Primary options acute care (Taranaki)
20 Mar 2019
The intent of the Taranaki primary options acute care (POAC) programme is to fund general practice to deliver acute services when a patient is kept out of hospital, for the specified conditions, treated in the specified way. There have been a number of enhancements to the
service which are outlined in the updated manual (attached below).
Please familiarise yourselves with the updated manual which
reflects the business rules of the service. The updates in the manual come into
effect on 1 April. Enhancements/changes include the following.
Funding is now available under the following categories:
- cellulitis and ACC Cellulitis
- IV treatment
- chest pain
- deep venous thrombosis - DVT / ACC DVT and DVT in
- ED redirect
- fever unknown origin -
- These can now 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 now be claimed at the time of the
initial consult. This can be up to 3 hours (6 hours for urgent care).
The following are the investigations that will be funded. These must be same-day, except for DVT with Clexane cover.
- Renal ultrasound: for suspicion of renal colic/stones where CTU is not available or not appropriate.
- Ultrasounds under the DVT pathway.
- Chest xray: for suspicion of pneumonia or pneumothorax.
Funding for claims
Claims that do not meet the business rules of POAC cannot be funded and can 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. 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 Monday 1 April must be within the new claiming timeframe of two months from the episode of care (for example anything prior to 1 February will be declined).
- Any care provided between 1 February and 1 April still falls under the old rules.
- Any care provided after 8am on 1 April 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?