SPEAKERS: Dr Niemah Khan & Mr Peter Brauer Date: Thursday 21 October 2021 | Time: 18h30 to 20h30
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Meetings between the SAOA and GEMS (with Opticlear in attendance) are scheduled on a biannual basis and the SAOA meets Opticlear four times per annum to address what are referred to as ‘operational issues’.
The SAOA has consistently strongly opposed policies such as the insistence of record cards to be provided to Opticlear when claiming for services rendered to children of nine years and under, the incorporation of the dispensing fee within the comprehensive vision and eye health examination and clinically unreasonable rejection of claims, amongst others. In this regard, it is to be noted that an official complaint was lodged against Opticlear with Opticlear appointed- schemes, for conduct regarded as undesirable, which includes the continued implementation of their policies. Furthermore the SAOA has submitted, as it has always done, input into GEMS optical benefits design, considering all the above raised matters.
A meeting was held between SAOA, GEMS and Opticlear on 30 August 2021 where the above issues were once again raised. On this occasion, the opposition by the SAOA was as a result of Opticlear informing the SAOA during a presentation, that the disputed policies would not be amended, despite our protest and complaint. The Chairperson requested that Opticlear and members of their clinical panel schedule another meeting with the SAOA as a matter of urgency to address the policies.
The following is an extract of the minutes of the meeting: “Chairperson requested that Opticlear schedule a meeting with the SAOA to discuss the clinical matters that are of a concern. The Scheme has heard in the past for clinical contact to happen. Opticlear to arrange an operational discussion by next week Friday for these discussions to be held. Chairperson noted CC;s comment that it is not a clinical aspect, however Chairperson request that discussion be held from a clinical point of view to close the matters together with Opticlear clinical person. Chairperson noted that this cannot continue in 2022 and needs to be closed".
In essence , the meeting was supposed to have occurred by Friday 3 September 2021. Despite the agreed approach, the meeting is yet to be scheduled. Under the circumstances, the SAOA regards the communication from GEMS to optometrists as an act of bad faith and is being addressed at the highest levels.
GEMS LETTER TO OPTOMETRISTS REGARDING LOOTING
The SAOA is aware of the letter from GEMS sent to optometrists who were affected by the looting and vandalism in July, requesting details of the impact on practices.
The SAOA has had discussions with GEMS and Opticlear relating to this matter and was not informed of the intended correspondence by GEMS. As we have not been advised of the intention behind this request, we urge practitioners concerned not to comply until we receive clarity from GEMS.
We will revert back to practitioners affected, once we have more information.
SOUTH AFRICAN MEDICAL SCHEMES: THE BIGGEST WINNERS AND LOSERS IN 2020
The Council for Medical Schemes’ latest annual report shows that the Discovery Health Medical Scheme (DHMS) remains the biggest in the country, despite having lost almost 50 000 beneficiaries in 2020, and also stands out as having the highest administration fees of all schemes.
The report detailed medical scheme membership movements between the end of 2019 and the end of 2020. Following DHMS’s 49,770 beneficiary loss was Fedhealth, which lost 13,015 beneficiaries. Bonitas lost 12,858.
The relatively unknown smaller schemes, conversely, had high overall growth in beneficiaries in the middle of a pandemic, reports News24, with Makoti Medical Scheme growing beneficiaries by 20.3%; LA-Health Medical Scheme gaining 7.1% more people and Building & Construction Industry Medical Aid Fund’s beneficiaries swelling by 5.9%.
Of the bigger schemes, only the Government Employees' Medical Scheme (GEMS) stood out by registering 71,463 more beneficiaries, a 3.8% growth year-on-year.
MSD TO SEEK SAHPRA APPROVAL FOR ITS PROMISING COVID-19 PILL
Pharmaceutical manufacturer MSD has confirmed it is to seek authorisation for its COVID-19 treatment, Molnupiravir, from SA’s medicines regulator. If approved, the pill, Molnupiravir, would be a potential game changer, as it would be the first treatment that at-risk patients could take at home.
All the currently approved therapies used in SA – including Dexamethasone and Remdesivir – require intravenous administration, and are limited to a hospital setting.
PAY-AS-YOU-GO: EVALUATORS HOLD SAHPRA TO ACCOUNT WITH ENCRYPTED REPORTS
Public health experts working part time for the South African Health Products Regulatory Authority (SAHPRA) are encrypting their reports in a bid to force the agency to pay them outstanding earnings before it can access their work, reports the Sunday Times.
External evaluators on technical committees assessing new medicines are angry about not being paid for several months by SAHPRA.
“Some of us haven’t been paid since April, and despite promises to resolve the matter nothing has really changed,” said one expert who asked that his identity be withheld. “We don’t know whether the regulator has cash-flow problems, if it is bankrupt or if it’s just a case of incompetence.”
Details of each activity/event will be made available in due course.
Based on repeated requests from members, please note that patient-friendly educational pamphlets are now in stock which are available to Members in Good Standing at low cost. Over the years, such pamphlets have proven to be a valuable assistance to practitioners in terms of patients’ eye health education and awareness. The pamphlets currently in stock, include:
Drivers Guide to Vision
The pamphlets are available in packs of 50, costed as follows: