Schemes soften stance on pay for virtual visits

SA’s biggest medical scheme administrators, Discovery Health and Medscheme, have softened their stance on virtual consultations with psychologists and agreed to pay out at the same rate as they would previously have done for faceto-face sessions.

Last week SA’s biggest doctor organisation, the SA Medical Association, expressed concern that Discovery Health and Medscheme were offering lower rates for virtual consultations covered by their client schemes.

At the time, both administrators said their policies were in line with international best practice and reflected the fact that virtual consultations did not involve a physical examination and had lower input costs.

SA is almost three weeks into a national lockdown triggered by the Covid-19 pandemic, which has left more than 1.86-million people around the world sick. By Monday, the number of confirmed cases in SA stood at 2,272, with 27 deaths.

Under the lockdown, people have been instructed to stay at home and only venture out for food, medicine or essential health services.

Direct consultations with medical practitioners have plummeted across the board, as patients and health-care professionals seek to minimise their potential exposure to the SarsCoV-2 virus, which causes Covid-19.

Discovery Health and Medscheme have now adjusted their reimbursement rates for mental health practitioners to meet that of face-to-face consultations. Discovery Health administers 21 medical schemes, including SA’s biggest open scheme, Discovery Health Medical Scheme, while Medscheme counts the biggest closed scheme, the Government Employees Medical Scheme, among its clients.

“We recognise that the primary reasons for the lower consult rate for most health-care practitioners do not apply to psychologists. Consequently it is fair, after constructive engagement with the psychologists, to adjust the tariff accordingly,” said Discovery Health CEO Ryan Noach.

Medscheme’s executive director for health-care management, Lungi Nyathi, said the administrator had agreed with the Clinical Psychology Forum (CPF) that virtual psychotherapy would be reimbursed at the same rate as face-to-face sessions. This was a significant departure from how global markets fund virtual consultations, she said, and had required developing new billing codes.

CPF chair Linda Blokland said the organisation welcomed the decision on reimbursement rates for mental health practitioners but was concerned that Discovery Health Medical Scheme’s request for a description of the virtual sessions might breach patient confidentiality.

Noach said additional information was required for virtual consultations to try to limit the scope for abuse. “It is a simple requirement for a quick e-mail and nothing more,” he said.

Discovery Health was fully compliant with the Protection of Personal Information Act, and its clinical data repository was protected by “the world’s best security systems and access controls”.

“The little bit of data that we’re receiving from psychologists is hardly as sensitive as the rest of the data we keep. Nonetheless, we treat all clinical data with absolute caution and sensitivity, and it is stored in a clinical vault accessible only under the appropriate consent conditions,” he said.

DIRECT PATIENT CONSULTATIONS WITH MEDICAL PRACTITIONERS HAVE PLUMMETED ACROSS THE BOARD