Filenews 6 May 2025 - by Marilena Panayi
In full application, the 5% penalty for specialist doctors who exceed the limit of requests (from personal doctors) set by the Health Insurance Organization for the issuance of long-term referrals.
The implementation of the relevant decision of the HIO began on April 1 and doctors should expect any reductions in their compensation at the end of June, since this procedure will be followed every three months.
It is recalled that the Organization had reached the specific decision after analyzing the data from the GHS software, which showed that a large number of long-term referrals, which include up to 12 visits, were not fully used by the beneficiaries of the System but were the reason for unnecessary visits to specialist doctors. For example, it was found that patients visit the specialist doctor 4 or 5 times, while the referral includes 8 or 10 or more visits.
Moreover, the increase in the number of long-term referrals was linked, on the basis of data, to the simultaneous decrease in the normal referrals issued by personal doctors to specialist doctors, following the application of a corresponding indicator affecting personal doctors' allowances.
Specifically, in the period between 2021-2022 and although the referrals of personal doctors decreased by more than 10%, the number of requests submitted by specialist doctors to personal doctors for approval showed a significant increase, reaching 53.8% per year.
It is reminded that according to the procedures applied within the framework of the GHS, long-term referrals are issued when the specialist doctor deems that the patient must have direct access to it without the need for a referral from his personal doctor to be constantly issued. For this purpose, the specialist doctor, in most cases, submits a request for approval to the personal doctor. The long-term referral includes a maximum of 12 visits (depending on the judgement of the specialist doctor) and not 2 as provided for in the short-term referral to a specialist doctor.
Yesterday, the HIO sent an announcement/update to all GHS specialist doctors, informing about the full implementation of the performance index regarding the number of requests they submit for the issuance of long-term referrals.
(The relevant decision was being piloted in the previous months).
"Following the announcement dated October 21, 2024, we remind you that as of April 1, 2025, the performance index has been fully implemented, per specialty where it is applied," the HIO states in its briefing and adds: "The performance of specialist doctors will be evaluated on a quarterly basis, in relation to the specified point of reference of their specialty (the number of requests differs from specialty to specialty)."
"With the full implementation of the performance index, 5% of the total remuneration of specialist doctors that exceed the reference point for this quarter will be cut."
It is noteworthy that the amount that will be cut off from those who exceed the set limit "will be redistributed to specialist doctors of the same specialty, whose performance is below the reference point for the specific quarter".
