The Executive Committee of the South African Urological Association, duly elected at our biennial Congress in Cape Town, wishes you all of the best for 2015.
We wish to thank Prof John Lazarus for organising and hosting a hugely successful Congress in Cape Town. A heartfelt thank you to Prof Marthinus de Kock for opening the Congress with a fitting tribute to Prof. Chris Heyns.
Our congratulations to Haroun Patel elected as an additional member of the New Executive Committee. We look forward to his contribution. We are fortunate to still retain the services of Paul Porteous. Paul is the most senior member of the Executive Committee and currently serves as Treasurer. With his keen insight into matters financial and his vast experience of association matters he is invaluable to the Executive Committee and the Association.
Our congratulations to Dave Smart as President Elect of the Association. Being a senior member of the Executive Committee and former Secretary of the Executive Committee, his contribution is significant and appreciated.
Shingai Mutambirwa serves as Chairman of the Academic Committee. Shingai is responsible for managing all the academic activities including the very successful Registrars Forum and Guy de Klerk Memorial lectures, research proposals and distribution of research funds. He has also undertaken the task of establishing a South African Prostate Cancer Registry and the establishment of Multi Disciplinary Teams for the management of prostate cancer. We wish him every success with these endeavours.
We are living in interesting times. The Competition Commission Enquiry into the private health care sector is ongoing. The certificate of need (CON) regulations will be revised after consultation with all stake holders. Our membership of the South African Private Practice Practitioners Forum (SAPPF) remains important in this regard.
The SAPPF submission to the Competition Commission has been done. The document runs to 350 pages and covers a history of 14 years. What the outcome is going to be regarding these, the Competition Commission and the CON consultation, remains to be seen. Hopefully after deliberation we may receive the freedom to proceed with a new coding and fee structure. The current impasse regarding these matters has become intolerable.
All of us should be aware by now that funders are conducting forensic audits on our members. In the last quarter of this year some of our members have come face to face with this with Discovery Health. Discovery investigated the modifier relating to code 1949 (modifier 0013). The audit covers the preceding three years and Discovery reclaims money paid out on 1949 where the modifier, 0013, had not been applied.
As the Executive Committee we believe that this represents an honest error in coding by some of our members. We arranged a meeting with Discovery and Paul Porteous and myself attended. After this discussion we seem to have achieved a stay of execution regarding code 1949. Discovery may reconsider further action regarding code 1949 and modifier 0013.
Discovery discussed further coding and billing problems with us. Creative billing, or “tariffmanship” has given rise to the phenomenon of so called template billing. In this a multitude of codes is billed for a procedure in all patients irrespective of the circumstances of the case. Applying template billing creates an outlier in their reimbursement system easily identified. A forensic audit will follow with all the problems relating to this. The same applies to abusive ultrasound billing. The funder will demand a clinical record, ultrasound report and images related to these patients.
Referring to the South African Medical Association (SAMA) Doctor’s Billing Manual (DBM), with the agreed billing rules and modifiers, template billing is impossible to justify or defend. The SAMA DBM is available in electronic format and can be downloaded from the SAMA website. Discovery Health currently focuses on urology in their forensic auditing. We expect to see further audits regarding template billing.
Prof Chris Heyns negotiated group membership for SAUA members of the SIU. The decision to do so was endorsed by a majority vote at the AGM in Cape Town. The most significant advantage of this is the opportunity it affords our academic colleagues and registrars for a relatively soft introduction into the international urological community. They proposed a dedicated SAUA plenary session, on the day of Society meetings, to the SAUA. It requires one of our members to deliver the Chris Heyns memorial lecture during this session and local research may be presented by our members wishing to do so. They will sponsor a speaker to our congress to deliver the Chris Heyns memorial lecture at our local congress. We have electronic access to their designated journal which is currently Urology. The journal may change.
Our next Congress, November 2016, will be a joint venture with the World Endourology Society in Cape Town. Prof Mohammed Haffajee and WITS will arrange the SAUA part of the congress. Prof Andre vd Merwe is the local organising secretary for the World Congress of Endourology. We wish them both well and assure them of our support for this event.
May you all have a wonderful festive season and a prosperous 2015.
With kind regards,