Fees for Newborns in ICU to Be Investigated

The Competition Tribunal is to investigate possible price fixing and collusion in the treatment of newborn in Intensive Care Units (ICUs).

The Council for Medical Schemes (CMS) turned to the tribunal as a result of complaint it received and which was referred to the Competition Commission in 2011.

The respondents in the case are the SA Medical Association (Sama) and the SA Paediatric Association (SAPA). The Board of Healthcare Funders of Southern Africa is also mentioned in the statement where the charges are explained.

CODE AMENDMENT

The issue is about Sama’s invoice guide for doctors where they amended a code in terms of which paediatricans were allowed to charge 50% more for treating newborns in ICUs as they could normally charge.

The invoice guide includes codes for various treatments and descriptions of what these comprise.

In 2009 the CMS and the Health Professions Council of South Africa (HCPCSA) introduced a new tariff code, Modifier 0019).  It was in terms of this that the amendments for the pricing of surgery for newborns were made.

newbornThe intention was to remunerate surgeons and anaesthetists sufficiently for complicated procedures, the CMS said in a sworn statement. The surgeons and anaesthetists could then increase their prices by 50%. This was limited to surgical procedures and was not meant to apply to aspects of newborn care.

CODE SWITCH

Sama also drew up a code list including an additional categories for newborn care in terms of which paediatricians were allowed to increase their fees by 50% for treating newborns in ICUs.

Later the Association of Paediatricians and the HCPCSA underwrote this.

However, the CMS now wants the code to be declared a transgression of competition stipulations because it is to the detriment of newborns needing intensive care. The CMS claims this comes down to price fixing.