Remuneration based on performance and quality criteria comes for personal physicians and changes in both their remuneration and their contracts with the OAU must be decided in the coming months, as the contracts currently in force expire in May 2022.
The processes at OAY have been going on for quite some time, with the dialogue between the Organization and the representatives of the personal doctors of the General Health System already started, at the moment when the Health Insurance Organization is preparing to announce an offer for the purchase of services by foreign experts. who will be invited to give their suggestions and help develop compensation / quality based compensation models for the primary.
The ultimate goal of OAY, the determination of the remuneration of the personal physicians, by 70% based on the number of beneficiaries that are registered in their list with the calculation being done per capita and by 30% based on quality criteria and performance indicators. This was also foreseen by the initial design of the General Health System, which was later changed, in order to meet the financial demands of the doctors, before the start of the first phase of GESS in June 2019.
At the moment, however, and given the fact that the personal doctors of the System have already received a reduction (10%) in their earnings, due to the blow received by the GESS fund due to government decisions on the pandemic, the change will not be “Abrupt” and the percentages that will be determined in the end, may differ (of 70% -30%) at an early stage, or even possibly determine their gradual adjustment over time. Of course, the personal doctors have already requested a refund of the 10% that has been deducted from them, however the issue is still under discussion. Based on the initial plans of OAW which may in the course be differentiated:
► 70% of the fee will be granted as a per capita fee.
► 20% will be a fee for other medical procedures.
► 10% will be allocated on the basis of quality and performance indicators.
(It is reminded that the existing contracts with the personal doctors, determine the average per capita compensation at 100 and 130 euros for adults and children respectively).
As for the 30% according to the initial planning of the Health Insurance Organization and based on those already provided by the relevant Regulations of the General Health System and have not yet been implemented, specific medical procedures and performance indicators are included:
Specific medical procedures:
► Management of chronic diseases.
. Promotion of specific preventive and detection programs.
. Additional services provided (eg resident visits).
Performance indicators:
. Enter information and data in the data management system.
. Number of referrals.
Γράφηση Prescribing drugs.
. Value of laboratory and diagnostic tests.
For performance indicators, OAY has long been monitoring and informing physicians, who receive monthly service usage reports with referrals to specialist physicians, referrals and the value of laboratory tests and the number and value of prescriptions for medicines and comparing their own activity with the activity of their colleagues in the System. Based on this practice, doctors know every month that if they are in the “green” category, then they are within the average of the category of providers to which they belong, and those who are informed that they are classified in the “red” category, are at “dangerous” levels.
In fact, this practice, which is already applied, seems to have brought the first positive results since in the past 7 out of 10 beneficiaries who visited a personal doctor provided a referral for specialist doctors, while the latest data show that this ratio has changed and now only 4 out of 10 patients are referred to specialists.
According to information from “F”, the Health Insurance Organization has set its intention to proceed with the application of compensation based on performance indicators on a pilot basis to the representatives of the personal physicians of GESS and it is expected that a relevant consultation will begin.
Regarding the purchase of services by experts, as we are informed, this is also a provision of the recovery plan and the goal is to define performance and quality criteria that will not only concern primary health care but also inpatient services. Therefore, the completion of the work of the experts is not related to the time of the start of the new data on the way of remuneration of the personal doctors and can not be an excuse for any delay in the application of the new rules on the way of remuneration of the personal doctors of GESS.
There is no need for legislation
The way of remuneration of personal doctors has been put in the public debate several times in the last days due to the position expressed by DISY in the Parliament for its modification, with the deputy president of the party Haris Georgiadis having stated several times that if legislative regulation is needed for specific change then it must be made.
However, as reported by “F”, for the implementation of the plan of the Health Insurance Organization but in general for the modification of the way in which the personal doctors are paid, no changes are foreseen, and are not needed, in the Law that governs the operation of GESS.
Of course, the implementation of any planning will be preceded by an agreement with the doctors of the System, so that no problems arise in the course and the dialogue will be carried out in the context of the consultation for the renewal of the doctors' contracts in a few months. In any case, all procedures must be completed by the first quarter of 2022, so that there is time to prepare until the signing of the new contracts of the personal doctors of the System next spring.
At present, at least publicly, no serious disagreements have been expressed between GPs and OASs. However, it should be noted that the dialogue has not yet delved into the depths of the financial negotiation.
Philenews
