The South African Society of Anaesthesiologists (Sasa) has introduced an alternative reimbursement model that is set to benefit patients and encourage best practice among clinicians in the private healthcare sector.
This model is already being used by Discovery Health in the roll-out of its arthroplasty network and also has the support of other healthcare administrators. Now, clinicians such as anaesthetists can enter into an event-based contract with Discovery Health.
This will enable Discovery to provide a single, fixed payment to the individual healthcare team members treating a patient for an episode of care (a comprehensive set of services required to treat a medical procedure or clinical condition).
For example, a hip or knee replacement requires a team of professionals comprising a minimum of an anaesthetist, an orthopaedic surgeon, hospital facility and a physiotherapist. The contract will cover the period for eligible patients from surgery into the recovery and rehabilitation period.
According to Sasa CEO Natalie Zimmelman this alternative reimbursement model spearheaded by Sasa is the result of four years of extensive research and consultation with the healthcare sector, and is aligned with the Health Professions Council of SA’s ethical rules and South African legislation.
“Sasa is committed to enhancing the delivery of healthcare services, ensuring that patient care is secured above all else. This led us to explore models that incentivise greater accountability and more collaborative work among clinicians, and offer the funder and patient cost certainty, without compromising the patient’s care.
“The new contracting model achieves all of these goals,” says Zimmelman, adding that it should not increase medical costs for patients and will, in fact, probably result in lower fees for private healthcare services over time, as all players in the healthcare system seek better efficiencies with good health outcomes.
Zimmelman says the eventbased contract is appropriate for the South African market, “which does not have the kind of sophisticated regulatory processes and active oversight seen in many other markets”.
She says the contract promotes a greater level of transparency, and makes clinicians and facilities (clinics and hospitals) more accountable to each other and to their professional peers.
“It’s a creative yet practical solution that ensures your doctor has the autonomy to look after your best interests as a patient, as he or she will be better able to oversee your care as part of a team.
“This new patient-driven care model protects the patient without adding cost. Because the clinician contracts directly with the funder, they will share the risk, and it will drive collaborative care and information sharing, while keeping the patient at the centre.
“Ultimately, it’s always about putting patient safety first while ensuring the sustainability of SA’s healthcare sector.”
Zimmelman says this model can be used as an example of a mechanism for the procurement of private healthcare services under the National Health Insurance.
Discovery Health’s head: health professional unit, Darren Sweidan, says the Sasa eventbased contract is an example of a positive move towards enhancing and placing value on the integration of anaesthetic services in holistic patient care, supported by an innovative fixed-fee reimbursement model.
“The approach of the eventbased contract provides regulatory certainty and societal peer review, and entrenches quality-of-care principles through the monitoring of team processes and care outcomes.
“Discovery applauds the Sasa event-based contract initiative in taking active steps towards alternative reimbursement and applying greater emphasis on patient-centred, team-based healthcare,” says Sweidan.