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Primary options acute care (Tairāwhiti)

The intent of the Tairāwhiti primary options acute care (POAC) programme is to fund general practice to deliver acute services when a patient is kept out of hospital, for specified conditions treated in a specified way. These conditions are expressed in the business criteria, outlined in the service manual. Claims that do not meet these criteria cannot be funded.

The manual has recently been updated and can be found below. Please familiarise yourselves with the manual which comes into effect on 1 May 2019.

Funded categories

Funding is available under the following categories:

  • abdominal pain
  • asthma
  • cellulitis and ACC cellulitis - IV treatment
  • chest pain
  • congestive heart failure - exacerbation
  • COPD
  • deep venous thrombosis - DVT / ACC DVT and DVT in pregnancy
  • dehydration
  • ENT
  • fever unknown origin - children
  • gastroenterology
  • hyperemesis gravidarum
  • ingested foreign body
  • IV adenosine in the management of SVT
  • musculoskeletal
  • neurology
  • pneumonia/respiratory infection
  • renal/urological
  • respiratory
  • respite care
  • severe allergic reaction
  • women's health.

Funded follow-ups

  • These can be claimed for either a GP or a nurse follow up. These are limited to one per episode of care, with no funded same-day follow-ups.
  • Practice observations can be claimed at the time of the initial consult. This can be up to 3 hours (6 hours for urgent care).

Funded radiology

The following are the only investigations that will be funded, and all must be same-day, except for DVT with Clexane cover.

  • Pelvic ultrasound: for suspicion of ruptured ovarian cyst or where the patient no longer qualifies for maternity funding (for example, is more than 14 days post termination of pregnancy/miscarriage or more than six weeks post vaginal delivery).
  • Abdominal ultrasound: for investigation of acute biliary colic in a haemodynamically stable patient.
  • Renal ultrasound: for suspicion of renal colic/stones where CT is not available or appropriate.
  • Ultrasounds under the DVT pathway.
  • Chest X ray: for suspicion of pneumonia or pneumothorax and for foreign body ingestion.
  • Hip X ray: for suspicion of SUFE.
  • X ray: for suspicion of pathological fracture where there is no history of injury.

Funding for claims

Claims that do not meet the business criteria of POAC cannot be funded and will be declined. This includes cases where the clinical presentation is:

  • a specific exclusion under POAC
  • low acuity and therefore would not have resulted in an ED presentation
  • high acuity and therefore unsafe to be managed in the community.

Cases will also be declined if there is insufficient documentation to support the claim or the funding could be claimed from an alternate pathway. Please remember the decline of a case is a decline against the criteria for funding, not a question of the clinical management.

Timeframes for claiming

  • Claims need to be submitted within two months of the episode of care.
  • Claims on hold (without an outcome) for longer than two months will be declined.
  • Any claims submitted after 8am on Wednesday 1 May must be within the new claiming timeframe of 2 months from the episode of care (for example, anything prior to 1 March will be declined).
  • Any care provided between 1 March and 1 May still falls under the old criteria.
  • Any care provided after 8am on 1 May must meet the criteria within the new manual.

Apply the litmus test:  Will using primary options prevent an ED presentation for this patient, with this presentation, under the stated categories for this episode of care?

Primary options acute care information manual (Tairawhiti) PDF 3.28 MB

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