Treatment of patients with moderate COPD exacerbation and/or suspected pneumonia that can be safely managed in the community.
This service is part of the Primary Options for Acute Care (POAC) programme.
Your Pinnacle Services Contract applies to this service. By claiming for this service, you have indicated that you have read and agreed to the business rules set out here.
This is NOT a clinical guideline.
All Pinnacle practices in Waikato region can claim for this service.
Patients with a moderate COPD exacerbation and/or suspected pneumonia that can be safely managed in the community.
Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions.
Once the episode of care is completed and the patient is no longer acutely unwell, they exit the POAC programme.
Once the patient exits the POAC programme, the case requires a clinical outcome to be lodged. No payment can be made for any claims unless the outcome is completed.
Where treatment in the community is no longer clinically appropriate, the patient may be admitted to hospital during a POAC plan of care. Please indicate this in the clinical outcome.
The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. If the claim cannot be funded by POAC, the patient may be liable to the practice for the fees incurred.
Prices listed below are GST inclusive.
Please make your claim via Primary Options, select COPD/Pneumonia and then attach the appropriate invoice(s).
GP/NP extended consultation: $79
To cover an additional 15 minutes of GP/NP time above the initial 15-minute consultation. This invoice can be claimed twice per episode of care to fund a maximum of 30 minutes of additional time.
GP/NP follow up of result of chest X-ray: $79
A follow-up visit may be funded for those patients who require follow-up of radiology investigations. This is limited to one per episode of care within 3 days of the initial consult.
Funded via third party providers
A chest X-ray is funded under this service, if clinically indicated. Patients who are not acutely unwell and do not require a same day X-ray are not funded under POAC and should be referred to primary referred radiology.
Radiology is only funded for same-day investigations (within a 24-hour period).
Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of POAC funding.
It has been recommended that in addition to a good assessment and history, the full range of appropriate observations should be documented, especially where the diagnosis is undetermined. It is important to state the time of consultations and interactions with the patient.
The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient.
The service is funded by Te Whatu Ora.
In addition to the funded services available via POAC there is another service that general practice can utilise to potentially avoid a hospital admission.
NB: This service is neither accessed nor claimed through Primary Options.
The Acute COPD Community Escalation Service (ACCESS) is a new expert triage, advice and treatment pathway with the aims of rapid assessment and admission avoidance.
Please call the dedicated COPD hotline on 027 202 6208 to speak to the clinical nurse specialist for advice and referral.
The service is available 8.30am - 5pm, excluding weekends and public holidays.
The ACCESS team is co-ordinated by a respiratory clinical nurse specialist (CNS) and includes a respiratory physician, CNS, physiotherapist and the START team.
START is an intensive home-based rehabilitation service which provides support for those discharging from hospital, presenting to ED or referred from general practice.
If your call is not answered, please leave a brief message including patient NHI, age, name and reason for referral. All calls will be answered within one hour.
If it is not practical or safe to wait for the call-back, please refer your patient to Waikato Hospital Acute Medical Unit or nearest ED if outside Hamilton.
Referral
Eligibility criteria
Exclusions
Any other reasons requiring inpatient treatment (can discuss this with COPD hotline).
Primary options team, Pinnacle Midlands Health Network
infoprimaryoptions@pinnacle.health.nz
027 687 7312
Pinnacle has contracts with a number of radiology providers under Primary Options for Acute Care (POAC).
Business rules for the Primary Options Acute Care programme (Waikato), which supports primary care through funding specific clinical services.
A web-based information portal supporting primary care clinicians to plan patient care through primary, community and secondary health care systems within the Midland Region.
Quick guides to assist practices with identifying eligibility criteria;invoices that can be claimed; managing claims and providing assistance with understanding remittance reports
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