07/01/2021 – 21:48
Pablo Valadares / House of Representatives
Otto Baptista (English), from the National Physicians’ Union, in a room
Representatives of medical entities, in a House of Representatives hearing, denounced the instability of services due to low wages for health plans for professionals, clinics and hospitals. The discussion was held on Thursday (1), in the Commission for Social Security and the Family, and was also attended by representatives of the National Agency for Complementary Health (ANS) and the Brazilian Association of Health Plans (Programs).
Starting next week, the Chamber must also address the issue through a special committee.
One controversy is the new reward models that have already been studied and adopted by some health plan operators. In a tone of relief, the Vice President of the National Federation of Physicians (Fenam), Otto Baptista, called for transparency in this debate and a reversal of the current precarious situation.
“A precarious contract puts the provider in a precarious and insecure position, who has to work overtime in order to arrive at a value that sustains and maintains his office or clinic. If we’re going to demand a shininess, it’s 0800 and a little song: and we’re in that expectation whether we’re going to take it Whether it will be redeemed or not, Otto Baptista said today’s table, CBHPM, is unfair and does not adequately reward a professional.
Most physicians are currently paid through a pay-per-procedure model (Service charges). However, health plan operators are discussing the adoption of other formulas, such as The fare is per person, where there is a fixed amount for each person served.
The president of the Brazilian Board of Ophthalmology (CBO), José Péñez Neto, submitted a petition from 14,000 doctors in the specialty with severe criticism of the The fare is per person, which will already be required on some ophthalmologists’ contracts with health plans.
“Oh The fare is per person It creates incentives to use only minimal resources in patient care, rather than striving for increasingly higher levels of quality,” Benez-Neto stated.
Among other reward models studied are global budgeting, with a single payment for the total service provided to the population served by the service provider; a collage, with payment for the patient’s clinical episode; DRG, with payment based on the classification of the condition or disease treated by a pre-agreed amount; and P4P, also known as pay-for-performance.
ANS is following up on this debate and has announced a virtual seminar on the topic for this month, as well as the resumption of the Technical Chamber for Contracting and Relationship with Service Providers (Catec).
The Director of Sector Development at the ANS, Cesar Serra, stated that there is no legal prohibition on any of the reward models and that the introduction should be to ensure quality patient care. According to Serra, the agency does not interfere in these negotiations between doctors and health plans.
No model works as a single solution. Operators and providers must weigh the pros and cons to agree on the model to be used depending on the situation and intended purpose. In the discussion involving the operator and providers, said Cesar Serra, we always have to put the consumer and the patient at the center of the discussion.
A member of the Professional Defense Council of the Brazilian Medical Association (AMB), Florisval Meinão has been vocal in his criticism of the new reward models.
“Well, the doctor’s work should be paid for what he does. The only formula for rewarding yourself for what you do is paying for services rendered. All of these (other) combinations are harmful, especially to patients.”
Renato Casarotti, president of the Brazilian Association of Health Plans, stated that the financial sustainability of the sector is as fragile as social security. He noted that from 2010 to date, 336 operators have either closed or merged, which represents a 32% contraction. According to Casarotti, pay-per-action, in some cases, leads to abuse and unnecessary treatment.
There are fewer people paying more and more, and this leads to a higher per capita cost. It is not easy to close the account. These other models emerged to counter what was happening in the field of complementary health as a whole. There will always be a pay-per-action, said Renato Casarotti, but as the only paradigm or the dominant paradigm, it generates an aberration.”
“Regardless of the compensation model, clinical outcomes must be improved, the cost of care reduced for the individual, and the patient experience improved,” he added.
The representative of the Federal Council of Medicine (CFM), Salomao Rodriguez Filho, reported the doctors’ strong dissatisfaction with the health plan operators. “There is a high preponderance of force on the part of operators, interference with physician independence, low pay, undue denial, contractual insecurity and non-compliance Leo 13.003 / 14 [que trata da obrigatoriedade de contratos escritos entre as operadoras e seus prestadores de serviço]”.
To overcome the current state of fragility, the CFM recommended medical protocols to guide work, primary care as a way to prevent and reduce accidents, electronic medical records, and a greater partnership between operator and providers.
The chair of the Social Security and Family Commission, Deputy Dr. Luis Antonio Teixeira Jr. (PP-RJ), called for a conflict between health plan operators and providers not to harm users.
“The current model can have a lot of problems, but one way or another, it manages to satisfy the concept of a user who is looking for a health plan. The operators are private companies and they have to strive for profit, but they have to commit to providing a quality service to those who buy that service,” the deputy said. .
Abramge and FenaSaúde argue that the search for new compensation models is a global trend. A survey conducted in the United States was cited, citing administrative bureaucracy, excessive treatment, fraud, exaggerated service and poor service as the main sources of waste in the sector.
The debate’s organizer, Rep. Herran Gonçalves (PP-RR), announced that the chamber will seek to overcome these differences through the Health Plans Special Committee. The College will analyze 249 bills dealing with this issue (PL 7419/06 and join).
“On Tuesday, our special committee will be installed, where we will focus on the topic. Let’s try to improve this model. This will be considered by all institutions interested in the topic.
According to the National Federation of Complementary Health (FenaSaúde), 75.6 million Brazilians are currently served through 696 healthcare plans (48 million users) and 351 dental-exclusive plans (27.6 million). The Federation’s Executive Director, Vera Valente, stated that the financial soundness of the plan is essential to ensure the quality of the service.
Report – Jose Carlos Oliveira
Edition – Pierre Tripoli
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