Acute Demand Services
Admission Avoidance
Key Purpose/Benefit
The Admission Avoidance Programme provides funding to support General Practice to proactively review patients with the intent of reducing demand on Secondary Care services (either ED attendance or Hospital Admission). The priority populations for this initiative are Māori, Pasifika, high-needs, and CSC holders. This is a limited resource to be used when self-funding is a barrier. Services included within this Admission Avoidance initiative are:
1. Funded Review following an exacerbation of an existing Long Term Health Condition where there is a high risk of deterioration or admission if a review does not occur. If further reviews are required – this is at clinical discretion
2. Funded Post-Admission Review. Review of a patient who has recently (within the last 14 days) been admitted to secondary services and is at risk of re-admission if a review does not occur. If further reviews are required – this is at clinical discretion.
3. Funded Acute Demand services (Cellulitis, IV Hydration, DVT Management) for Casual/Unenrolled populations who attend Walk-in clinics in General Practice or Accident and HealthCare.
Please Note: All consultations under this programme must be in person and delivered by a clinician able to prescribe, assess and change the management of a patient’s condition as required This could be the GP, Nurse Practitioner, or practice-employed clinical pharmacist.
Eligibility Criteria
An eligible patient must:
• Be a New Zealand citizen or have New Zealand residency status and
• >14 years old
• Priority for CSC/High User Health Card holders, Māori, Pacific, Quintile 5 but not limited to only this population group.
• Clinical eligibility – to be determined by practitioner.
Claiming
• For ‘exacerbation’ claim - patient must have presented to any service - not necessarily their
usual GP - for the first appointment. The claimable funding is for a follow-up appointment to an issue previously managed by a clinician
• Currently, invoicing is a manual process. Please fill out this form for each consultation that is to be invoiced under this programme (there is no need to send the PHO an additional invoice). You may wish to keep a record of claims as part of your practice process.
• BCTI’s (Buyer Created Tax Invoices) will be generated and will be sent to the practices at the end of each month with data to support the invoice process. Payment will occur on the 20th of each month.
Consultation type
Follow-up Consultation: Exacerbation of existing health issue* $85.00
Post-Admission Review
Acute Demand Services (Cellulitis, IV Hydration, DVT Management) for Casual/Unenrolled populations
$85.00
Same amount as currently paid
• Please note, if any error or rejected claims occur, you will receive a notification from canon@wboppho.org.nz in your practice inbox.
For any questions, please reach out to NSAdmin@wbopppho.org.nz.