During the course of your planned surgery or procedure, an anaesthesiologist has various degrees of involvement. The anaesthesiologist manages individual risk factors during your procedure. The following aspects outline the anaesthesiologist’s involvement, which in turn plays a role in the composition of your anaesthetic account.
The basic anaesthetic account
- The pre-operative visit, meaning the visit by your anaesthesiologist before your surgery, which includes an examination, a risk assessment, interpretation of special investigations and the formation of an anaesthetic plan. This visit has a standard tariff independent of the planned surgery. This visit can be performed by any of our colleagues.
- Post-operative visit, meaning a visit by your anaesthesiologist after your surgery, or a follow-up visit, albeit in the ward or in ICU. The first day of treatment in a intensive care unit post-operatively can have additional cost implications.
- The surgical procedure has standard base unit value.
- Anaesthetic time.
- Emergency or unscheduled surgery.
- Modifiers related to the anaesthetic technique:
- Blood pressure control
- Peri-operative blood salvaging
- Modifiers related to age:
- Neonates below 28 days of age or below 2500g body weight
- Neonates below 1 year of age
- Elderly patients 70 years of age and older
- Modifiers related to your physical health:
- Body mass index above 35
- ASA status: a measurement of your physical status
- Modifiers related to the body region undergoing surgery.
- Modifiers related to the position in which you are during surgery including a separate modifier for head and neck procedures.
Added procedures not included in the basic anaesthetic account
- Procedures performed by the anaesthesiologist:
- Invasive monitoring devices, for example, an arterial line or a central venous line
- Gastric intubation
- Ultrasound guidance for placing the abovementioned lines or doing peripheral and plexus nerve anaesthesia
- Fiber-optic camera guided airway intubation
- Regional anaesthesia and pain management that includes:
- Neuraxial anaesthesia, for example, a spinal, epidural or a caudal block
- Nerve plexus or peripheral nerve anaesthesia
- Set up, maintenance and supply of patient controlled analgesia devices (PCA)
A basic unit value is allocated to each of the above entities, as determined by the eMDCM (South African Medical Association Medical Doctor’s Coding Manual). A basic unit value is also allocated to the time duration of the anaesthetic care that you receive, including, but not limited to the duration of your surgery. The basic units are then added up, and multiplied with a Rand Conversion Factor (RCF). With this formula a monetary value is calculated with respect to the anaesthetic service you received. The Rand Conversion Factor is determined by each anaesthesiologist firm or each individual anaesthesiologist. In the case of Van Zyl Anaesthesiologists, the factor value is based on practice cost studies done by the PPBU (Private Practice Business Unit). The PPBU is an affiliate of SASA (South African Society of Anaesthesiologists). These studies were done when there were no clear guidelines concerning tariffs paid to medical practitioners in South Africa. The tariff we use is in line with the tariff paid by some of the largest medical aid schemes in the country. Our tariff is also linked to inflation.