NEWS
Next phase of ICD-10
INSIDE
coding postponed
News.............................................pg 1
As medical schemes
the escalating costs. The
and providers frantically
objective would be to move
prepare for the
to a Diagnosis Related
implementation of
Groups (DRG) system
Phase 3 and 4.1 of the
that would address the
ICD-10 coding system,
differences in the payment
which would have
systems of the private and
become mandatory in
public sectors and allow for a
the beginning of January
fixed price system according
next year, the
to the DRG into which a
Speakers at the IHRM coding seminar. From left to right: Dr Johann van Zyl
Department of Health
patient is classified.
(associate: Towers Watson), Dr Maurice Goodman (head of Health Profession
( DoH) has announced
“Ideally, we want to move
Strategy: Discovery Health), Irene Zambelis (CEO: IHRM) and Etienne Dreyer
that it has been
into an environment where we
(member of the Ministerial Task Team on ICD-10 coding).
postponed to 1 July
can maintain choice but drive
2014 due to what it called ‘an
treatment and medication prescribed, down costs, which means we have
extended preparatory phase’.
was published on the DoH’s website
to find an alternative reimbursement
The decision followed a survey
in July. When phases 3 and 4.1 are
model between fee-for-service and
conducted by the Ministerial Task
implemented, it will enable medical
capitation, and that is where the
Team on ICD-10 coding in 36 state
schemes to properly validate claims
DRGs fit in,” Dr van Zyl said. But
facilities in five provinces, which
and reject those that don’t adhere to
to implement such a system, will
showed that the public sector was
the ICD-10 standards.
require proper understanding of how
far from ready to implement the next
Information collected through
codes work because clinical codes
phase, with some facilities not even
this coding system is vital for
from the basis of DRGs.
aware of its existence. The task team
the appropriate planning of
Referring to perceptions that the
has now started with a similar survey
healthcare needs, determining
Competition Commission’s market
in the private sector, including the
the country’s disease burden,
inquiry ‘will provide the silver bullet
main hospital groups, pharmacies
performance improvement,
that will solve all the problems in
and medical schemes.
facility management and fair and
private healthcare sector’, Dr Van
However, they are still consulting
appropriate reimbursement for
Zyl said the danger is that while
with the Board of Healthcare
health services rendered.
the industry is waiting for the
Funders on how to conduct the
“Because planning and resource
investigation, it is missing huge
survey among doctors, “Because
allocation is critical to NHI, it will
opportunities to address the lack of a
it is pointless to send it to a doctor
require accurate coding across all
proper clinical coding system.
while someone else in the practice
providers,” said Dreyer.
“It is a much bigger picture than
is actually doing the coding based
Also speaking at the seminar,
just diagnoses or procedural coding
on the doctor’s notes,” said Etienne
Dr Johann van Zyl, an associate
- it is getting to a point where all
Dreyer, a member of the task
at Towers Watson, with a special
this will work together to generate
team and chair of the Monitoring
interest in coding systems,
data on all aspects of a patient’s
Compliance and Communication
emphasised the need for an
diagnosis, symptoms and treatment,
subcommittee.
international coding format that
and ultimately to analyse what is
Speaking at a coding seminar
will allow for benchmarking against
driving the cost.
hosted by the Institute for Health
other countries and maintaining the
“The market inquiry will not
Risk Managers (IHRM), Dreyer
coding structures.
address these issues. It is a
emphasised the objective of
He urged stakeholders to work
commercially driven investigation
standardising coding across the
together to find solutions for
that will look at issues such
private and public sectors to ensure
the coding and cost issues that
as cost, price fixing, collusion
consistent ICD-10 coding throughout
are mainly responsible for the
and price negotiations. But it is
SA. An official Master Industry Table
unsustainable position the healthcare
missing the point because it is
for SA, which includes around 4000
system is finding itself in, blaming
not only about price - it is about
new codes aimed at giving a more
the fee for service environment and
how we manage choices and
detailed description of factors such
the provision of almost unlimited
healthcare quality,” Dr Van Zyl
as diagnosis, symptoms, and the
choice in the private sector for
concluded.
Cardiac..................................... pg 22
Allergy..................................... pg 28
Focus on Pain...................... pg 29
Gastroenterology.............. pg 41
Centres of Excellence....pg 43
HIV/TB Forum......................pg 44
Wound Care.......................... pg 47
Vaccination........................... pg 51
Infection Control............... pg 52
Dermatology........................pg 54
Ethics........................................pg 58
Practice Management... pg 61
Opinion.....................................pg 63
Continued from page 1
schedule that will be used as a norm
to basically determine what amounts
to overcharging.
“The document reflects the change
of approach from that which was
initially envisaged and is cognisant of
the consultations the Tariff Committee
has had with affected stakeholders,”
the HPCSA said. The council said while
consultation was initially requested
on the appropriateness of a specific
tariff schedule, it became clear that
the process for determining the norms
was an important first step. This
process will, among others, entail
the establishment of a consultative
Participant Conference that will be
made up of representative groupings
of parties most directly affected by
the establishment of a fee schedule
and the selection of a Technical
Panel by the Tariff Committee that
will be responsible for deliberating
on disputes that might arise and
reviewing inputs from the public. The
main aim of the Participant Conference
will be to achieve consensus among all
parties on what amounts appropriate
and non-appropriate charging by
healthcare providers.
The deadline for comments on
the proposed process for 2014 is 17
November (see Table 1 for timelines)
and should provide inputs on the
suitability of the 2014 process, criteria
for the selection of participants, and
the most suitable manner in which the
Participant Conference can deal with
issues relating to coding within the
proposed structure. The comments
should be emailed to bekima@hpcsa.
co.za or faxed to 012-338-9347.
Events & Diary....................pg 64
New Products/
Developments....... ..............pg 66
Treasure Hunt..................... pg 67
For reaction from stakeholders on the proposed process, see article on p13
MEDICAL CHRONICLE NOVEMBER/DECEMBER 2013 3