SASCI News 2013 October (Annual Report)

  • November 20, 2013

After another busy year where SASCI’s role as a representative body of cardiologists has once again been extended, I have to start this letter by thanking the hard working SASCI executive:  Dave Kettles (Vice-President), Sajidah Khan (Africa PCR, International Congresses, Education and Guidelines), Cobus Badenhorst (Treasurer), Adie Horak (Secretary and SASCI @ World Paed Cardio Congress 2013), Graham Cassel (ex-officio President: Africa PCR and non-invasive coronary imaging), Mpiko Ntsekhe (Academic: Visiting Professors Program and AfricaPCR), Chris Zambakides (CTO working group), Len Steingo (SA Heart PPC: Coding and Funders), Mark Abelson (SA Heart PPC: Coding and Funders), Jean Vorster (SA Heart Congress 2014), Gill Longano (ISCAP), Liezl Le Grange (ISCAP), Craig Goodburn, Hans Buyl and Tracey du Preez (Industry representatives)

2013 was a year of many new developments and I am pleased to report on our activities.

The year started off with the 2nd AfricaPCR program that was held in Cape Town in February. The AfricaPCR Interactive Case Corner and a full day AfricaPCR program were embedded in the World Congress of Paediatric Cardiology and Cardiac Surgery 2013. The main AfricaPCR Program also included a “How should I Treat” session on Pericardial Disease and two “Learning” sessions on Balloon Mitral Valvuloplasty and TAVI.
In support, two SASCI Breakfast Symposia were also hosted to bolster the adult coronary content.  Adie Horak was the SASCI program convener with able assistance from Dave Kettles and Mark Abelson. These symposia were well attended and the subject matter led to enthusiastic audience participation.
AfricaPCR 2014 will take place from 13 – 15 March 2014 In Cape Town at CPTICC. The scientific program’s planning is well advanced and will cater for both the high level interventionalist and those still building capacity. Go to www.africapcr.com  for the programme at-a-glance.

The African AfricaPCR Board members are Farrel Hellig (SASCI), Tom Mabin (SA Heart Educational), Mpiko Ntsekhe (PASCAR), Sajidah Khan (Academia) and Harun Otieno (Kenya). We will continue to develop AfricaPCR to be a course “by and for” our continent 
The SASCI AGM (incl ISCAP) for 2014 will take place at AfricaPCR Congress. All members are urged to attend this year meeting. Members will receive notification of this meeting together with all the details regarding date, time and venue.
  

SASCI supports the SA Heart Congress and will contribute to the scientific program for 2014. Jean Vorster (SASCI) has been tasked to assist Sajidah Khan (SA Heart Durban Branch) in developing a valuable interventional program.   

Other activities include: 

SASCI and Tom Mabin’s TAVI Appeal Hearing took place on 15 March 2013 in Pretoria after the Council for Medical Schemes (CMS) initially ruled “in favour” of Medshield not funding TAVI based on the funders own rule exclusion. The ruling of the appeal committee was received in April and is in our (patient’s) favour. The Medical Aid was directed to pay for the TAVI procedure in full and it is viewed that the Medical Aid cannot exclude therapy only based on their own rules (even if these are approved by CMS). The Medical Aid did appeal and the CMS Appeal Board hearing took place on 26 July 2013. The decision was expected by mid-September but was frustratingly not received by mid-early November (at the time of writing). SASCI remains cautiously optimistic that the appeal committee ruling will be upheld. 

This process is extremely important as the CMS is mandated to look after the interests of the medical aid member and protect their rights. Please go to www.medicalschemes.com if you need more information on CMS or refer your medical aid patients if needed. 

A SASCI delegation consisting of Farrel Hellig, Len Steingo, Graham Cassel, David Jankelow and George Nel is meeting with Discovery Health to discuss pertinent issues. The CT Angio project and reimbursement methodology for procedures are under discussion. The SASCI Exco did advise Discovery Health to remove the current barriers (patient co-payment and motivations) to CTCA and to then assess utilisation. It is envisaged that new reimbursement models will be developed to better reflect the changing face of intervention so that lesion subsets such as bifurcation and CTO’s, will have specific codes to reflect the complexity, training and time required for such procedures.

The Executive Committee of SASCI has reviewed the data regarding the Aneugraft pericardial covered stent and supported the application for this product to be made available to local practitioners. A letter was issued by Dave Kettles on behalf of the SASCI Exco and has been send to Discovery Health. Approval was finally received in July 2014. 

SAMA CPT Coding - Mark Abelson and Len Steingo have undertaken the huge task of submitting new codes to SAMA this year. Due to their hard work and excellent preparation (and on the day representation by Len) most submissions were accepted. These are the first cardiovascular codes in many years to be included in the SAMA Doctor Billing Manual (2014).


• Interpretation items 1286 and 1287 – SASCI requested that the code interpretation should be changed from “per vessel” to “per lesion” and this has been approved.
• Renal Denervation (RDN) – A new dedicated code will be added to the 2014 DBM. The description will indicate that the item is applicable for each renal artery.
• Fractional Flow Reserve (FFR) – Two dedicated add-on codes have been granted. These will be codes to be added, per vessel, to the primary procedure code.  This will be charged equivalent to IVUS.
• Transcatheter closure of the left atrial appendage (LLA) – A new dedicated code will be added. 
• Trans-catheter Aortic Valve Implantation (TAVI) – A dedicated code will be added. However, as there are few TAVI  codes in the CPT® structure, further attention will be given to include a range of TAVI codes and not only one.   
• Vascular Closure Device - A dedicated code was NOT granted as closure is seen as inherent part of the procedure.
• Percutaneous coronary angioplasty using a drug eluting balloon (DEB) – A dedicated code was NOT granted but the description of items 5058 – 5068 will be revised to include the use of a drug eluting balloon.  This will be charged equivalent to a stent.
• Z-codes – Are problematic as some medical aids use this to justify non-payment. SASCI approached SAMA to understand the reasons for Z-codes and the process to be followed to get Z-codes removed.  SAMA firstly confirmed that the Z coding should NOT be used to motivate non-payment as the code only indicates that a code is new within the coding structure. Utilisation data has been submitted to SAMA for codes 1272 (coronary sinus lead implantation) and 1274 (aspiration of thrombus from coronary artery or saphenous vein bypass graft) and we expect removal of the Z-code in 2014.

Coding remains a major challenge with huge time impact as even with inclusion in SAMA DBM individual funder (administrators) still need to decide to firstly include the code in their reimbursement structure and if funding is made available.  

SASCI will engage the funders in 2014 to secure the use of these codes and possible funding for these new codes in 2014. 
Mark Abelson has written a Summary and Motivation to medical aids for blanket reimbursement for FFR/IVUS. The Executive Committee of SASCI has reviewed the data on the appropriate use of Intra-Vascular Ultrasound (IVUS) and Fractional Flow Reserve (FFR) and strongly recommends that the cost pertaining to the use of these devices should be routinely covered by the medical aids. In October Medscheme sent a letter to SASCI confirming that they have reviewed the funding indications for IVUS and that Medscheme will fund IVUS when it is performed by a cardiologist.

Educational for members and fellows:

French-Reunion-South African 2013 took place from 17 – 19 April 2013 in Bordeaux, France. Tom Mabin once again represented SASCI on the organising committee and a high quality program with exceptional faculty has been assembled. This was the final FRSA meeting SASCI will officially be involved in.

During EuroPCR in May 2013 SASCI once again had high visibility with two joint “How should I treat?” sessions (with Croatia, Cyprus and Serbian Societies as well as Polish Society). In addition SASCI participated in a new learning program based on presentation of “complication cases” chaired by Graham Cassel. Live cases to the main PCR auditorium from Farrel Hellig’s unit at Sunninghill also took place.

SASCI participated in a Joint Country Society Session during the TCT 2013 Congress held in San Francisco (27 October - 1 November). Graham Cassel, Dave Kettles and Chris Zambakides represented SASCI at the congress. The session was about “Multivessel Disease: Matching the Therapy to Doctor and Patient Preference (Presented by the South African Society of Cardiovascular Intervention, the Interventional Working Group of Cardiology Society of Serbia, the Working Group of Interventional Cardiology of The Croatian Cardiac Society, the Cyprus Society of Cardiology and The Working Group of the Hellenic Society).

Individual members continue to share their experience with colleagues. “A Radial Access Workshop” was held at Steve Biko Academic Hospital in October with Adriaan Snyders as operator. Five cases using radial access was performed with success. Vascular Access is very topical and will also future prominently in the AfricaPCR 2014 Program in Cape Town. 

A dedicated CTO portfolio within the SASCI Exco has been created with the aim to create awareness and improve CTO procedure outcomes through education and training. CTO is a lengthy procedure which calls for patience and precision. If members are interested in learning these procedures they can contact Chris Zambakides and Farrel Hellig. Crossroads held a theoretical workshop in mid-2013 on CTO’s. A SASCI CTO workshop is considered for 2014 which will be planned and run through SASCI office after Exco approval.

There has also been a great deal of interest in rotational atherectomy and therefore a dedicated portfolio has been established, led by Adie Horak. A SASCI Rotablator workshop is planned for the weekend of 25 January 2014. This workshop is proudly sponsored by Boston Scientific. Please contact the SASCI office if you want to attend this meeting.

South African Fellows once again have the opportunity to attend the annual Society for Cardiac Angiography and Intervention (SCAI) Fellows Program in Las Vegas (December 2013). Arrangements are well under way and the four SA recipients, Alfonso Pecoraro, Zaid Moosa, Pumeshen Bisetty and Tawanda Butau are looking forward to attend. This program is made possible through generous support from SCAI and Boston Scientific. SASCI also facilitated the process to ensure that a Mauritian delegate also gets the opportunity to attend this year and we are working on expanding future SCAI invitations to other African countries. The 4 delegates attending this congress will give feedback at our next Fellows workshop that will be held in June 2014.

Visiting Professor Program 2014 - SASCI can confirm that Prof Tony Gershlick (University of Leicester, UK) will visit South Africa from 15 February to 15 April 2014 as our Visiting Professor. During his tenure, SASCI, in collaboration with the SA Heart Branches, will host evening lecture meetings for our SA Heart, SASCI and ISCAP members. Prof David Holmes (US) is a possibility as our next visiting professor either in late in 2014 or early 2015. Medtronic is thanked for their continued support of this program and thanks go to Pharma Dynamics who is sponsoring the Visiting Professor evening lecture series.
 
Sajidah Khan is the South African national coordinator for the new ESC eLearning Platform. This program will focus on web based Fellows training offering training in 6 sub-specialties with the first module being interventional cardiology. Planning for the introduction in 2014 (of this substantial training program) is well advanced and SASCI is receiving guidance from the respective Heads of Medical Schools. Participants need to become members of the EAPCI association and a fee of EUR120 per calendar year applies. The duration of EAPCI Learning Programme is 3 years (in addition to theoretical training there is a very specific interventional case mix requirement for certification). 

Dr Aine Mugabi, the 2012 recipient of the RC Fraser International Fellowship in Cardiovascular intervention award will travel to Dr Martyn Thomas’ (Consultant Cardiologist & Clinical Director for Cardiovascular Services) unit at Guy's & St Thomas' Hospital in London for a period of one month in January 2014. During his tenure he will have the opportunity to expand his knowledge and further his abilities. The 2013 recipient, Ahmed Ismail Vachiat, a Physician and Fellow in Cardiology at Charlotte Maxeke Johannesburg Academic Hospital, was announced at the 2013 Fellows workshop. This award is annually sponsored by Boston Scientific.

The 8th Annual SASCI Fellows Program took place from 26 – 28 April 2013 at Lagoon Beach with Dr Mark Abelson as Program Director and the faculty was: Jean Vorster, Dave Kettles, Tom Mabin, Chris Zambakides and Farrel Hellig. The meeting in its new interactive format was a resounding success and attended by a record number of 32 South African Fellows as well as a delegation of nine from Mauritius and two from Kenya. In total more than 70 delegates attended this truly African learning initiative and our biggest Fellows Program yet! We plan to continue to grow the African and Mauritius delegations and plan to expand on the interactive nature of the presentations. The 9th Annual SASCI Fellows Program will take place in June 2014 in Johannesburg under the leadership of Chris Zambakides. The SASCI office requests that all fellows/registrars and recently qualified cardiologists should contact the SASCI office if they would like to attend the 2014 workshop. Members are also requested to approach Chris Zambakides or George Nel if they want to be considered as faculty.

Interventional Society Of Cathlab Allied Professionals (ISCAP) - Our Associated Group continues its high activity levels and we request that you support them through assisting with giving lectures when requested and creating opportunities for your team to get involved in the Society (at branch or national level). Noteworthy is that a basic cath lab training manual (sponsored by BBraun) will be available to all paid up SA Heart/SASCI/ISCAP members early in 2014. Well done to the steering committee of ISCAP! Read the full report on activities elsewhere in this issue.

To the SASCI executive and our industry partners, a BIG round of thanks for your support, your passion and your hard work throughout the year. The following corporate supporters have demonstrated their commitment to our society and education in South Africa: Amayeza Abantu, Angio Quip, Aspen, AstraZeneca, Baroque, B Braun, Boehringer-Ingelheim, Boston Scientific, Cipla Medpro, Condor, Cordis, Disa Vascular, Edwards, Medtronic, Paragmed, Pharma Dynamics, Sanofi, Surgical Innovations, Torque Medical, Viking and Volcano. We are looking forward to working in collaboration with you in 2014.
Please contact your Executive Officer George Nel on 083 458 5954 / sasci@sasci.co.za if you need any assistance or need to formally communicate with the executive.

Best wishes for the festive season!!

Farrel Hellig
SASCI President

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