NIB First Choice Network
Launched on 1 September, the network is designed to control costs for policy holders by promoting the use of specialists within the First Choice Network to reduce claim costs. Specialists are included/excluded from the network based on historical cost analysis for services already provided. NIB estimates that 90% of specialists currently used by NIB policy holders are within the First Choice Network. The efficient market price (EMP) is the set (maximum) price that NIB will pay for certain services. If a specialist is not included in the network, please note that the EMP is all that NIB will pay and there will be a portion that the customer will have to pay (called a gap payment).
The EMP is divided by NIB into two components: the Hospital EMP, and a combined surgeon and anaesthetist EMP. In the latter category both the surgeon and the anaesthetist are individually assessed and if either are outside the EMP then they are spoken to individually by NIB, not as a grouping. If there is any suggestion made from sources outside NIB that your fee is too high then contact NIB directly to discuss this.
Essentially nothing will change from a billing perspective and there is no need to negotiate any contracts.
NIB will not be pursuing the establishment of contracts for procedures with hospitals as they cannot control the portion that is paid to surgeons and anaesthetists. The maximum amount payable for a procedure will continue to be policy based. A policy holder can choose the services of a specialist who is not within the First Choice Network, but will need to pay a portion to cover the gap payment.
Practices can set up portals to process invoices directly to NIB, but they will first need to discuss this with NIB. More about the network and process can be read here. Click here to find out which procedures will initially be included in this new process. Other procedures will be included over time.
Proposed MCNZ changes to recertification
The NZSA wrote a submission in response to MCNZ’s recertification consultation in March (read here).
The MCNZ received 149 submissions in total and has now outlined its next steps in a letter from MCNZ Chair Dr Andrew Connolly, including forming a stakeholder group to evaluate the responses and make recommendations to the Council. MCNZ has also released a paper outlining the evidence for MCNZ’s vision and principles for recertification changes and its position that optional regular practice reviews should be offered by medical colleges.
SPANZA advisories on Tramadol
Following the FDA announcement on 20 April 2017 regarding the use of Codeine and Tramadol in children and in breastfeeding women (read here) the Society of Paediatric Anaesthesia in New Zealand and Australia (SPANZA) asked groups of experts to review the literature and produce advisory statements. The first is regarding the use of Tramadol in children and was circulated in May. The second is regarding the use of Tramadol during breastfeeding and in the neonate.
Affiliated Provider funding for anaesthesia consultations
Southern Cross has advised that anaesthetic and intensivist consultations will not be part of its Affiliated Provider (AP) only funding services for 2017. They say that while these are the only exceptions under their AP-only specialist consultation programme, they will continue their discussions with anaesthetists to investigate appropriate models of contracting with these two specialist groups. Pain specialists will be listed in Southern Cross’ Health Care Finder directory and members will be using this to identify AP-only providers that they should use to be reimbursed.
Decision to delist tramadol hydrochloride oral drops 100 mg per ml
The NZSA welcomes PHARMAC’s decision to progress the proposal to delist tramadol hydrochloride oral drops 100 mg per ml from Part II of Section H of the Pharmaceutical Schedule, and instead list a 10 mg per ml strength of tramadol hydrochloride oral solution for use in DHB hospitals. This was the subject of a consultation letter dated 4 October 2016. In summary, the effect of the decision is that:
– tramadol hydrochloride oral solution 10 mg per ml will be listed for use in DHB
hospitals from 1 January 2017.
– tramadol hydrochloride oral drops 100 mg per ml will be delisted from 30 June 2017.
Burnout rife among DHB senior doctors
Burnout is rife among senior doctors in New Zealand’s public hospitals and higher than in comparable international studies, according to the Association of Salaried Medical Specialists, with half of senior doctors and dentists surveyed reporting very high levels of burnout.
Key findings of the survey include:
- Half (50.1%) of hospital specialists reported symptoms of burnout – i.e, high levels of fatigue and exhaustion.
- 42.1% said this was due to their work, and cited frustrations with management, intense and unrelenting workloads, under-staffing, and onerous on-call duties.
- 15.7% attributed their burnout to their interactions with patients.
- Three out of five female specialists (59.4%) were likely to be experiencing burnout, compared with 43.9% of male specialists.
- Burnout was even more prevalent among female doctors aged 30-39, with (70.5%) experiencing burnout. More than half (51.1%) attributed this to their work.
- Some medical specialties reported higher levels of burnout than others – in particular, emergency medicine, psychiatry and dentistry.
The full report can be read here
Sole supply of propofol
Sole Supply Contracts (Hospital Supply Status) have been awarded to two suppliers for propofol:
• AFT Pharmaceuticals’ Provive brand MCT-LCT 1% inj 10 mg per ml, 20 ml vial;
• Fresenius Kabi (NZ)’s Fresofol brand 1% MCT/LCT inj 10 mg per ml, 50 ml vial and inj 10 mg per ml, 100 ml vial.
These products will be the only brands of propofol that can be used in DHB hospitals from 1 June 2016 until 30 June 2019. The 50ml and 100ml vials of Fresofol were introduced on 1 April. All other presentations of propofol currently listed were delisted from 1 June 2016. The NZSA wrote a submission to Pharmac earlier in the year expressing strong support for continued availability of Provive and Fresofol and said consistency of supply for NZ’s leading anaesthetic drug is essential.