Filenews 22 October 2024 - by Marilena Panayi
The Health Insurance Organisation is trying to put an end to unnecessary visits to specialist doctors by introducing, among other things, a performance indicator that will relate to long-term referrals issued, mainly by personal doctors, at the request of the System's specialist doctors.
In fact, and according to the relevant decision, those specialist doctors who exceed the percentage of long-term referrals set by the HIO will see their salaries reduced by 5% and the money cut off will then be distributed to their colleagues, of the same specialty, who will move within the prescribed limits.
The HIO reached the decision to apply this indicator to specialist doctors, after analyzing the data of the GHS IT system, resulting in specific findings:
>> With the application of this indicator and its inclusion in the calculation of the reimbursement of personal doctors, a reduction was achieved (on average by 10.5% per year) in the number of simple referrals issued by personal doctors to specialists.
>> The reduction in simple referrals, however, has led to a doubling (53% on average per year) of long-term referrals requested by specialists, since long-term referrals are not counted for reimbursement purposes of personal doctors.
>> This practice leads, in many cases, to unnecessary visits and consequently to unnecessary expenses for the GHS since, as it is also found from the System's data, the beneficiaries of long-term referrals, in a very large percentage, do not use the visits they are entitled to because in reality and based on the data, they do not seem to need them.
For the most part, long-term referrals (involving up to 12 visits per year) are issued by specialist doctors upon request to the personal doctor of the beneficiary they serve on a case-by-case basis.
Regarding the number of visits ultimately made by patients, the GHS software shows that in most cases, not all visits included in the long-term referral are used. For example, patients visit the specialist 4 or 5 times, while the referral includes 8 or 10 or more visits.
Regarding the implementation of this performance indicator for medical specialists, the HIO proceeded yesterday with a relevant update, stressing that from now until the end of 2024, the measure will operate on a pilot basis and the performance of doctors will not be taken into account in the calculation of their compensation. From January 2025 the measure will normally apply.
"The aim of the application of the performance indicator is the proper functioning of the provision of health services by specialist doctors so that the health needs of beneficiaries are effectively met without creating unnecessary visits resulting from requests for long-term referrals from the specialists themselves, which lead to the waste of resources and the fall of the unit price (on the basis of which doctors are compensated)", states in its relevant briefing to doctors the HIO.
He adds that for each medical specialty different limits will apply and explains that "for each quarter the performance of each specialist doctor will be calculated in relation to the benchmark of his specialty. With the full implementation of the performance index, 5% of the total remuneration of specialist doctors exceeding the benchmark for that quarter will be cut. This amount will be allocated to specialists in the same specialty whose performance is below the benchmark for that quarter."
Specialist doctors will be informed through the monthly statement about the reference point of their specialty but also about their own performance.
During the pilot phase, the HIO says, the scientific societies of doctors will be consulted to decide on the limits and targets to be applied from January onwards.
