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Programmes » Musculoskeletal (POAC) - Tairāwhiti

Musculoskeletal (POAC)

Tairāwhiti | Musculoskeletal | Under 18 | Over 18 | Over 65

Overview

Treatment of adults with suspicion of pathological fracture where there is no history of injury and children aged 8-16 years for suspicion of SUFE (unexplained hip, or knee pain, especially if the hip is internally rotated and flexed). 

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.

Details

Which practices can claim for this service?

All practices in Tairāwhiti region can claim for this service. 

Who is eligible for this service?
  • Patients domiciled in Te Whatu Ora Tairāwhiti area.  
  • Adults for suspicion of pathological fracture where there is no history of injury.
  • Children aged 8-16 years for suspicion of SUFE (unexplained hip, or knee pain, especially if the hip is internally rotated and flexed). These children require an x-ray AP pelvis and lateral of the hip. A frog lateral is useful for comparison with the other side if the slip is subtle. 
Who is excluded from the service?
  • Patients not domiciled in Te Whatu Ora Tairāwhiti area.
  • Suspected septic arthritis, osteomyelitis. The pre-hospital treatment that has been provided cannot be funded via POAC, as admission to hospital is inevitable. Refer acutely to ED/orthopaedics. 
  • Suspected spinal tumour. Please refer via orthopaedics using the high suspicion of cancer tab. 
  • Injury related x-rays, ultrasounds, consultations or procedures – these are funded by ACC. 
  • Chronic rheumatological conditions management/investigations including joint injections. 

Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions. 

When is the service complete?

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.  

Claiming guidelines

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 is unable to be funded by POAC, the patient may be liable to the practice for the fees incurred. 

Please make your claim via Primary Options, select Musculoskeletal and then attach the appropriate invoice(s).

Prices listed below are GST inclusive.

GP/NP/CP follow up: $79 or RN follow up: $39 or

Rural GP/NP/CP follow up: $89 or RN follow up: $49 or

This funding is available to those practices that receive rural funding. 

Afterhours GP/NP/CP follow up: $99 or RN follow up $59

This funding can be claimed when care is provided after 5pm, on weekends or on public holidays.

A follow-up visit may be funded for management post X-ray(based on treatment provided as evidenced in clinical notes).

This is limited to one consult within the acute episode of care. While follow up consultations can be virtual, to be eligible for funding, documentation needs to include a two-way conversation between the practice and the patient. A sent message with no documented response does not meet the definition of a consultation.

Funded via third party providers  
SUFE: An AP Pelvis and lateral X-ray of the hip is funded under this service. A frog lateral is also funded if appropriate for comparison with the other side if the slip is subtle. 

Pathological fracture: X-rays are funded under this service. Patients who 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). 

What level of clinical notes do I need to submit?

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. 

Does the patient have to pay?

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. 

How is the service funded?

The service is funded by Te Whatu Ora. 

Contact

Primary options team, Pinnacle Midlands Health Network
infoprimaryoptions@pinnacle.health.nz
027 687 7312

RELATED RESOURCES
Primary Options radiology providers
Published: 15/07/2020 | Document

Pinnacle has contracts with a number of radiology providers under Primary Options for Acute Care (POAC).

View resource
POAC business rules - Tairāwhiti
Published: 03/08/2020 | Document

Business rules for the Primary Options Acute Care programme (Tairāwhiti), which supports primary care through funding specific clinical services.

View resource
Te Manawa Taki / Midland Region Community HealthPathways
Published: 14/11/2024 | 1 link | Website

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.

View resource
Tests, treatments and procedures health professionals should question
Published: 10/08/2020 | 1 link | Website

Recommendations on five low-value practices and interventions, from the Australasian Faculty of Occupational and Environmental Medicine.

View resource
Primary Options resources
Published: 18/02/2027 | 22 files | Document

Quick guides to assist practices with identifying eligibility criteria;invoices that can be claimed; managing claims and providing assistance with understanding remittance reports

View resource | Download files
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