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CASSA Newsletter January 2011

CASSA has the honour of hosting the annual South African Heart Association Congress in 2011. The congress will take place from 23-26 October at the...

SAHA 2011

CASSA has the honour of hosting the annual South African Heart Association Congress in 2011. The congress will take place from 23-26 October at the brand new and ultra modern East London ICC. Please diarize this prestigious event!

Some of the topics delegates can look forward to include, amongst others, Pulmonary Hypertension, Atrial Fibrillation, Ethics and Sudden Death.

ACCREDITATION OF ICD PRACTITIONERS

Introduction

The purpose of these guidelines is to form a basis upon which cardiologists (non-electrophysiologists) intent on doing ICD implantation would be accredited by CASSA, in terms of their proficiency in a double-blinded way. These guidelines would apply equally to cardiologists who have not as yet started ICD implantation as well as those who may have performed this procedure. They apply to cardiologists who are not electrophysiologists. People who have received accreditation from a reputable organization such as HRS or ESC will be exempt from the theoretical part of the accreditation process.

Basic requirements

1. Proficiency in cardiac pacing.
2. Attendance of a CASSA accredited course and passing of a CASSA accredited test
3. CASSA mentoring and review of cases
a) For novice implanters
b) For Cardiologists already implanting

The complete accreditation guideline document can be perused on the CASSA website www.cassa.co.za or can be obtained from Mrs Franciska Rossouw franciska@cassa.co.za /0828061599.

Applications to be accredited as an ICD practitioner is now open and candidates who are interested can contact the CASSA Executive officer on the contact details above.

COUNCIL OF MEDICAL SCHEMES/PMB BENEFIT DESIGN

The CASSA EXCO took part in the PMB guideline meetings at the Council of Medical Schemes toward the end of 2010.
Herewith a short summary of the main discussion points:

Background:

The mandate of the CMS is to oversee that the medical aid benefit of patients is applied correctly and fairly across schemes and options. Lately they have been inundated with complaints from members who felt that they have been treated poorly or unfairly. Complaints about PMB conditions where treatment was only funded partially or conditionally were also on the increase and the Council scheduled meetings with all key stakeholders to re-define the PMB guidelines and standardize the implementation of funding for these conditions across schemes and options.

The Process:

In Circular 45 of 2010 the CMS invited all role players in the market to prepare documents on what they deemed ‘desired care’ for each of the PMB conditions and to submit these to the Council prior to the meetings scheduled for Nov and Dec.

CASSA prepared the necessary documents and submitted these to Council.

During the meetings specific individual PMB codes were not discussed, but the principles of what constituted ‘desired care’ which should be funded by all options of all schemes were defined.

These are:

Evidence Based Medicine – Evidence based medicine is the conscientious, explicit and judicious use of current best evidence whereby individual clinical experience is integrated with the best available external clinical evidence form systematic research. PMB guidelines should therefore cover the ‘average’ case as well as the ‘complicated’.

Cost-effectiveness: Health economic analysis should accompany best clinical outcomes as set out in the EBM definition above. Some of the parameters that are used when a HTA is done are re-admission to hospital, downstream costs etc. The CMS does not have a HTA division and none of their staff is trained in doing Health Economic studies which could prove to be a barrier in getting new medicines or devices accepted as part of the PMB guidelines in future.

Affordability: The issue of affordability remains a tricky one. Affordability of a certain treatment will be assessed by looking at the financial impact of such a treatment on the population of a specific option in a specific scheme. The state sector, as it has limited resources and huge numbers, will be used as benchmark when affordability assessments are done.

The Result of the meetings:

CASSA proposed the ESC guidelines as ‘desired care’ and this was accepted by the CMS.

The process going forward is that any procedure that is currently being funded will automatically become a PMB, any new procedure that is currently not funded but is in the guidelines, and where health economic evaluation indicates that it is either more efficacious at the same cost or equally efficacious at a lower cost, or both, will automatically become a PMB. The more difficult area is one where cost effectiveness is not demonstrated and a decision needs to be taken on a threshold for affordability in such circumstances. It was agreed that there would be regular review of the clinical data and cost effectiveness data for new devices. For new procedures which are not yet in the guidelines, it was agreed that companies need to bring the products to the respective professional body, which will evaluate the validity of the product and procedure and then recommend to the CMS a cost effectiveness evaluation after which the device/procedure will be evaluated for its potential to become a PMB.

ANNUAL CASSA TRAVEL GRANT

As part of its vision of education and training, CASSA has awarded an annual travel grant of R20 000 for individuals who would like to attend international arrhythmia-related conferences/courses.

Contact Franciska Rossouw on 082 806 1599/franciska@cassa.co.za for information on CASSA and its events.

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