Frequent ED attendees (POAC)

All Pinnacle practices in Waikato region can claim for this service.

Pinnacle MHN and Waikato DHB (WDHB) will be working together to identify and support these patients, with the aim to re-engage patient with their general practice. The expectation is that this will give the patient and their whānau more control in managing their health and ultimately reduce unnecessary emergency department attendances.

If the practice is unable to make contact with the patient, or the patient does not attend the consultation, please inform the Primary Options team.

Te Whatu Ora will identify these patients and notify practices of eligible patients.

Any patient not identified by Te Whatu Ora.

The episode of care ends when the maximum number of claims are submitted.

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

Prices listed below are GST inclusive.

Frequent ED – GP/NP Attendance: $236.00         

GP/NP attendance (in person or by telephone or video) at a multi-disciplinary hospital meeting to develop a management plan (Up to 60minute meeting).              

Frequent ED – GP/NP Consultation: $236.00

GP/NP consultation to discuss management plan to avoid the patient attending ED acutely (Up to 60-minute consultation).  

*Frequent ED – GP/NP Follow Up: $236.00 each appointment

Follow-up GP/NP visits for the events identified in the care plan where the GP/NP has agreed with the patient that they will return to General Practice rather than presenting to ED.

*Maximum 4 funded appointments in 1 year (maximum 1 hour consult each time).  

Submitting your referral

Submit your referral via Primary Options. When you have the initial consultation with the patient lodge a new referral and select the Frequent ED attendees pathway for the patient.

• The case number generated will be used for the duration of the patient’s care.
• At each consultation lodge a singular invoice using the original case number, add the consult notes and select the appropriate invoice.

Please be aware if you do not ‘outcome’ the case you will receive this case as part of the reminder email sent out on a regular basis. If you do not want to receive a reminder for this case, please ‘outcome’ the case. You will still be able to lodge singular invoices for this case number regardless of whether this case has had an ‘outcome’ submitted or not.

Additional information

• A claim needs to be lodged by the referring clinician at the time the decision is made to use this funding to provide a service. A clinician should ideally invoice for every consultation as it occurs, NOT retrospectively.
• To keep track of what has already been claimed for each patient, it is recommended that an alert is put on the patient’s record, indicating the case number being used for claiming. You can view each advanced form submitted to the team by clicking in to the ‘forms’ section in the patient record. Alternatively, you may contact the Primary Options team on 0800 646 764 if you wish to check what has been paid out.
• This service only funds what is listed in the claiming section above. No co-payment should be charged to the patient for this service.  If the patient requires additional time or services, such as ECGs or dressing changes as part of the consult, please advise the patient there may be an additional cost.

Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of funding.

It has been recommended that in addition to a good assessment and history, the full range of appropriate observations should be documented. It is important to state the time of consultations and interactions with the patient. 

No co-payment should be charged to the patient.

The service is funded by Te Whatu Ora.