13 May 2011

The NZMA is supportive of ACC’s internal review of elective surgery decision-making, released today, to ensure more effective and transparent decisions on surgery claims, says NZMA Deputy Chair Dr Mark Peterson.
 
The review analyses the impact of elective surgery process changes introduced since early 2008 and looks at how decision making can be improved.
 
Dr Peterson said the NZMA was pleased that ACC was responding to issues, raised by the NZMA and other health groups, such as delays in providing decisions in response to applications for surgery, lack of consistency in decision making, and the large number of cases going to review. 
 
There has been particular concern regarding the difficulty in differentiating between age-related degeneration and accident as cause of injury, says Dr Peterson.
 
“The NZMA has consistently advocated that patient care must not be compromised and that patients must have access to appropriate and timely care. We would hope that ACC will now address these issues to ensure this is achieved.”
 
A key finding of the review is that there is an underlying lack of confidence on the part of key external stakeholders in the robustness and fairness of ACC’s elective surgery decision-making for declined cases, however there was a willingness to work with ACC on solutions.
 
Dr Peterson says he is pleased to see that the review acknowledges improvements are needed in the timeliness of decision making and that ACC needs to strengthen the transparency, independence and currency of clinical evidence.
 
“Particularly pleasing is the intention to obtain advice from appropriately skilled and qualified practitioners, to use the best available evidence in their decision making and the intention to establish regular forums of the key stakeholders, including the relevant professional groups.” 
 
The review incorporates the views of ACC staff, clients, many in the elective surgery sector and other health organisations.