FROM: Lund-Byrne Associates - Independent Practice Associations Pros and Cons



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An independent practice association (or IPA) is an association of independent practitioners. The typical IPA encompasses all specialties, but an IPA can be solely for primary care or may be single specialty. Practitioners retain their practice's independent corporate status but become part of a separate organisation with other practices, to enable them to contract as a group to provide services to funders Many independent practitioners don't want to give up control to a larger entity, but want the benefits of a larger organisation. Many see an IPA as a tool to protect independence, income and lifestyle. Going it alone is becoming increasingly more difficult. Participating members have an investment in their own future that can leverage the collective power of all the practices. Patients can be recruited /retained by simplifying access for funders and patients. Practice costs can be reduced. The operating cost for network management can be shared. It allows members to set their own standards of care within the framework of funder expectation. It can establish the IPA as a branded healthcare service.

Left out of contracts Loss of patients to existing networks Declining revenues Increasing costs related to data collection and use Acceptance of any terms of remuneration that are offered Practice value is diminished FROM: Lund-Byrne Associates - Independent Practice Associations Pros and Cons Q: Has the role changed from what IPAs did in the past? A: IPAs are not just a contracting entity as in the past. They have emerged as a supportive organization to bring structure and tools to small/solo offices so they can participate in coordinated care, which is the future of medicine. The effort is to bring added value to the practicing physician that facilitates the care of his or her patients, and fulfil the care-management and reporting obligations that could otherwise be too burdensome. FROM: Family practitioner Steven Davis, medical director of Torrance, Calif.-based HealthCare Partners, IPA. South Africa has excellent GPs, but because of the nature of medical scheme benefit options and associated managed care interventions, many of these skills have been lost. A significant proportion of medical schemes spending goes toward managed care organisations, broker fees, specialists and hospitals with only a small portion going to GPs or primary care physicians. Therefore the IPA s started representing the interests of GPs, particularly in negotiating contracts with schemes and administrators, motivated by but also supported by sound business principles. The IPA Forum was established in 2007 by ASAIPA in conjunction with the other major IPA Networks and Medscheme. The Forum still exists today, but only cooperates with Medscheme. However, due to a request from Bankmed in 2009, the 3 major IPA Networks (ASAIPA, SP-Net, and SAMCC) founded a non-profit company, namely the IPA Foundation, who as a single body represents these 3 networks. GPMG has also since joined the Foundation. 2

ASAIPA is currently involved in the following projects to deliver primary healthcare in South Africa: Coordinated Care ASAIPA in conjunction with Connected Care are on a mission to get general practitioners on an IT platform by way of the adoption of the Medinotes software program (developed by a doctor for a doctor) that can be operated on a tablet. As soon as the doctor is operating on an IT platform, integration will take place with all the relevant role players to enable electronic health records and coordinated care. Accountable care ASAIPA has a proven record in working together with the IPA Foundation in managing the cost effective and quality primary care its member doctors are delivering, by way of practice profiling and peer monitoring. Networks ASAIPA and its members are closely involved in various scheme funded networks established to deliver cost effective quality healthcare. Independent Practitioners Associations ASAIPA is looking into recruiting students to ensure succession planning in GP practices, involving allied health professionals in IPAs and promoting specialisation in family and public medicine. ASAIPA is also trying to address malpractice insurance issues, by way of engaging with the insurance industry and profession regulators on accreditation standards and protocols. Community Oriented Care ASAIPA is actively seeking involvement in COPC projects to establish the viability of private / public participation as well as to determine the sustainability of an inclusive affordable primary care model. Exploratory talks have already been had with funders, ICT companies, and Universities. National Healthcare ASAIPA is of the opinion that national health can be delivered through public health initiatives like COPC, and ASAIPA is ready to be the key role player in mobilizing primary care physicians to be the gate keepers in primary healthcare delivery. Talks have been had with NGO s that do GP recruiting for the National Department of Health. 3

What ASAIPA is: The Alliance of South African Independent Practitioners Associations (ASAIPA) is a national network of, and representative organisation for South African independent practitioners associations (IPA s). Currently ASAIPA represents 17 (seventeen) IPA s throughout South Africa, consisting of more or less1500 independent general practitioners (GP s) in individual and/or group practice. Where ASAIPA is: ASAIPA has a national footprint in every province throughout South Africa, with the bulk of its membership being in the interior of the country. ASAIPA GP s practice in urban, suburban, township, semi-rural and rural areas, and are all voluntary members of their local IPA s on an any willing provider basis. How ASAIPA is constituted: ASAIPA operates in accordance with its constitution of a voluntary association of members, and is also legally registered as a non-profit organisation. It may therefore not pay any surpluses to its members, but may only use its income to attain its objectives and service its members. How ASAIPA is governed: The membership of the IPA is by the IPA, not the individual doctors. They are members of their IPA s and exercise their control, via their IPA s. Apart from the doctor in the IPA, the highest authority is the Council of IPA Chairpersons, who decides on policy and direction. The day to day running of ASAIPA is performed by the Executive Committee consisting of: Dr George AlDrich (Chairman) Chairperson: Oranjemed IPA, Dr Anton Prinsloo (CEO) Chairperson: Limpopo IPA, Mr Henru Krüger (COO) ASAIPA Head Office, Mr Hermann Kohlöffel (CFO) Chairperson: NIMPA, Dr Mike Nicholas (Additional Member) Chairperson: Western Cape IPA 4

Dr Anton Prinsloo - ASAIPA CEO: (Medical Doctor, IPA Chair, Company Director and Health ICT expert) In private GP practice since 1994. He held the following positions during the last 15 years: SAMA branch president, Director of GPNet Healthcare Limited, Limpopo IPA chairman, Exco of the board of ASAIPA, Central Peer Review Committee of Medscheme and vice chairman of the National Convention on Dispensing (NCD). He is currently CEO of ASAIPA, a director of the IPA Foundation and also the CEO of the newly founded Mobile Health Enablement ICT Company, Connected Care. Mr Hermann Köhloffel - ASAIPA CFO: (Property Investor, IPA Manager, Managing Director IPA Operations Investment Company and Healthcare Entrepreneur) Healthcare Economics, Healthcare Management, Healthcare Administration, Healthcare Consulting, Managed Care, Group Practice Management, Medical Practice Management Multi-disciplinary Medical Practices, Emergency Services, Strategic planning, Restructuring Mergers & Acquisitions, Finance & Administration, Finance & Project Management, Marketing & Branding, Recruitment & Human Capital Management Mr Henru Krüger ASAIPA COO: (Attorney, Accountant, Internal Auditor and GRC Specialist) Medical Schemes Industry, Financial Services Industry, Healthcare Governance, Legal Advice, Legal Compliance, Contractual Agreements, Commercial law, Litigation, Alternative Dispute Resolution, Financial & Management Accounting, Internal Controls, Process Improvement, Strategic Planning, Risk Management, Operations management, Customer Service, Managed Care, Project Management Dr Mike Nicholas Additional Member: (Medical Doctor, IPA Chairperson & Executive Manager) Dr Mike Nicholas obtained the MB,ChB degree at Stellenbosch University as well as a Diploma in Occupational Medicine. He has been in private practice in Sea Point, Cape Town, since 1985. He is passionate about the rightful role that GP's should play as gatekeepers, as well as the survival of the General Practitioner in South Africa and has been involved in medical politics since the early days of GPNet. He firmly believes that we as South Africans should protect our excellent Private Practice in this country as it is under severe threat and that all the role players from medical funders to private hospitals to all the doctors including specialists should work together in this regard. Dr. George Aldrich ASAIPA Chairman: (Medical Doctor, Farmer, IPA Chairperson, Company Chairperson & Director, Healthcare Expert) In private practice as a general practitioner since 1989 with a full CDE Clinic since 2009 and also handling 50% of the Sub - Acute Unit in Life Pasteur Hospital. Farming since 1986 and named South West Free State potato farmer of the year in 2005. Started Elite Med 24 in 1996 at Hydromed Hospital (Medi - Clinic) in Bloemfontein, which was the first independent company that ran a 24 - hour emergency unit at a private hospital in South Africa and served as President and CEO from 1996 to 2001. On the management of Oranjemed since 1996, serving as Chairman since 2001 and also Chairman and CEO of Flexor, which is the business arm of Oranjemed. CEO, Chairman and Director of Cairnhall Investment Holdings who is the owner of the Cairnhall Private Hospital in Bloemfontein and also CEO and Chairman of Cairnhall Properties who owns the buildings in which Cairnhall Private Hospital is located. Chairman and Director of Flexitron SOS, a computer and software business which specialises in software within the medical and related professions. Chairman of the Board of ASAIPA since 2006. 5

General membership benefits: Relevant member communication Broad interaction with the Healthcare Industry Contracting with all healthcare stakeholders Assistance with healthcare management & governance Legal assistance Practice resources: Assistance with day to day practice management Assistance with Continuing Professional Development Procurement arrangements Information & Communication Technology resources Value added membership benefits: Iemas member cooperative benefits Access to Sanlam s complete suite of specialist financial services for professionals Assistance with patient retention and chronic medication through National Chronic Solutions Access to Connected Care s robust IT platform in the form of the National-Sign-On initiative Medinotes. and Medimail Access to NHC Health Centre's cash practice model and practice management system Access to Health-Soft s e-scripting, e-pharmacopoeia (Medical and layman's), e-medical illustration, e-pill identification, e-pathology (currently under development), and e-time. Access to Health-Worx s fee-for-service practice model and practice management system Access to Med-EDI practice management, billing & switching Access to practice funding and debt handling solutions Access to Healthbridge s practice and business solutions Accounting Solutions from SFS Auditors 6

Point of care machines at reduced prices, from Ethitech Online resources library and online access to the IPA News You will receive a discounted price on these practice management software: Medinotes / Health-Soft / Health Worx / Med-EDI / NCS (National Chronic Solutions) and Healthbridge Members enjoy exclusive marketing, patient communication, and business services options through NHC Health Centres Members enjoy exclusive advertising options with the IPA News (Official Media Partner) Free Doctors Desk Reference Book - an elegant book for members, containing important and very useful information to use in practice sponsored by Arctic Health Pre-approval of products and services indicated by the ASAIPA stamp of approval And much much more. From left to right: Dr Faruk Salojee, Dr Hans Botha, Dr George Aldrich, Dr Hugh Akerman, Dr Abdul Dasoo, Mr Henru Krüger, Dr Shanaze Ghood, Dr Mike Nicholas, Dr Wessel Neuhoff, Dr Carel Bouwer, Dr Anton Prinsloo, Dr Sarel Kritzinger, Dr Bertus Esterhuyse, Dr Kobus Meintjies, Mr Hermann Kohlöffel, Mrs Antoinette Martin (Absent: Mr Eugene Hofmeyr & Dr Lindi Shange) 7

Our Stakeholders Electronic clinical notes and secure doctor communication: Connected Care http://www.connectedcare.co.za Dr. Anton Prinsloo sales@connectedcare.co.za Group practice options and management: Health-Worx http://www.health-worx.co.za Eugene Hofmeyr eugene@health-worx.co.za Chronic medicine solutions: NCS http://www.ncspharm.co.za Luan Van Zyl luan@ncspharm.co.za Medical billing and collections: GRID Express http://www.gridexpress.co.za Craig Pike craigp@mededi.co.za Financial services for general practitioners: Sanlam http://www.sanlam.co.za Marius Booysen mariusb@sanlam4u.co.za 8

Our Stakeholders Medical practice marketing & patient communication: NHC https://www.nhcltd.com Hermann Kohlöffel nimpa@icon.co.za Administrative and financial practice management Practice Cash Flow Solutions http://www.pcfsolutions.co.za Herman Kohlöffel adminmanager@pcfsolutions.co.za E-scripting and electronic health solutions: Health-Soft http://www.health-soft.co.za Wim van Zyl / Hannes Robberts wim@health-soft.co.za / hannes@health-soft.co.za Practice management solutions: MedEDI https://www.mededi.co.za Craig Pike craigp@mededi.co.za Medical publications and advertising: SA Media Holdings http://www.bathicmauritius.mu Jacqui Rowe jacquir@samediaholdings.co.za 9

Our Stakeholders Finance options for medical practices: Elite Medical Finance http://www.elitegroup.co.za Maartens Swanepoel maartens@elitegroup.co.za Point of care machines: Ethitech http://www.ethitech.co.za/ Gerhard Doubell gerhard@ethitech.co.za Medical Imaging Products : Impilo Medical Systems http://www.impilomedical.co.za/ Charles Clark charles@impilomedical.co.za Switching & business intelligence for medical practice: Healthbridge http://healthbridge.co.za/ Ivone Veiga-Moroldo csc@healthbridge.co.za Complimentary Medicine: Arctic Healthcare (Pty) Ltd http://eyeqsa.co.za/arctic-healthcare/ Hilana Cronje info@arctichealth.co.za 10

Our Stakeholders Cooperative membership benefits for general practitioners: IEMAS http://www.iemas.co.za Yvonne Middleton Yvonne.Middleton@iemas.co.za Cash Flow solutions for Medical Practitioners and Practice Management: Mettle Medical Finance http://www.mettle.net/ Puni Modiboa / Lebe Oosthuysen Office no: 011 671 1940 mmf.sales@mettle.net / loosthuysen@mettle.net Professional indemnity insurance for obstetrics: Natmed Financial http://natmedfinancial.com/ Stephen Kellerman info@natmedfinancial.com Accounting & auditing services for medical practitioners: SFS Accountants & Auditors Albert Schreüder albert@spesfin.co.za Medical publications and CPD: Medpharm http://www.medpharm.co.za/ Douw Greeff douw@medpharm.co.za 11

Head office: 012 348-8855/8150 Suite 51, Rynlal Building 012 361-3684 5th Floor, 086 657 7628 320 The Hillside Street charmaine@asaipa.co.za Lynnwood, Pretoria www.asaipa.co.za 36826, Menlo Park 0102 085-310NPO VAT no. 4400223931 Chairpersons IPA NAME CELL TEL NR E-MAIL Pretoria Dr. Shanaze Ghood 082 579 7391 012-375 5028 shanazel@gmail.com South West Gauteng Dr. Faruk Saloojee 082 852 2941 011-412-4528 faruk@gpnet.net Eastern Gauteng Dr. Wessel Neuhoff 083 377 6603 011-811-5780 neuhoffw@samedical.co.za Vaal Dr. Abdul Dasoo 082 417 4747 016-421-2829 akedasoo@polka.co.za North West Dr. Hans Botha 082 651 7729 018-297-5577 habab@iafrica.com Limpopo Dr. Anton Prinsloo 082 446 9263 015-223-0219 ahprinsloo@vodamail.co.za Mpumalanga Dr. Kobus Meintjies 082 491 1678 017-811-5821 medentco@skyafrica.co.za Oranjemed Dr. George Aldrich 082 494 5713 051-522-9261 aldrich@intekom.co.za Eastern Cape Dr. Antoinette Martin 082 414 4972 041-363-4466 amartin@pegp.com Western Cape Dr. Mike Nicholas 082 881 0484 021-434-9741 docmike@viamediswitch.co.za KZN Dr. Hugh Akerman 083 631 6105 033-345-8032 hakerman@iafrica.co.za Rustenburg Dr. Carel Bouwer 082 800 0759 014-596-6492 bouwercj@mweb.co.za Nimpa Healthcare Mr. Hermann Kohlöffel 082 443 0358 011-214-9000 nimpa@icon.co.za KOSH Dr. Sarel Kritzinger 083 463 3131 018-468-5458 sarelkritzinger@telkomsa.net SASDOC Dr. Bertus Esterhuyse 083 456 5922 016-971-2127 bertus.esterhuyse@gmail.com Health-Worx Mr. Eugene Hofmeyr 082 456 1226 011-214-1700 eugene@health-worx.co.za Atteridgeville Dr. Lindi Shange 082 443 1158 074 123 8204 lindishange@mweb.co.za 12