www.statoquotidiano.it. FOGGIA, 04/17/2023. Holes in Apulian Healthcare: the Regional Council approved today the measures for the containment of the expenditure for the agreed pharmaceutical assistance, for the containment of the expenditure for medical devices and for the direct purchase of drugs and medical gases, with the determination of expenditure for each healthcare company.
“These are – explains the Councilor for Health, Rocco Palese – indispensable measures and to be implemented urgently and in a mandatory manner in order to be able to reduce in 2023 three large aggregates of expenditure. However, we hope that, within its competence, the National Government will integrate the national health fund as requested by all the Regions, to cover the greater expenses incurred by the Regions and thus reimburse the costs incurred for the covid and providing specific funding for the increase in energy costs, labor contracts and inflation”.
The containment measures were submitted to the assessment of the joint interministerial table for the verification of LEA compliance and the Operational Plan and they are all approved by the sided Ministries as well as by AIFA with the issue of a positive opinion. – For the pharmaceutical expenditure under the agreement, the provisional data for the year 2022 show the non-compliance with the relative Ceiling established at the regional level, with an overrun of around 7.3 million euros.
The expenditure data show that the overrun of the regional agreed expenditure ceiling recorded for the year 2022 is substantially attributable to the non-compliance with the company spending ceilings by the Local Health Authorities of TA (+6.3 million compared to the ceiling), BT (+2 million compared to the ceiling) and LE (+1.3 million compared to the ceiling) at which companies, therefore, the activation of corrective actions by the respective General Managers is particularly urgent.
The junta has therefore established for the year 2023 the budget objectives for each ASL aimed at determining, in addition to compliance with the expenditure ceiling assigned to the single SSR company, also a further reduction in spending, totaling 47.5 million euros on a regional scale under the roof, broken down on the basis of the population of the individual ASLs. The Giunta has given a mandate to the General Managers of the public companies of the SSR to implement the actions for the strengthening of control activities vis-à-vis prescribing physicians that do not comply with the regional and company guidelines on the appropriateness of prescribing drugs, resulting in an inappropriate use of public resources and the exceeding of the expenditure ceilings set by current legislation, with particular reference to the therapeutic categories subject to regional measures to contain expenditure pharmaceutical.
As part of the monitoring actions on pharmaceutical expenditure “(…) should the report result in prescriptive activities inconsistent with the cost containment provisions, the Manager adopts, in agreement with the Medical Director, the containment measures deemed necessary, including reporting to the disciplinary bodies if the reasons for the non-compliant prescriptions refer to non-compliance with the legislative provisions and administrative (…)”.
The Council has ordered that the bimonthly reports to be sent to the Region required by law must also be signed by the Administrative Directorby the Health Director, by the Directors of the Social Health Districts, as well as by the Director of the Management Control Area of the same Company, and must provide evidence of the actions to contain pharmaceutical expenditure implemented at company level during the observation period The Council confirms that “The failure of the health and hospital company to maintain the annual ceilings for pharmaceutical expenditure and medical gases, entails the forfeiture of the General Manager by law”.
– For medical devices, the council has confirmed all the cost containment measures.
The Giunta therefore attributed the expenditure ceilings for the purchase of medical devices to the public companies of the SSR aimed at complying with the 4.4% expenditure ceiling on the regional health fund. The Giunta has established, as a minimum objective for the General Managers of the public companies of the SSR, the gradual reduction, over the three-year period, of the expenditure values for the purchase of medical devices to the threshold values established by state legislation, to be declined in the annual reduction by at least one third of the difference recorded in the previous year.
Given that, as part of the proposal for the 2023/2025 Operational Plan, currently being formalized by the accompanying Ministries, measures aimed at reducing the expenditure for the purchase of medical devices are also included, the Giunta has established that the maintenance of the expenditure for the purchase of medical devices is within the limits of the ceilings assigned also for the years 2024 and 2025. The Giunta has also established that, in order to reduce spending on Medical Devices, the strategic managements of healthcare and hospital companies provide for:
a) within 15 days, for the assignment of challenging budget objectives, aimed at reducing spending on Medical Devices, towards the Directors of the company medical units; both on the performance objectives and on the assignment objectives that contribute to the evaluation of the simple and complex structure directors of the medical Operating Units for the confirmation/revocation of the assignment.
b) within 15 days, from the adoption of specific procedures and corporate directives aimed at implementing policies for the priority use of devices characterized by the best cost-benefit ratio, with particular reference to medical devices subject to the Regional Council provisions referred to in the narrative for the purpose of rationalizing expenditure.
c) within 15 days, to the adoption of specific corporate procedures and directives aimed at scheduling and carrying out periodic audits towards prescribing doctors, with particular reference to the specialist branches most involved in the use of medical devices with a high cost impact, subject of the Regional Council provisions referred to in the narrative, in order to bring the prescriptive trend back to compliance with the appropriateness of use of the same.
d) within 15 days, to implement, through the company supervisory areasi, urgent verification activities on the corporate purchase prices of medical devices, with particular reference to the categories with the greatest expenditure impact for which the framework agreements of the Aggregator/Consip are not available, or refer to old corporate agreements, in respect of which quickly activate the company tender procedures and, pending the same, the renegotiation of the prices of the existing contracts.
Furthermore, the Giunta gave mandate to the Board of Directors and to the General Manager of InnovaPuglia SpA to: establish an active collaboration with other regional Aggregating Subjects in order to adhere to the centralized tender procedures for medical devices initiated by the same if earlier than the provisions of the planning of InnovaPuglia SpA and to guarantee compliance with the terms for tenders contract on medical devices, and plan, well in advance, the re-indication of tenders for these product categories that are close to expiry/exhaustion.
With particular reference to the regional centralized tender procedure called by InnovaPuglia SpA with regard to the supply of “orthopedic prostheses and specialist traumatology devices, accessory material and related services” and recently canceled by the Puglia Regional Administrative Court, the Giunta has asked to urgently provide for the re-indiction and rapid completion of the same, in order to take short times of the economic advantages deriving from the tender award prices and achieve the expected savings.
– Also for the direct purchase of drugs and medical gases, the Giunta confirmed all the containment actions for pharmaceutical expenditure issued by the region The Giunta has therefore established for the year 2023 the pharmaceutical expenditure ceilings for the direct purchase of drugs and medical gases for each company. The Giunta ordered that the General Directorates intensify the verification and control actions of the prescribing appropriateness of the prescribing specialist doctors, as well as their compliance with the guidelines aimed at an appropriate use of public resources, and taking into due consideration the updates on prices of the medicines involved in the centralized tenders carried out by the InnovaPuglia Aggregator.
In cases in which framework agreements are not available from the aggregator, the obligation remains, by the public companies of the SSR, to provide for the completion of bridge tender procedures. The Giunta has also ordered that the General Directorates define suitable internal procedures aimed at verifying and removing all situations of conflict of interest, even potential, which may influence the prescriptive behavior of specialist doctors.
It was resolved that, in order to reduce pharmaceutical expenditure for direct purchases of drugs and medical gases, the strategic departments of the SSR companies provide:
a) within 15 days, to the assignment of challenging objectives aimed at reducing pharmaceutical expenditure towards the Directors of the company medical units, through the priority prescription, compatibly with the clinical needs of the patients, of the therapeutic choices characterized by the best cost-effectiveness ratio , with particular reference to the pharmaceutical categories subject to regional provisions and to expired patent drugs, both of a synthetic and biotechnological nature; both on the performance objectives and on the assignment objectives that contribute to the evaluation of the simple and complex structure directors of the medical Operating Units for the confirmation/revocation of the assignment.
b) within 15 days, the adoption of specific corporate and inter-company procedures and directives (for cases of induced prescriptions), aimed at the periodic verification and assessment of the appropriateness of higher cost pharmaceutical prescriptions;
c) within 15 days, the adoption of specific company procedures and directives aimed at implementing priority use policies for expired patent drugs (both synthetic and biotechnological/biosimilar), with particular reference to drugs awarded as part of the procedures centralized regional tenders for use in direct purchase channels, i.e. for drugs with prices in line with the reference price of the AIFA Transparency List for use in the partner channel;
d) within 15 days, the adoption of specific company procedures and directives aimed at the scheduling and periodic implementation of audits of prescribing doctors, with particular reference to the specialist branches most involved in the prescription of drugs with a high cost impact for direct purchases, in order to bring the prescriptive trend back to compliance with the appropriateness and limitations of use under the NHS regime established by AIFA.
It has been established that the cost for the direct purchase of drugs and/or medical gases incurred by the ASL and deriving from prescriptions induced by specialist doctors operating at other public companies of the SSR, if following inter-company checks it is attributable to inappropriate prescriptions, it must be charged to the reference company of the prescriber and, for this purpose, it will be deducted in the reporting by the ASL.
It was also established that the maintenance of pharmaceutical expenditure for direct purchases of drugs and medical gases remains within the limits of the ceilings assigned also for the years 2024 and 2025. The pharmaceutical expenditure ceiling for direct purchases starting from 2024 is fixed to 8.30% of the FSN.