1. Surgicom and HealthMan
   
   
   Secretarial, financial management, consulting and communication services are provided for Surgicom by Health Management and Networking Services (Pty) Ltd (HealthMan). HealthMan is a privately owned healthcare consultancy specialising in the management and administration of specialist and healthcare networks. Their focus on promoting the professional and commercial interests of both specialist networks and healthcare practitioners, coupled with their extensive industry experience, quality service and industry contacts, make them the preferred choice in healthcare consulting.
   
   HealthMan has focused exclusively on consulting to private practice since inception in 1996. Areas of expertise include network administration, legal support, healthcare research and financial modelling. HealthMan consultants play pivotal communication, representation and negotiation roles in their relations with key healthcare industry stakeholders: Networks, Funders (i.e. Medical Schemes and Managed Healthcare Organizations), Professional Associations, Hospitals, Pharmaceutical Companies and Suppliers. HealthMan was also responsible for NHRPL 2009 submissions for virtually all SAMA disciplines and has done most of the research work and support for the various legal challenges that have happened or are in progress.
   
   HealthMan’s client base includes the ENT, Ophthalmology, Paediatric, Psychiatry, Gynaecology and General Practitioner Management Groups as well as the Faculty of Consulting Physicians of SA (FCPSA), the Namibian Private Practitioners Forum and SAPPF. HealthMan also represents various allied health professional groups including the Clinical Psychology Forum, iZandla (RF) (Pty) Ltd  (Physiotherapists) and the SA Speech Therapy & Audiology Association.
   
   The HealthMan Management Team supporting Surgicom comprises:
   

   Casper Venter: Managing Director	Funder Relations & Project Management
   Ernst Ackermann: Director	Corporate Governance
   Mardi Roos: Director	Network Support, Operations & Forensic Audits
   Peet Kotzé: Director	Administration, Finance & Data
   Ria Botha:	Coding Data Analysis
   Dalene Jordaan:	Practice Support
   Brenda Gous: Senior Coding Specialist	ICD10 and Procedural Coding Queries
   Carl Bouwer: IT Manager	Communications, Events (CPD), Mobile App & Websites
   Hillary Finnegan: Network Support Manager	Network Support, Membership & General Queries

2. SURGICOM, SAMA & SAPPF
   
   Surgicom recognizes that one of its primary functions is to represent the private practice aspirations of members of the Association of Surgeons, who in turn is a sub-group of SAMA. We will continue to work with the Specialist Private Practice Committee (SPPC) of SAMA but also support SAPPF in their sterling efforts on behalf of private practice in this country. Their effectiveness is beyond question. Surgicom has been a full member of SAPPF since January 2014. SAPPF has a proven track record in dealing with many challenges, including skilful handling of three successful legal actions in respect of the RPL, PMBs and HPCSA’s initial attempt to determine ethical tariffs. In 2020 Dr Simon Strachan become the Deputy CEO of SAPPF alongside the long standing CEO Dr Chris Archer and after the sudden passing of Dr Chris Archer, Dr Simon Strachan became the new CEO. In 2021 Dr Philip Matley (Surgicom Chairperson) was elected as the new Chairman of SAPPF. Under new leadership SAPPF undertook a whole new basket of challenges, some highlighted:
   
   
   • Successfully challenged the HPCSA fee increase for 2022.
   • Certificate of Need – SECTION 36-40 of the National Health Act (NHA) has been ruled to be unconstitutional by the Gauteng High Court.
   • Participated in the process to revamp the Discovery Health forensic processes.
   • COIDA – challenged the 0% increase in fees and engaged with the fund on the fees for 2023/24.
   • Opposed the BHF application for Competition Act exemption.
   • Supported the IPAF application for Competition Act exemption.
   
   
3. WHAT DOES SURGICOM DO FOR SURGEONS?
   
   

   1. Surgicom strengthens the mutual organization of all surgeons who do any form of private practice, and through its associations with SAMA and SAPPF, enables surgeons to have a say in their destiny. We have successfully defended our interests against formidable structural opposition both around the negotiating table and in the courts. All surgeons have benefitted considerably. It is unfortunate that not all have contributed by becoming Surgicom members. Going forward it is unthinkable that surgeons can face an uncertain future without sticking together as part of an efficient cohesive organization. Surgicom is that organization.
      
   2. Surgicom provides a comprehensive range of advisory services through the HealthMan office and the Surgicom helpdesk. These include assistance with unresolved practice related queries, e.g. medical scheme problems, non-payment of PMB’s, rejections of accounts or specific codes, reversals of payments and assistance with forensic audits.
      
   3. Surgicom provides an informative and interactive website as well as a regular newsletter and email communications regarding important developments.
      
   4. Surgicom facilitates the consolidation of surgical claims data to negotiate coding and reimbursement with Medical Schemes.
      
   5. Surgicom assists with procedural coding (new procedures, unit values, SAMA and CPT coding, billing rules, ICD codes, PMB references) as well as billing policies, creditor policies and legal requirements. We are committed to participation in the new SACHI initiative. We continue to update relevant coding and meet regularly with the relevant funders and their administrators.
      
   6. Surgicom engages with the Department of Health, BHF, CMS, SAMA and the devices and pharmaceutical industry.
      
   7. Surgicom provides various commercial offerings such as credit card terminals, asset finance, and PPS reviews.
      
   8. Surgicom, through the helpdesk, assists members with queries and complaints relating to the Consumer Protection Act and other areas of legislation as well as providing support and assistance to members who have been the focus of forensic audits and enquiries.
      
   9. Surgicom, through HealthMan, has an agreement with ABSA bank entitling members to a better rate on credit card point of sale terminals in the practice. Please contact HealthMan for further information - 011 340 9000.
      
   10. Surgicom members receive regular communications from HealthMan including their highly valued Private Practice Review as well as the annual Salary Review and various Healthcare Publications.
       
       
4. THE GOVERNANCE PROJECT WITH DISCOVERY HEALTH
   
   This pilot project was launched in July 2016 and is aimed at reducing managed healthcare hassle, enhancing quality of care and improving surgeon remuneration including the potential for a share of savings model in the future.
   
   In the initial phase, clinical and financial data relating to five common areas of practice will be collected from participating Surgicom members, analysed, and presented back to them. The categories that have been chosen are appendicectomy, cholecystectomy, groin hernia, anal conditions and varicose veins. These procedures comprise approximately 41% of all general surgical procedures remunerated by Discovery Health Medical Scheme. 87% of the 540 general surgeons, who do at least some private practice, perform at least one of these procedures. Each participating surgeon will receive a confidential analysis of their profile with regard to these procedures and how this compares with national and regional norms.
   
   Surgeons whose practice is confined to one of the areas outside of these five categories (e.g. specialist breast practice) will still be able to participate in the pilot, complete the discharge summaries and be paid. However they will not receive any data analysis in the first phase as the initial analysis is confined to these five procedures.
   
   Members will be requested to adhere to agreed pathways of care but these represent standard treatment protocols and are not exclusive of new technologies. The analysis of outcomes (both clinical and financial) may identify certain outliers (both good and bad). By engaging with the individual surgeon, an attempt will be made to understand the reasons behind these particularly good or poor outcomes. A peer-mentoring committee comprised of Surgicom Board members will assist in this process where necessary.
   
   Participating Surgicom members will be remunerated each time they log on to Discovery Health ID and by providing a quick and easy digital discharge summary for every “event”. These events are not confined to the five areas being studied but include every procedure (in or out of hospital), every endoscopy (in or out of hospital) and every hospital admission (with a procedure or not). The summary can be completed either on the web or using an app that will be provided for an ipad. The discharge summary can be sent to the referring doctor. In 2018, Discovery Health remunerated each participating surgeon at a rate of R427.70 for completing the discharge summary via the HealthID platform, in 2023 this fee has increased to R536.00. In future phases we will look at introducing further remuneration for surgeons in the form of a share-of savings model. Surgicom membership is a pre-requisite for participation in this pilot.
   
   
5. CODING
   
   Surgicom is actively involved in all the coding bodies. We support CPT as a model for future coding structures. Our experience with the Medihelp - CPT contract places Surgicom as an important repository of CPT coding expertise. The South African Classification of Healthcare Interventions (SACHI) is a multi-party organisation that manages modernisation of coding in South Africa.
   
   In 2015 Surgicom published a coding manual based on the 400 most frequently used general surgical codes.
   
   In 2015 Surgicom established a new coding sub-committee under the leadership of Suresh Raidoo. Since then 27 new codes have been prepared for submission for incorporation into future coding structures.
   
   The 2019 edition of the Surgicom Coding Companion has been released and is accessible through the website. This version edited by Mike Wellsted and Brenda Gous is an essential resource for surgeons in private practice and is particularly recommended for those who are new in practice.
   
   A yearly Comparative Tariff analysis document is also released and published on the Secure Section and App by HealthMan.
   
   
6. Communication
   
   
   Communication will be via email and the Surgicom website, with limited communication via sms, fax and post. Members receive a Private Practice Review (PPRev) newsletter updating them on industry news on a monthly basis. Surgicom newsletters will be sent regularly. Members will also receive the SAPPF newsletter with regular updated news pertaining to practice i.e. codes, legislation, tariffs, etc.
   
   Member meetings will be convened from time to time in the various regions at which matters of importance to private practice will be discussed.
   
   
7. Experiences of Surgicom Members
   
   We constantly receive feedback from our members who have benefited from Surgicom’s intervention in a dispute with a funder or hospital, a coding issue a forensic inquiry or simply obtaining good advice.
   
   
8. Surgicom Membership
   
   Please contact the HealthMan offices for a breakdown of the current Surgicom membership fee structure.
   

   • Additional levies may be required from time-to-time in order to fund various legal challenges.
   • New surgeons in their first year of private practice are entitled to one years’ free membership.

All surgeons that do private work are earnestly urged to join Surgicom. We thank the 345 General Surgeons who have already joined and supported Surgicom in the Past.

If you have not yet joined Surgicom, kindly complete the membership application and ACB (debit order) authorisation forms and email back to lilly@healthman.co.za