Treatment of adults with acute heart failure 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 the Te Whatu Ora Lakes area.
Adults with acute heart failure that can be safely managed in the community.
Patients domiciled in Te Whatu Ora Lakes area.
Patients not domiciled in Te Whatu Ora Lakes area
Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions.
The following may indicate potential life threatening event in patients with dyspnoea. Consider acute referral when any of the following exist:
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 Congestive Heart Failure - Exacerbation and then attach the appropriate invoice(s).
IV medication invoice: $87
This invoice is a package of care i.e. it includes an allocation for staff time as well as consumables, it cannot be claimed along with any other claims.
GP/NP/CP extended consultation: $79 or
Rural GP/NP/CP extended consultation: $89 or
This funding is available to those practices that receive rural funding
After Hours GP/NP/CP extended consultation: $99
This funding can be claimed when care is provided after 5pm, on weekends or on public holidays.
To cover an additional 15 minutes of GP/NP/CP time above the initial 15-minute consultation. This invoice can be claimed twice per episode of care (acute presentation only) to fund a maximum of 30 minutes of additional time. This invoice can only be claimed at the time of the initial consultation.
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 (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.
GP/NP home visit: $126 or RN home visit: $79
This is limited to one per episode of care within 3 days of the initial consult and cannot be claimed on the day 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.
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.
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 (Lakes), 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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