ED redirect
Overview
This service is designed to ensure low acuity presentations to ED are actively redirected back to primary care. The initial consultation fee is funded for eligible patients.
In the first instance, ED will contact the patient’s registered general practice to determine if there is an appointment available. If an appointment is not available ED will contact one of the contracted overflow providers (currently Medicross and Carefirst) to determine if there is capacity to see the patient.
ED will not redirect a patient unless the receiving practice has accepted them. Patients will be provided with information regarding the appointment that has been made for them, in the form of an 'ED redirection voucher' (example below).
For conditions that meet Primary Options Acute Care criteria, practices can then initiate a separate referral and claim via the usual Primary Options Acute Care process.
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.
Details
All Pinnacle practices in Taranaki region can claim for this service.
- Practices can only claim an ED redirection subsidy for patients who have been redirected from Taranaki Base Hospital.
- Patients who reside within Te Whatu Ora Taranaki boundaries.
- Patients eligible for New Zealand funded healthcare services.
Patients who have not been actively referred from ED.
The episode of care ends when the outcome and claim are submitted.
Payment will be made once an outcome has been lodged for the case.
Prices listed below are GST inclusive.
ED redirect GP/NP consultation: $89.00
This invoice funds the initial consultation for the redirected patient.
ED redirect GP/NP consultation after hours: $100.00
This invoice funds the initial consultation for the redirected patient after 5pm on a weekday, on weekends or public holidays.
ED redirect sundries: Variable
This requires an itemised list of any extra charges incurred by the patient.
Submit your referral via Primary Options using the initial condition coding: ED Redirect
When invoicing for the service please lodge an 'outcome and invoice' form and select the appropriate invoice(s).
If the patient meets POAC criteria, please initiate a separate referral for any invoices claimed under that POAC pathway.
Once the patient is at the practice, the GP/NP will assess the patient and determine whether the condition meets any Primary Options Acute Care criteria or is considered normal GP business/non-acute.
If the patient meets Primary Options Acute Care criteria, please claim one of the above invoices to cover the cost of their initial consultation and then initiate a separate claim and continue to claim as you normally would for a Primary Options Acute Care case.
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.
Patients will be given an ED redirection voucher with the details of their appointment. Below is an example.
There is no co-payment to be charged to the patient.
The service is funded by Te Whatu Ora.
Contact
Primary options team, Pinnacle Midlands Health Network
infoprimaryoptions@pinnacle.health.nz
027 687 7312
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