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FCPSA Office
P O Box 2127, Cresta, 2118
Unit 16 Northcliff Office Park
203 Beyers Naude Drive
Northcliff
2115
Tel: 011 340 9000
Fax: 011 782 0270
www.physician.co.za
Dr Adri Kok (CEO)
PO Box 2896, Alberton, 1450
Tel: 011 907 8827/8
Fax: 011 907 9429
E-mail: jakok@mweb.co.za
5 February 2011
Dear Doctor
FCPSA MEMBERSHIP AND FEES – SUPPORT FOR SOUTH AFRICAN PRIVATE PRACTITIONERS FORUM (SAPPF)
AND DEPARTMENT OF HEALTH LEGAL CHALLENGE
1. COMPOSITION OF FCPSA
Recent years have proven that consulting disciplines and smaller sub-specialties within the consulting groups
have had poor representation at the previous SPPC or have not been represented at all. This is specifically
relevant to dealing with coding matters and dispute resolution with medical schemes. It is envisaged that within
a consolidated FCPSA, the FCPSA representatives will have a proper mandate to represent the interests of its
members, including all sub-specialties.
In order to ensure there is proper co-ordination between the specialist groups that comprise the FCPSA, the
following specialists have been identified to assist as the board of directors. The FCPSA will remain focussed on
the commercial and legal aspects and the Societies will continue with its Academic and Ethical roles.
Region Directors Discipline Email
S Gauteng Dr Adri Kok Specialist Physician adrikok@vodamail.co.za
Dr Hendrik Vermooten Specialist Physician hvermooten@mweb.co.za
Dr Nivesh Sewlall Pulmonologist sewlalln@medicine.wits.ac.za
Dr Hilary Carman Dermatologist hilaryc@wol.co.za
N Gauteng Dr Elsa van Duuren Rheumatologist evduuren@mweb.co.za
Dr Wiebren Duim Neurologist neuro@duim.co.za
KZN Dr SABS Abdool-Gaffar Pulmonologist docsabs@mweb.co.za
Dr Andrew Ramdass Specialist Physician ramdassas@ispace.co.za
Dr Aslam Amod Endocrinologist amod.trials@telkomsa.net
N Cape Dr Joseph Mynhardt Specialist Physician joseph@mynhardtkim.co.za
Free State Dr Freek Bester Specialist Physician fcjbester@bestgib.co.za
W Cape Dr Roy Spammer Specialist Physician rspammer@mweb.co.za
Dr Hilton Kaplan Endocrinologist hkmd@ct.stormnet.co.za
Mpum/Limp Dr Frans Theron Specialist Physician theroninterniste@gmail.com

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2. REGULATORY BACKGROUND
During July 2007 the Department of Health (DoH) published regulations to determine procedures to be followed
in the determination of a Reference Price List (RPL). These regulations set the scope for Practice Cost Studies to
be done.
In December 2007, the ANC announced the introduction of a National Health Insurance Plan (NHI) as one of the
top priorities for Government. Since then the environment for private practice has changed significantly.
The National Health Amendment Act was published in 2008, mandating the Reference Price List (RPL) as the
legal maximum tariff for medical services and establishing an elaborate process for price regulation. In the latter
part of 2008 the Health Professions Council of South Africa (HPCSA) announced that it intended to withdraw the
Ethical Tariff and establish the RPL as the maximum tariff for medical services, indicating that this was necessary
for the introduction of the NHI.
These events indicated that Government is serious about Price Regulation for medical services. The
amendments to the National Health Act and HPCSA ethical rules were challenged by SAPPF and temporarily
withdrawn. The Council of Medical Schemes has recently issued a new discussion document on pricing of
healthcare services.
3. RPL & PRACTICE COST STUDIES
In order to assess actual costs to run a private practice as a specialist, approximately 890 specialists submitted
practice cost studies during 2008 and 2009. A number of specialist disciplines were rejected as the number of
responses was considered too low by DoH. Of the approximately 340 physicians in private practice, we only had
a 12% response! Despite a much higher response in other groups the DoH still did not accept the cost studies
nor has the DoH completed the verification process. This was the whole basis for the legal challenge embarked
on since November 2008 as the DoH did not comply with the Regulations to the National Health Act. There was
no support from SAMA in the legal challenge.
If, as Government and the HPCSA have indicated, the RPL becomes the maximum fee for medical services in the
public and private sector, and we are not at a cost based structure, few medical practices will survive
economically. We thus had no other option but to take the Department of Health to court to force them to
complete their review of the submissions, follow the law that regulates the RPL process and publish a cost based
RPL.
The total fee for the legal challenge and court case was R6,000,000. The hearing was set for the 22 nd -24 th
February 2010. Judge Ebersohn passed judgment on the court case at the end of July 2010 and declared the RPL
processes to have been illegal and accordingly null and void. This judgment renders all RPL’s published since
2007 to be illegal.
The result of the RPL being declared invalid is that it has left a void and SAPPF would have to focus on trying to
negotiate a result for 2011. It should be noted that the interactions of the competition commission hamstrings
the processes as it is impossible to jointly negotiate with schemes on tariffs for 2011. It is however intended to
apply for a Competitions Commission exemption in the near future. The first meeting with the Competitions
Commission was held on 3 February 2011.

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Whilst the RPL judgment compels the DoH to pay for the cost of the legal challenge as well as the cost of
preparing RPL cost studies, this recovery could be a time consuming process and could eventually lead to a nil
payment by the DoH. If recovered, these funds should possibly be kept for future legal costs.
4. SOUTH AFRICAN PRIVATE PRACTITIONERS FORUM (SAPPF)
The SAPPF has been established following a general disillusionment of SAMA’s support for Specialist Private
Practice in South Africa. This process followed consultation with all specialist stakeholders, a strategic workshop
in November 2007 and numerous meetings of the now defunct Specialist Private Practice Committee (SPPC).
In summary:
SAMA provided no support to the SPPC
SAMA provided no financial support to the specialist RPL process and practice cost studies
SAMA provided no support to the RPL legal challenge
SAMA provided no support to challenges of the changes to HPCSA Ethical Rules
SAMA provided limited input to the proposed new coding system
Specialists need a properly constituted organisation that supports the interests of all specialist societies and its
members. We urge all Physicians to support SAPPF in its various endeavours to promote private practice.
At its meeting on 30 January 2010, attended by representatives of most of the specialist societies, the SAPPF
Board of Directors unanimously and without abstention adopted the following resolution:
“The SAPPF resolves that it:
1. Is committed to represent the interests of its specialist members
2. Does not recognise the SAMA SPPC as representing private specialist interests
3. Will continue to seek a solution to cooperate with SAMA”
5. SOUTH AFRICAN CODING SYSTEM
The SAPPF is in the process of drafting a new National Procedural Coding Structure of international standards
and has joined the Private Health Informatics Standards Committee (PHISC) to set the standards of the new
coding structure. All medical schemes, pharmaceutical companies, switching houses, hospital groups and other
professional organizations are members of PHISC. It is important that the Medical Profession determines its
scope of practice and therefore needs to remain in control of any changes to the current coding system or any
proposed new system. The ICD10PCS proposed by DoH is not appropriate for South Africa and is not in use
anywhere else in the world.
It was also proposed by DoH that the ICD10PCS coding system must be researched and developed by the private
sector at its own costs. Thereafter ownership must be handed over to DoH. This position is not acceptable to
SAPPF and SAPPF will continue its efforts on introducing a new South African system. The coding committee is
chaired by Dr Stefaan Bouwer, a Gauteng ENT specialist and President of the ENT Society.
The coding initiative will be co-ordinated by an independent entity established for this purpose. South African
Classification of Healthcare Interventions (SACHI) will become the custodian of coding.

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6. HEALTH MANAGEMENT & NETWORKING SERVICES (PTY) LTD (HealthMan)
SAPPF and the FCPSA alliance with HealthMan has been very productive and has also been very beneficial as
expertise is needed regarding cost studies, medical scheme matters, matters pertaining to legal issues,
communication and information regarding NHI and coding structures. HealthMan was the lead consultant in the
RPL process, various legal challenges and practice support services. They have been consultants to various
specialist groups since 1997.
The annual cost study cost is included in the composite fee as we have to present annual cost studies in terms of
the National Health Act. As we move towards the introduction of the NHI, we would need input from actuarial
firms and financial consultants to advice on alternative re-imbursement models and costs of practice. We expect
to be involved in several legal battles as this seems the only way to deal with the DoH and others in government,
although we are trying to avoid this at all costs by widely negotiating and discussing issues.
In addition, the following value add services are available:
Free online SMS service for patient communications – www.physician.co.za website.
HealthMan has an agreement with ABSA bank thus entitling you to a better rate on credit card
transactions. The Merchant rate is 2.40 % on credit cards and 1.15% on debit cards. Monthly rental is
R120 per month (VAT Excl)
HealthMan has contracted a reduced tariff with HealthFocus on their practice management software at
purchase.
HealthMan has agreements with Glenrand M.I.B. Medical Malpractice Practitioners Scheme and
Alexander Forbes thus entitling you to a better rate on malpractice insurance premiums. Quotations
available upon request.
Prosper Financial Services will review and advise on employee benefits and investment structures
PPS reviews and analysis by a Prosper consultant
Wealth preservation programme with Citadel
Online access to obtain CPD points, as well as online access to view your CPD points
Online ICD10 search function
Practice advisory services to assist with medical schemes problems, ie, non-payment, reversals, PMB’s
etc., through the HealthMan office.
Helpdesk to assist with general medical schemes queries
Online access to various medical journals
Online Human Resources library with access to standardised employment contracts, procedures for
dismissal, legal directives, labour regulations, etc.
7. ANNUAL SUBSCRIPTION FEES
It is proposed to charge members a single composite fee that is inclusive of all services envisaged in a given year.
This will ensure that SAPPF and FCPSA have adequate resources to fund its activities.
FCPSA & SAPPF Combined Membership Fee Structure 2010:
Full Time Private Practice
Endocrinologists / General Specialist Physicians / Nephrologists – R 500.00 (Incl. VAT) per
month

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Neurologists / Pulmonologists / Rheumatologists – R400.00 (Incl. VAT)
Dermatologists – R250 per month (Incl. VAT)
(Please note that these groups have structured societies who are also representing them
and have already made a contribution to the legal fees)
Public Service & Very Limited Private Practice
All Specialties – R300.00 (Incl. VAT) per month (not applicable to Dermatologists)
Please note that the abovementioned fee includes the services rendered by HealthMan as well as the work that
SAPPF will do on procedural coding and other projects.
We would also like to ask each physician who has not contributed to date, to contribute a once-off voluntary fee
of R1000 to the Legal fees in respect of the RPL challenge.
SAPPF Banking Details
Branch:
Absa Northcliff
Account Number: 40 7290 8323
Please use your Name and Surname as Reference number.
8. COMMUNICATIONS
Regular and relevant communications are important in times of change. Most societies already use the services
of E2 Solutions in this regard. Where a society is not contracted to E2, communications will be via the FCPSA
portal. There is no additional cost for this service.
9. DATA BASE
It is critical to have a complete data base of practitioners in South Africa. Please ensure that your practice
details are included in the application form. Updates can be done via the office at 011 340 9000 or 011 782 0270
Fax. As an alternative you can update your details via your society website if managed by E2 Solutions.
If you have not yet joined FCPSA and SAPPF, please complete the attached Membership Application and ACB
authority and fax it to 011 782 0270. Please do not hesitate to contact us should you have any questions.
Kind regards
DR ADRI KOK
FCPSA: CEO
FOR QUERIES CONTACT: MARDI ROOS – 083 444 5437 – roos@healthman.co.za
Johannesburg: Mr Casper Venter on (011) 340 9000 or fax (011) 782 0270
Cape Town: Mr Ernst Ackermann on (021) 864 2542 or fax (021) 873 7440
E-mail the HealthMan offices at queryphysician@healthman.co.za