconstitutional

SouthAfrica’scourtshavedealtadouble-blowtothecountry’slockdownrulesthisweek,-reportedBusinessTech(3June2020).

OnJune1,theGautengHighCourtruledinfavourofbusinessgroupSakeligaafteritchallengedtheregulationsrequiringessentialservicestoregisterwiththeCommissionforIntellectualPropertyandCompanies(CIPC).OnJune2,thealertlevel3andalertlevel4lockdownregulationsweredeclaredinvalidandunconstitutionalbytheGautengHighCourt.TheCourtsuspendedthedeclarationofinvalidityoftheregulationsfor14days,meaningthatthelevel3regulationsremainineffectfornow.OnJune3,theHighCourtinPretoriaorderedthatanypersonwhohastestedpositiveforCOVID-19cannotbeforcedtoquarantine,be,orisolatedatastatefacilityifthatpersonisabletosuccessfullyself-quarantine.

Statelab'stestingbacklogcontinues

InApriltheNationalHealthLaboratoryService(NHLS)announcedthatitwillbeabletoprocess36000samplesadaybytheendofthemonth.Atthatstageitcouldonlydo5000testsaday.

BySunday(19April),114711testshadbeencompleted.Thisnumberincreasedto121510byMonday,ofwhich40698wereinthepublicsectorand80812wereintheprivatesector.

Accordingtohealtheconomist,ProfAlexvandenHeever,testingisthecheaperrouteforSA-provideditisdoneatasufficientscaletocontaintheepidemic.–BusinessDay(20April2020).ThecountrycouldlosearoundR13-bnperdayoflockdown,saidVandenHeever.

OnMay27,HealthministerDrZweliMkhizeadmittedthatSAwassufferingfromabacklogoftests.AsofMay27,634996testshadbeenconducted.Butofthose,“atotalof29948testsreflectsabacklogofunallocatedtests”.Thestatementclaimedthisiscausedbythelimitedavailabilityoftestkitsglobally(thatis,inadequatesupplyofextractionkitsandhighthroughputsofPCRkits).COVID-19resultsfromtheNHLSaretakingatleastaweektoreachpatients,whileprivatesectorteststakesabout72hours,reportedGroundup.

HealthcareworkersatriskwithoutPPEs

OnMarch29,SundayTimesreportedthathealthcareworkersareatriskofbeinginfectedbyCOVID-19withoutadequatepersonalprotectiveequipment(PPE).AccordingtoNatalieZimmelman,chiefexecutiveoftheSASocietyofAnaesthesiologists(SASA),oneinsixofthe500000COVID-19patientsgloballywasahealthcareworkerinfectedatwork.HealthMinisterZweliMkhizeassuredhealthcareprofessionalsthattheywouldhaveallthePPEstheyneedtoprotectthemselvesagainstCOVID-19.ThisfollowedtheNationalEducation,HealthandAlliedWorkers’Union(NEHAWU)decisiontoasktheLabourCourttoordertheHealthDepartmentto“meaningfullyengage”withitsmemberstoensuretheyhavetherightequipment.

OnApril7,thefirstconsignmentofprotectiveequipmentfromChinawasreceived.TheR69-morderwasfundedbytheSolidarityFund,billionairePatriceMotsepe’sphilanthropicorganisation,FirstRandandNaspers.AtotalofR750-mhasbeenmadeavailable.

OnJune1,BasicEducationMinisterAngieMotshekgarevealedthatafightabouttenderstoprovideschoolswithPPEshascauseddelays,preventingschoolsfromopeningafterathreemonthlockdown.

Alsoreadthefollowinghighlightsbyclickingonthebuttonbelow:

‘NHIunlikelytobeimplementedby2026’

Privatesectorcomplainsaboutfrostytreatment

StatelaboratoryfleecedofR93-m

Cubanhealthworkersregisterin3days

NegligenceclaimsagainstthestatesoartoR104-bn

Expertsrebelover'nonsensical'lockdown

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COVID-19:Thebigwaveiscoming“ItisonlyamatteroftimebeforetherestofSouthAfricareachesthesurgeinCOVID-19

coronaviruscasescurrentlybeingexperiencedintheWesternCape,expertswarn,”reportedCityPress(7June2020).

NEWSONMEDICALSCHEMES

CMSchangestackoncheaperoptions

InDecember2019theCMS,issuedCirculars80and82,prohibitingSAmedicalaidsfromofferingLow-CostBenefitOptions(LCBOs)tolow-incomemarketsegments,sayingitwouldunderminetheNHIscheme.Accordingtothecirculars,productsconsistingmainlyofprimaryhealthcareplansforbasicday-to-daycareweresettobecomeunlawfulbyMarch2021.(TheNHIisonlyduetobegindeliveringservicesin2026.)

InFebruary2020theCMSissuedacircular,invitingnominationsfortwo“stakeholder-based”advisorycommitteestodevelopaLCBOframeworkbyMarch2021.ThenominationdeadlinewasFebruary28.

RichardBlackman,chiefexecutiveofficerofDay1Health,aninsurerthatofferstheseproducts,saiditappearsthattheCMShadmadetheannouncementprematurely,beforeconsultingroleplayersintheindustry.IftheCMSdidnotwithdrawitscircular,itcouldexpectafloodofappealsintermsoftheMSA,hesaid.

AccordingtoMikeSettas(FreeMarketFoundation)theregistrarwasnowrequestingdiscussionswithroleplayerstofindapermanentsolutionforlow-incomeproducts.Butthisprocesscouldtakeyears,andtheinterimexemptionframeworkwillexpireattheendofMarch.

Doctorsgrumbleoverlowervirtualrates

InApriltheSAMedicalAssociation(SAMA)objectedstronglytothedecisionbyDiscoveryHealthandMedschemetopaylessfortelemedicineconsultations-coveredbytheirclientschemes-thantheydoforface-to-faceinteraction.

SAMAchair,AngeliqueCoetzee,saidmedicalschemeshavenotprovidedarationaleforthelowerrate,orindicatedawillingnesstonegotiate.

DiscoveryHealth,with19clientschemesincludingDiscoveryHealthMedicalScheme(DHMS),setvirtualconsultationratesat65%ofthoseusuallyprovidedforface-to-faceconsultations.CEO,RyanNoachsaidthelowerrateappliestoalldisciplines,includinggeneralpractitioners(GPs)andspecialists,sincevirtualconsultationsareshorter,havelowerinputcosts,anddonotrequireconsumablessuchastonguedepressors,swabs,andgloves.Discoveryisreviewingtheratesformentalhealthpractitionersandconsideringadjustingtothefullrate,asvirtualconsultationsareofasimilardurationtothosetheydofacetoface.TheratefordoctorsconsultingonDiscovery’sDrConnect(onlineplatform)hasbeenincreasedto75%ofthein-roomconsultationrates.

Medschemeisalsopayinglessforvirtualconsultations.

SavingswillnotbeenoughtocoverCOVID-19costs

SavingsfromamassivedropinhospitalclaimsduringthenationallockdownwillnotbeenoughtooffsetasurgeincostsastheCOVID-19epidemic

deepens,accordingtoDiscoveryHealth.

InAprilhospitaladmissionsdroppedby50%comparedwithlastyearandweredownby40%yearonyearsincethecountrymovedtoLevel4LockdowninMay.

"TheCOVID-19pandemiccouldcostmedicalaidschemesbillionsatatimewhentheirincomeisexpectedtodeclineasanincreasingnumberoffinanciallydistressedmembersdowngradetheirmedicalaidplansorareunabletopayforthematall,”reportedSundayTimes(31May2020).Medicalschemesarerequiredbylawtokeep25%oftheirannualcontributionincomeinreservetobufferthemagainsthealthcrisessuchasCOVID-19,butnotallschemesmeetthissolvencythreshold.

AccordingtoDHMS,additionalclaimsofbetweenR7-bnandR31-bncanbeexpectedfrommedicalschemes.However,DHMSandFedhealthhaveseenamarkedreductionintypicalin-hospitalclaimsandmentalhealthclaims.Ontheotherhand,anincreaseinchronicmedicationcomplianceandtheutilisationoffluvaccines,havebeenexperienced.

A'SurgicalRecoveryPlan'willbeneededtocatchupwiththousandsofcancelledoperations,reportedDailyMaverick(31May2020)

Schemesmaybeallowedtobendrules

InApriltheCMSissuedacircularallowingmedicalschemestoapplyforexemptionstotheMedicalSchemesActtolaunchlifelinessuchascontributionholidays,oraccesstheirmedicalsavingsaccountstocoverpremiums.TheR160-bnmedicalschememarketcoversabout8.9-mmembers.

Paymentreliefoptionswillbeconsideredonacase-by-casebasis.Optionstosupportmembersincludelowermonthlycontributionsbydowngradingtheircurrentplan;freezingofcontributions;paymentholidaysforaperiod;orusingotherfundingmechanismstoassistincontributionrelief.

DoHoutlinescoverforCOVID-19

OnFriday,May8,theDepartmentofHealth(DoH)publishedchangestotheMedicalSchemesActwhichoutlinescoverforCOVID-19inSA.ItdetailsthediagnosisandtreatmentofCOVID-19asaPrescribedMinimumBenefit(PMB)bymedicalaids.

Thefollowingtreatmentswillbecovered:

Screening;Clinicallyappropriatediagnostictests;Medication;Medicalmanagement,hospitalisationandtreatmentofcomplications;andRehabilitationofCovid-19.

Alsoreadthefollowinghighlightsbyclickingonthebuttonbelow:

ParentsworryaboutmedicalcoverfornewbornsinICU

Schemesfightforlow-costbenefits

Medicalaidsgrilledoverracialprofiling

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CircularsfromtheCMS

ThefollowingCircularswerepublishedbytheCMSbetween

AprilandJune2020.

28of2020ClaimsinformationforbeneficiariestreatedforCOVID-19

29of2020ConfirmationofpurchaseoftheRAGilbertPharmaciesbyPlatinumHealth

30of2020PurchaseofRAGilbertPharmacies

31of2020SAICAAccountingGuide

32of2020SignaturesrequiredrelatingtotheAnnualStatutoryreturnelectronicsubmissionfor31December2019

33of2020Understandingmedicalschemereserves

34of2020UpdateddeadlinesforthesubmissionoftheHealthcareUtilisationAnnualStatutoryReturnfor31Dec.2019

35of2020MedicalSchemesActRegulations:Amendment

36of2020Virtualannualgeneralmeetings

37of2020EndofSAMWUMEDMedicalSchemesCuratorship

38of2020Self-administeredschemes-implementationofCircular77of2019

39of2020PaymentofCommissiontoBrokersandBrokerages

40of2020ProposedamalgamationbetweenSizweMedicalFundandHosmedMedicalAidSchemeeffective1August2020

SPECIALNOTES

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