The RPL process finally became legal last year after regulations were published under the National Health Act that allowed the department to publish the list. In terms of the regulations, healthcare providers had to submit all information relating to the costs of running a practice to enable the department to determine a fair fee.

HealthMan managing director, Casper Venter, said despite several requests to the department to discuss possible problems experienced with the submissions, the department only engaged with the ophthalmologists at very short notice. HealthMan conducted the practice cost studies for the GPs, most specialist groupings and allied health professions. The studies included more than 680 GP and more than 680 specialist practices. It showed that providers should be paid on average between 100% more for consultations and 200% more for procedures if their costs to run a practice were taken into consideration.

According to health director-general, Thami Mseleku, all submissions were considered but he indicated that some presentations were ‘not very useful’ and flawed. However, the department apparently refrained from engaging with provider groupings whose submissions failed to meet the department’s requirements. The Board of Healthcare Funders’ head of benefit and risk, Dr Rajesh Patel, also criticised some of the submissions. He said in some cases sample sizes were too small while some of the data were contradictory and not of a very high standard. But Dr Allers refuted this saying that the sample sizes for most disciplines were representative and that studies have been conducted according to the department’s requirements.

SAMA’s new president, Dr Norman Mabasa, said the department appear to suffer from ‘chronic unhappiness with submissions’.

“They want us to collect the information at great cost and then criticise it without having anything in place on their side to compare it against. We are not going to allow them to continue this way. It appears as if they like to go to court and that is where we re going to take them if they fail to consider our inputs yet again,” Dr Mabasa said.

The later than expected publication of the list has caused a headache for schemes that had to submit their contribution increases and benefit options to the CMS by the end of last month. Venter said it appears as if schemes have now decided to allow for a 10% across the board increase on last year’s guideline tariffs, which is again lower than the current CPIX of 13.9%. According to Venter the increase should be between 25 and 30% to make up for the lower than CPIX increases providers received in the past two years after SAMA stopped the publication of the reference prices in 2006.

Article courtesy of e-Chronicle