Pneumonia (POAC)
Overview
Treatment for adults and children with moderate pneumonia that can be safely managed in primary care.
This service is part of the Primary Options for Acute Care (POAC) programme.
Your Pinnacle Services Contract applies to this service. By claiming for this service, you have indicated that you have read and agreed to the business rules set out here.
This is NOT a clinical guideline.
Details
All practices in Waikato region can claim for this service.
- Patients domiciled in Te Whatu Ora Tairāwhiti area.
- Adults with pneumonia that can be managed safely in primary care – moderate pneumonia (CRB65 score 1 or 2 – see below) with no other co-morbidities.
- Children with pneumonia that can be safely managed in the community.
- Patients not domiciled in Te Whatu Ora Waikato area.
- Pulmonary embolus - refer acutely to respiratory medicine.
- Suspected large pneumothorax - refer acutely to respiratory medicine.
- Severe community acquired pneumonia (CRB65 score >= 3 - see below) - refer acutely to respiratory medicine. These patients cannot be funded via POAC for pre-hospital treatment, as the hospital admission is inevitable.
- Severe pneumonia in a child or any pneumonia in a child < 3 months of age or any child with chronic lung disease, who is immunocompromised or has red flags as per fever in children pathway - refer acutely to paediatric medicine.
- Mild community acquired pneumonia (CRB65 score 0– see below).
- Investigations to rule out malignancy. Urgent CXR through primary referred radiology via high suspicion of cancer pathway should be used.
- URTI.
Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions.
Score 1 point for each feature present:
- confusion
- resp rate > 30 breaths/min
- blood pressure systolic < 90mm Hg or diastolic < 60mm Hg
- 65 years or older.
The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. If the claim cannot be funded by POAC, the patient may be liable to the practice for the fees incurred.
Please make your claim via Primary Options, select Pneumonia and then attach the appropriate invoice(s).
Prices listed below are GST inclusive.
GP/NP/CP follow up: $81.37 / nurse $40.17
A follow-up consultation for management post CXR result (based on treatment provided as evidenced in clinical notes).
This is limited to one consult within the acute episode of care. While follow up consultations can be virtual, to be eligible for funding, documentation needs to include a two-way conversation between the practice and the patient. A sent message with no documented response does not meet the definition of a consultation.
Rural GP/NP/CP follow up: $91.67 / nurse $50.47
A follow-up consultation for management post CXR result (based on treatment provided as evidenced in clinical notes).
This funding is available to those practices who receive rural funding.
This is limited to one consult within the acute episode of care. While follow up consultations can be virtual, to be eligible for funding, documentation needs to include a two-way conversation between the practice and the patient. A sent message with no documented response does not meet the definition of a consultation.
After Hours GP/NP/CP follow up: $101.97 / nurse $60.77
An after hours follow-up consultation for management post CXR result (based on treatment provided as evidenced in clinical notes).
This funding can be claimed when care is provided after 6pm, on weekends or on public holidays.
This is limited to one consult within the acute episode of care. While follow up consultations can be virtual, to be eligible for funding, documentation needs to include a two-way conversation between the practice and the patient. A sent message with no documented response does not meet the definition of a consultation.
Funded via third party providers
A chest X-ray is funded under this service, if clinically indicated. Patients who are not acutely unwell and do not require a same day X-ray are not funded under POAC and should be referred to primary referred radiology.
Radiology is only funded for same-day investigations (within a 24-hour period).
Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of POAC funding.
It has been recommended that in addition to a good assessment and history, the full range of appropriate observations should be documented, especially where the diagnosis is undetermined. It is important to state the time of consultations and interactions with the patient.
The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient.
The service is funded by Te Whatu Ora.
