Policy on Undesirable Business Practices

Transcription

1 Policy on Undesirable Business Practices

2 socioeconomic conditions have impacted on professional practices necessary to determine what constitutes undesirable business practices to protect public UBP Policy - part of the many policy directives on ethical conduct and professional practice of HPCSA - an integral part of Regulations specifying Acts/Omissions in respect of which disciplinary measures may be instituted against health care practitioners registered with the HPCSA.

3 BUSINESS MODELS Acceptable business models: solo practice, partnerships, associations, incorporated practice. franchising only permissible if not in breach of ethical rules (eg. Advertising, canvassing, exploitation, fees & commissions) Practitioner may outsource administration for non-professional services may form a cc to provide administrative services to practice has to ensure that the outsourced entity does not violate ANY of the ethical rules of council

4 Undesirable Models Corporate ownership: direct or indirect corporate ownership of a professional practice by a person other than a registered practitioner under the HPCSA is not permissible in any form Corporate involvement under specified conditions is permissible

5 Corporate Involvement - conditions:- (i) practitioners take responsibility for the compliance of corporate with ethical rules and policies of HPCSA (ii) practitioners not able to hide behind the corporate veil but take individual responsibility for all business transactions and operations of the business; (iii) no provision is made for hiving off fees to a corporate entity (iv) no coercion by corporate entities on practitioners to enter into arrangements that would violate ethical rules

6 Employment of Practitioners Following agencies recognized: The public service Universities/Training Institutions-(limited for purposes of training and research) Registered members of the profession Other employing agency apply to council - contracts There should be no perverse incentives included in remuneration eg. per patient incentives or bonuses for top-ups Service level agreements allowed

7 Perverse Incentives What constitutes perverse incentives? Over-servicing Preferential usage Benefits based on volume sold/price Referrals Ownership of high technological equipment Advertising free airtime voucher with spectacle frame

8 Perverse Incentives Shareholding not permissible to: Receive or acquire shares/financial interest free of charge or at a price less than market value Own shares or have financial interest in a non-listed company, unless it complies with the set criteria:

9 Shareholding Criteria (non-listed company): Arrangement to be in writing and signed by all parties. Document to contain details of number and value of shares, number of shares held as percentage of total shares, circumstances in which shares were acquired and the length of time shares have been held Document submitted by the health care professional to HPCSA with application for approval of ownership of shares

10 Shareholding A health care professional who obtained permission to have a financial interest in a company, laboratory, private clinic, hospital, etc. should display a conspicuous notice to this effect in his/her waiting room after these shares have been vetted by the HPCSA

11 Perverse Incentives Rental of Space - Rentals should not be lower than market related rates or at preferential rates - Rental should not be conditional to achieve a certain turnover nor be selectively applied

12 Perverse Incentives Commission - A health practitioner should not accept a commission or any financial gain from anybody in return for services, substances or materials - Sharing of fees with any person who has not taken part in the service for which the fees are charged is not permissible

13 Managed Health Care & Preferred Provider Networks Growing recognition of the need for managed health care schemes(mhcs) HPCSA strongly believes that patients needs should at all times be paramount in any system of health care delivery No scheme should be allowed to interfere in the clinical management of patients

14 Managed Health Care & Preferred Provider Networks: Principles Professional independence should be inviolate Harmonisation of regulatory frameworks amongst the different role-players in the managed health care field so that no single party allows for violation of ethical rules of HPCSA The HPCSA does not condone intervention from advisors in clinical management of patients, if there is such intervention, advisors share the responsibility for the well being of the patient; Scheme protocols should be harmonised with the ethical dispensation of the HPCSA.

15 Managed Health Care Considerations Access to confidential information responsible use of informed consent signed by patients Accountability: if Tx differs from that of the medical scheme or MCO, submit to the patient in writing. Party that intervenes in clinical management must accrue liability Clinical guidelines developed by practitioners Contracts legal, clinical and ethical norms adherence Cost-saving benefits appreciated and must be passed on to the patients eventually

16 Managed Health Care Disclosure clearly communicate details to members: services covered, not covered, extent of the coverage, any utilisation review requirements Inform Px of medically appropriate treatment irrespective of cost/extent of coverage. Financial Incentives not to influence practitioner judgment eg. withholding of care

17 Managed Health Care Quality of Care paramount and QA mechanisms must be introduced Risk Sharing (capitation) under-servicing - utilization review, practice profiles and peer review necessary Sharing of Fees - charges levied for services should be on a previously agreed rate and not based on a percentage of the income of the practitioner.

18 Managed Health Care Gatekeepers patient allowed to select new gatekeeper at any time or report dissatisfaction Group Practices across statutory councils - lodge application to committee

19 Preferred Provider Networks Credentialing and accreditation of providers objective, transparent and based on professional competency, qualifications, experience etc Sales must not be used as credentialing criteria Formularies based on best practice principles and cost-effectiveness ensuring good patient care

20 As health care professionals, we would be failing in our duty if we place any other interest before the clinical needs of our patients. HPCSA on its part will live up to its motto of protecting the public and guiding the professions

21 UBPC Council appointed Committee on Undesirable Business Practices and Professional Practice: An Auditor A Lawyer Member from the affected profession Chairperson who should be a member of the Council Two additional members from Council

22 THANK YOU FOR YOUR ATTENTION