Always the money question ! 88% of what dollar value
On a case weighted basis the price paid at secondary care level for operations is or was around $2,500. so 88% of that leaves a fee of $300.00. That sounds cheap !especially for that level of investment by the practitioner . So is the new CW payment by the DHB to secondary care now closer to $5000.00 which would give a payment of $600.00 to primary care . That is about 2.7 times what the Whanganui DHB pays primary care for excising suspicious lesions .
I have a difficulty deciding whether I cut out suspicious lesions or not when it comes to pigmentation . My concern is Is it melanoma . From my 1000 patient base I cut out 2-3 melanomas annually and also a few seb keratoses that grew erraticly and quickly and other freckles . From my point of view do I review them more often over a period at a consultation fee + photo fee or do I cut it out and save all the buggerising around . But who pays if it didn't need to come off ? me because I unnecessarily excised a pigmented lesion or the DHB ? What is an acceptable melanoma to nonmelanoma excision ratio ?
Taking Photos and writing referrals to the DHB takes time and energy , and equipment They still dont take photo attachments to emails and I dont get direct acknowledgement of referrals from the DHB: thy go to the practice manager . I also need to put the patient on regular and sometimes frequent recall to ensure the fast growing Melanoma isn't lost with cancellations , non attendances, Christmas, surgical holidays etc
The BCCS and SCCs are a lot easier and my success rate on them having a correct pre histology diagnosis is higher than with the variegated , irregular pigmented lesions I stress over. Referral to a dermatologist or Mole map is $200- $240 ( More than I get paid to excise the lesions by the WDHB so there is this constant stress of too mamny excisions being seen as poor diagnostic skill , doing it for the money , ripping off the system as opposed to too lenient a criteria for excision .and may be catching the one marginal lesion that turns out to be a melanoma.!
What do other DHBS pay GPs for excision of skin cancers do GPs do punch biopsies first ? How many Hutchisons melanotic freckles do you leave ? are those pigment in the grooves melanotic lesions on old skin with lots of freckles and vessels left or should they all be punch or other biopsies rather than referred for surgical excision ?
What does Northland DHB pay GPs to excise lesions? Easy answer, nothing.
Because Northland's turned into a GP Ghetto Bill. Sadly our DHB has been singled out for special annual underfunding by the ministry, not helped by our disastrous demographic. Everything is ultimately sacrificed at the alter of surgical KPIs.
With the demographic does Northland get $1000 for each smoker who gets to 4 weeks verified quit ? or are you one of the lucky DHBs / PHO service that get $2,000 for a 4 week quit ? Is there a Quid Pro quo with the new PHO service ?
I have no idea Bill, all I know is as GPs we don't see a cent.
CLICK HERE to listen to Rick Cutfield, endocrinologist from the Waitematā DHB, give an update on managing hypothyroidism
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