KMA- NHIF RESOLUTIONS ON ISSUES RAISED BY DOCTORS

On Wednesday 19th KMA President Dr. Were Onyino accompanied by our CEO had a meeting with the NHIF CEO Dr. Peter Kamunyo at the NHIF OFFICES to discuss issues raised by doctors which include:

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  1. Surgical pre-authorization form,
  2. Separation of facility and doctors’ fees,
  3. Approval of forms by consultant or senior House registrars and registrars in training institution,
  4. Approval of contracts & Enpanelling,
  5. Technical review of procedures before approval,
  6. Health Systems Research 
  7. Doctors Charges.

They agreed on the following on the issues raised:

  • Surgical pre-authorization form. – KMA articulated the issues with the new NHIF preauthorization form requesting for doctors’ personal details to be excluded from the pre-authorization forms. Instead an electronic verification platform be established linked with the KMPDC database which is the custodian of all Doctors’ data. This will prevent the use of the data in fraudulent claims and activities. It was agreed that NHIF will relook the form details and make changes to protects doctors’ data.
  • Separation of facility and doctors’ fees- KMA through managed healthcare committee will work toward projects aimed at costing services provided by Doctors under the NHIF scheme.KMA suggested that there be a  separation of the packages to take into consideration the doctors’ fee and institutional costs to guarantee quality delivery of healthcare service.
  • On Approval of forms by consultant or senior House registrars and registrars in training institution. KMA will request the Medical Council KMPDC to recognize the Senior House Registrars and define their scope of practice which will enable NHIF update their database to include them in the list of recognized specialties to provide the much-needed services. The SHR are not authorised currently to sign claim forms by NHIF with many forms signed by them being rejected. This is despite the fact that they are Consultants awaiting insertion of their names into the Consultants’ register at KMPDC. This has forced them to resort to using their senior’s details to get the necessary approvals. KMA proposed that NHIF recognizes this group and their scope of practice.
  • Approval of contracts & Empaneling -KMA reported that its members have experienced delays in accreditation of medical facilities. In as much as this role was transferred to KHPOA, the period between accreditation and contracting by NHIF takes long. KMA president proposed digitization of the process to fast track it. KMA proposed that there be an interagency collaboration where both accreditation and the due diligence visit for purposes of contracting be combined for efficiency purposes and avoid the duplication of roles.
  • On technical review of procedures before approval, KMA proposed there be involvement of doctors in authentication of the preauthorization claim forms and proposed that KMA provide the technical support towards achieving this.
  • With doctors charges there is currently a challenge with NHIF meeting the medical council recommended doctors’ rate according to the KMPDC fee guidelines thus KMA will work with specialist associations and the medical council to advise on rates and the scope of practice for the different specialties based on regions which NHIF can honor.
  • Health Systems Research- NHIF every year collects massive data on health system from its clients and this if analysed would generate lots of information to influence health policy. KMA through the managed Health committee shall work with NHIF to promotes health systems research in collaboration with other partners in the health sector.
  • KMA discussed with NHIF to consider a model where the gatekeepers in primary healthcare are the Medical Officers who will be supported by other cadres to ensure quality delivery of Healthcare to mwananchi in keeping with its mission. This has been successfully implemented in other jurisdictions with UHC programmes. This will avoid wanton wastage of resources by ensuring proper utilisation of the expertise within our disposal.

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