COID work compromised with new system

30-Jun-2015

In August last year, the Department of Labour’s Compensation Fund changed the system it uses to make payments to Doctors for services rendered on its behalf. 


Michael Botha, Managing Director of Synchramed

In August last year, the Department of Labour’s Compensation Fund changed the system it uses to make payments to Doctors for services rendered on its behalf. Since the system implementation change, however, many Doctors have not received payment for legitimate claims submitted for services rendered on the new system, but also claims submitted on the old system just prior to the system change over. This, in some instances, has had a significant negative cash-flow implication for Doctors who rely on timely payment to run their practices. In fact, the backlog here is to the point where certain Doctors are considering no longer offering to do Compensation for Occupational Injuries and Diseases (COID) work.

Certainly this cannot be allowed to happen as the implication could be disastrous. So what is needed and what should be considered urgently by the Department of Labour’s Compensation Fund in order to get things back on track – which in essence needs to be done sooner rather than later?

  • Firstly, a revised roll out plan for the new system is needed. Whilst I am confident such a plan was in place prior to the “go live” of the new system, there is no doubt it needs to be significantly revised as many shortcomings have been identified in the new system which has resulted in the untenable situation we now find ourselves in.
  • A roll-back plan is needed. As a result of the magnitude of issues encountered, serious consideration should be given to reverting back to the old system until such time as all issues have been resolved in the new system and it can be proven that it operates as intended, and can be relied upon to do the job going forward. An honest assessment would conclude that the new system is not ready for commercial deployment – and a quick alternative needs to be found. Rolling back to the old system would appear to be the most logical at this stage.
  • Phased run down of the old system to ensure all debt claimed via this mechanism is settled. Following on from the point above, a Big Bang approach should not be adopted when the system is deployed again – the Department, Doctors and employers do not have the infrastructure and capacity to handle this. The roll out needs to be phased and tightly controlled - by doing so it will make it more manageable and of course, any concerns can be raised immediately without causing a bigger impact.
  • Helpdesk support should be implemented. There just simply is not enough support (front line, second or third tier) to cater for the current demand. The Compensation Fund staff is being overwhelmed by volume, and subsequently, service levels have suffered greatly and in some instances appear non- existent.
  • Communication is critical: Not enough communication is taking place and it is essential that all stakeholders are kept in the loop when it comes to the system and process as well as the timings – so that adequate preparations can be made.
  • Adequate Resourcing is a fundamental pillar. The Compensation Commission has the financial resources to do this, but has not looked at adequate resourcing. While this is critical to overall operations, more pointedly in the short to medium term they need to gear up to be able to service two systems during the roll out/run down phase.

The implications of the new process and system has had far reaching affects – as both employers and Doctors are being impacted - employers paying monthly contributions as required by statute and Doctors not being timeously rewarded for the healthcare they are rendering in this regard. The move to the new system is certainly understandable as legacy technologies and processes need to be upgraded but we need to acknowledge that there is a problem before this escalates further.

As an industry, we need to work together and build a workable solution sooner rather than later as this will allow the Fund to continuing delivering on it’s mandate of providing compensation for occupational injuries, diseases and rehabilitation, as well as delivering value to all their clients.