CMS rejects practitioners’ ‘pay in advance’ proposal

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A proposal by struggling private health sector practitioners to tap into medical schemes funds for advance payments has been turned down by the Council for Medical Schemes (CMS). Fin24 says private sector practitioners have bee put at risk, with many specialists having shut their doors since the beginning of the lockdown in March.

Last week, private practitioners made a plea for assistance to medical aids and banks, through industry groups and associations including the South African Private Practitioner’s Forum (SAPPF), the South African Medical and Dental Practitioners Association, and the South African Medical Association.

Their proposal was that medical aids should pay practitioners in advance, so that they can continue practising without worrying about going out of business, as patients shun healthcare facilities out of fear of contracting COVID-19 and elective procedures are postponed.

Dr Chris Archer, CEO of the SAPPF, suggested that medical schemes could tap into the funds that they have accumulated during the lockdown, to provide the practitioners with the assistance they need, since those funds have not been paid as fees for services that would normally have been rendered by the practitioners.

However, Dr Sipho Kabane, registrar and CEO of the CMS, said the proposals have failed to demonstrate the societal benefit from a medical scheme beneficiary perspective. Medical aids are required by the Medical Schemes Act to keep their reserves at 25% of annual gross contributions. In a letter, Kabane said the CMS was available to support the practitioners in line with regulations … but agreements with schemes needed to be in line with regulations.

Damian McHugh, executive head of marketing and sales at Momentum Health, said the company was looking at the financial implications for members and the practitioners, but any decision would have to be in line with regulations.

Full Fin24 report

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