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COVID Claiming Cut-Off

OVID-19 Care in the Community Framework (From 1 October 2023)IMPORTANT: Please see below claiming cut off timeframesPlease read the below framework guidance carefully. Claiming continues to be via the POAC claiming mechanism, please use codes relevant to the period of activity being claimed.COVID testing is now also claimed via the POAC claiming mechanism ONLY for the following scenarios:Positive supervised RAT for those who meet antiviral criteria AND are physically unable to self-test.&nb...

COVID Care Claiming Deadlines

Important message regarding claiming cut-off dates for COVID-19:Please note that all COVID-19 claims up to 26TH SEPTEMBER 2022 must be submitted by 5 NOVEMBER 2023. From here the following schedule will be followed (no exceptions will be accepted)As at 31/12/24 claims accepted from 1 December 2022As at 31/01/24 claims accepted from 1 March 2023As at 29/02/24 claims accepted from 1 June 2023As at 31/03/24 claims accepted from 1 August 2023As at 30/04/24 claims accepted from 1 November 2023As...

Testicular Torsion - Policy Update

Policy Updated: October 2023Please Note: This is not intended as a clinical guideline for management of suspected Testicular Torsion in Primary CareBackground:Requests have been received for POAC to fund scrotal ultrasound investigation for the purpose of excluding testicular torsion.  Diagnosis should usually be made based on clinical presentation; diagnosis and treatment should not be delayed. See relevant pathways:Scrotal Lumps in AdultsScrotal Pain and Swelling in ChildrenEpididymo-orch...

Community CT Head for Minor Head Injury - POAC Winter Funding Initiative

POAC Winter Funding Initiative (till 30th September 2023)A short-term winter funding initiative for CT Head scans to be performed in the community following minor head injury is available until the end of September 2023.Patients with a minor head injury who meet specific referral criteria may be able to have a CT Head in the community, via POAC, as an alternative to sending the patient to ED for assessment. Patients must have been discussed with, and endorsed by, an ED consultant who will also p...

POAC updates and new resources for IV cefazolin

IV cefazolin prescribing and administration resourcesIn response to the ongoing sentinel event cases (hospitalisation with or without subsequent amputation and AKI) with use of community IV cefazolin, the POAC regional clinical governance group endorsed the development of flow charts for both prescribers and administrators.These have been designed to be printed and laminated, and placed in clinicians workstations and on Nursing drug cupboards. They highlight the HealthPathways "red flag" present...

POAC important updates Nov 2022

POAC Christmas Hours- POAC coordination will be available throughout this time, with the exception of the statutory holidays. Please continue to refer in the usual way. Note there may be reduced capacity for respite admissions over this time, and referrals received after 12 noon will likely not be admitted until the following day unless pre-arranged with the facility. IV iron HealthPathway –updated dosing June 2022. Single dose 1000mg for all patients over 35kg –see here&...

POAC important updates August 2022

POAC BLOG POST August 2022-important updates COVID claiming and MoH guidance around acute care-see FAQs and MoH claiming guide for general practice Accuretic recall –please note the GP funding to change patients to an alternate medication is bulk funded through your PHO. POAC does not fund this activity. Claims received will be deleted. IV iron HealthPathway –updated dosing June 2022. Single dose 1000mg for all patients over 35kg –see here . This has been confirmed as a safe and effective ...

Updated COVID-19 Testing and Assessment Funding

With the revised testing strategy, the following fee structure has been applied:RAT TESTING RAT Supervised Test (without clinical assessment) $45 + GSTRAT Supervised Test (with clinical assessment) $120 + GST  To be paid for assessment, click the box on RAT form indicating assessment completed.  For earlier cases submit a COVID-19 e-Notification, tick no swab, in clinical notes write 'RAT CONSULT' PCR TESTING PCR Test (without clinical assessment) $60 + GSTPCR Test ...

Renal Colic HealthPathway changes and COVID funding update

Change to the renal colic HealthPathway The management of the acute episode of renal colic has been updated. In particular it includes POAC-funded imaging after acute presentation for all patients aged >/= 50 years, even if pain has fully settled. This information is in management 3, “primary care management” drop box. The usual requirement of IM/PR analgesia prior to requesting imaging continues COVID-19 funding The COVID-19 page on the POAC website details the funding available to prima...

IMPORTANT REMINDERS FOR CLINICIANS FROM POAC REGIONAL GOVERNANCE GROUP

Testicular Torsion - A recent case has highlighted the importance of considering testicular torsion, even when there is a less common presentation.  A 12 year old boy presented on a Sunday with generalised abdominal and pelvic pain, which had been intermittent over a period of a couple of years and had recently worsened. The patient was doubled up with pain when the pain episodes occurred and there was accompanying vomiting, but no testicular pain. The patient was offered but declined a tes...

POAC XR requests when patients have had a COVID swab

In order to avoid sending symptomatic patients to community radiology providers unnecessarily, your co-operation is respectfully requested: please consider very carefully whether a POAC chest X ray is indicated for patients presenting with LRTI. Acute chest X ray under POAC is not indicated unless it has the potential to avoid same-day hospital presentation or change immediate management. In accordance with the Auckland Regional HealthPathway for Community Acquired Pneumonia (CAP) in Adults, che...

Important reminders for clinicians from POAC regional governance

Diabetic foot- use of IV antibiotics in primary care for patients with active foot disease will only be funded where there is clear documentation of discussion with a named endorsing specialist prior to treatment. There have been more than 12 sentinel event cases reported by POAC in last 18 months where IV antibiotics have been given without prior discussion, resulting in hospitalisation and serious outcomes. Red flags on HealthPathways- red flags exist for a reason and are there as a safe...

POAC facilitation of ACC DVT scan

When a query DVT relates to an ACC case, POAC can arrange the DVT scan (and cover any surcharges if applicable) on behalf of the practice if there is difficulty obtaining an appointment in a timely manner using the usual mechanisms. Call in the usual way on (09) 5357218 and have the ACC number to hand. This should also be included when sending the radiology request form via email referral@poac.co.nz, by fax (09) 5357154 or through the POAC website (if your clinic does not electronically refer)-...

Updated algorithm for COVID-19 assessment and management in the community

The COVID-19 assessment and management algorithm (HERE) has been updated. The new algorithm now aligns with national rates for COVID-19 swabbing and comes into effect from midnight, Friday 18 September.  Please note that from this time there will no longer be different payments for ‘Out of Hours’ swabbing and face-to-face visits that do not result in a swab. These will now be paid at the rate of $60 per patient, rather than $80 per patient. These rates will be in place until further not...

Cellulitis HealthPathway-important updated advice for atypical location sites (e.g. hands, face, over a joint)

A recent review of POAC cellulitis cases has identified many cases where IV antibiotics have been administered for cellulitis at locations other than on limbs A sample of these cases has been reviewed with the regional Infectious Diseases specialists and the following changes have been made to the best practice recommendations within the Cellulitis HealthPathway: -when cellulitis location is atypical (hand, face ,head and neck, over a joint) specialist discussion is advised for all but mild case...

Increase in hospital admissions for AKI secondary to Cephazolin use

A review of multiple recent cellulitis cases has shown an increase in hospital admissions for Acute Kidney Injury (AKI) secondary to cephazolin use. In these cases, cephazolin doses have not been considered for reduction in patients with known or possible renal impairment, and Probenecid has been given. These cases have been reviewed by the POAC regional governance group Please note the following information: IF IV cephazolin is indicated i.e.: -Patient >/= 15 years -No improvement or worseni...

New OST Claiming Process

As of 1st July a new process will be introduced for referring and claiming for OST services. No action will be required by the GP practice.  All new OST referrals and quarterly invoicing will now be automatically processed by the POAC team using the CADs register of active patients. A reminder that no co-payment should be charged to the patient. Any queries should be directed to POAC accounts@poac.co.nz See all details HERE...

CELLULITIS IN PATIENTS WITH DIABETIC FOOT DISEASE

Over the last 12 months POAC claims have been made in seven cases where IV antibiotics were administered to patients with active diabetic foot ulceration who have then required hospital admission.  Five of these admissions resulted in amputation. POAC aligns its funding with the best practice, regionally agreed Auckland Regional HealthPathways. The Cellulitis in Adults pathway recommends against primary care administration of IV antibiotics in cellulitis associated with active ulceration in...

TSANZ statement on nebuliser use during Covid-19

Novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by a newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its identification in December 2019, COVID-19 has spread internationally and was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on 30 January 2020.It is recognised that some respiratory therapies such as nebulisation, high flow oxygen, non-invasive ventilation, and the use of cough a...

INR monitoring during Covid-19

Outpatient INR monitoring for patients receiving warfarin during COVID-19 pandemic. The need for regular INR testing among patients receiving warfarin to achieve safe anticoagulation is difficult during this time of “social distancing” to minimise the risk of spreading the virus. Hospitals, general practitioner practices and pathology services are minimising patients visits greatly. The following should be considered during this time to minimise patient contact: 1. Review if a direct oral a...

CXR UNDER POAC FOR LOWER RESPIRATORY TRACT INFECTION

In light of the current COVID – 19 pandemic POAC would like to take the opportunity to reinforce the POAC funding policy for CXR in Community Acquired Pneumonia (CAP). In accordance with the Auckland Regional HealthPathway for Community Acquired Pneumonia in Adults Chest X ray is not usually needed in CAP unless it will change management. Acute CXR under POAC is not indicated unless it has the potential to avoid same-day hospital presentation or change immediate management. In most cases of ...

Rivaroxaban now an option pre-ultrasound for delayed DVT scans

The ultrasound DVT pathway has been updated to include a stat dose of 15mg oral Rivaroxaban where there is a delay >6 hours to ultrasound. This is an alternative to administering Clexane. Ensure to check contraindications and cautions - see link here for the Ultrasound DVT information The on-call Haematologist should be called for Friday delays where >1 dose may be required over the weekend. In addition to this change, note: Always calculate the Wells score FIRST unless special case (...

Top tips for adult dehydration management

POAC only funds dehydration cases for moderate dehydration with vomiting and must include a trial antiemetic and oral fluids for all patients presenting with moderate dehydration in primary care. After 60mins, reassess and if insufficient response then give IV fluids + antiemetic. Excludes patients with diabetes and children <15yrs. For migraine presentations, IV fluids are only funded if assessed as moderate dehydration and unable to tolerate oral fluids. Full adult dehydration guideline see...

New Toothache Auckland Regional HealthPathway

This new pathway provides guidance on the likely causes of toothache by type of pain and options for pain relief.  In addition it discusses the limited role of oral antibiotics, which antibiotics to use, and that intravenous antibiotics are not indicated for dental abscess. The pathway also suggests possible sources of assistance if cost is a barrier to accessing dental care. Please circulate and discuss at upcoming clinical meetings as POAC will not fund IV antibiotics for any dental relat...

Top tips for adult cellulitis management

A trial oral Fluclox 1g QID unless : symptomatic PVD, symptomatic venous insufficiency or BMI >40 for all patients presenting with cellulitis in primary care Discuss all cases for consideration of IVs without a trial of oral antibiotics with the Infectious Diseases team unless the criteria above are met-POAC funding requires specialist approval IV antibiotics pre or post incision and drainage are not funded through POAC-discuss with surgical team at hospital if required Great article on IV an...