A study by the Mercer consultancy company coordinated by the former Minister of Welfare presented. The “transformation into employees of regional health services, the effects would be harmful in terms of decreased patient care, organizational flexibility and higher costs”. But the solution is not the status quo and in the analysis it is proposed that the MMGs organize themselves into a partnership between professionals to manage the studios that will become the Houses of the spoke community. And to do so, a new convention will be needed. I STUDY
10 FEB – “The“ family doctors ”provide first-level assistance through about 60 thousand proximity studies and the presence in the home of the assisted person wherever he is, including the most disadvantaged areas, such as in residential structures. He is responsible for providing integrated and continuous care to every single person regardless of gender, age and type of pathology. He takes care of everyone in the context of the family, community and culture of belonging, thus adapting to the conditions of the context as part of a more or less good life. With reference to the proposed “advertising”, or a transformation into employees of the regional health services, the effects would be harmful in terms of decreased patient care, organizational flexibility and higher costs “.
To reject the addiction for mmg is a new study on “General practitioner in the new territorial social and health services” realized by Mercer (consulting company in the field of human resources and investments) with the coordination of the former Minister of Welfare Maurizio Sacconi.
According to the study, the problems that would arise with the addiction of family doctors are multiple:
1. less participation of the patient who loses freedom of choice and relationship of trust
2. higher costs induced in the salary mass of public medical management by the massive entry of professionals who come from a particular public salary structure and compare with the income of other colleagues who usually combine public and private services;
3. contractual and legal rigidity (holidays, permits, absences and replacements) which result in more limited hours of availability for users, high irremovability, unquestionable work and in particular compliance with the service standards envisaged;
4. less continuous training of public employees compared to self-learning of freelancers in addition to the training obligations that may be established by conventions;
5. multiplication of the necessary operators due to the constraints on working hours;
6. greater difficulties in coordination with other doctors and in mobility towards the patient;
7. impossibility of guaranteeing the same proximity to the private medical office and home visit times due to the necessary concentration of public offices;
8. greater burdens for public finance in relation to the costs of structures and tools, now borne by professionals;
9. share of remuneration linked to performance usually reduced and not very incentive in public work;
10. Certain financial unsustainability of Enpam, the social security fund for doctors who work in the profession.
But in addition to the dependence tout court, the studio also rejects the hypothesis of the double track: “The hypothesis of a transition, even worse if long, from one regime to another with the remaining “until exhaustion” of positions destined to cease has been practiced only within public subordinate work to absorb contractual differences in the occasion of mergers between entities. In this case, the experiment would have devastating effects on citizen-patients because it would add two radically different service models with the probable effect of bringing together the vices of one and the other “.
But in any case, the study does not claim that maintaining the status quo is the best solution: “Rather, a drastic evolution of the affiliated freelance profession is needed which, faced with the new responsibilities and opportunities of today and tomorrow, must organize itself in associated forms according to the model referred to in art. 10 of Law 183/2011, already significantly experienced by other professions such as accountants, labor consultants, engineers, architects and which has led, also through adjustments to the social security regulations of the individual Funds, not to lose contributions. An example is given by the companies operating in the dental sector which pay an additional contribution equal to 0.5% of the annual turnover to the “Quota B” management of the general pension fund, pursuant to the budget law for 2018 “.
Minimum 6 mmg per study and maximum 2 thousand patients.
The study hypothesizes as the best solution for doctors’ offices (which will become the Houses of the spoke community with the PNRR) “the indicative indication of a number of six GPs in the STP spokes in order to guarantee an adequate service to their patients in time and professional terms hypothesized. Obviously, the number of doctors can vary in the different circumstances of the patients. Instead, it is hoped that the development of technologies will gradually absorb the need for administrative employees in every area “.
In this hypothesis, “the indemnity arranged by the ACN should be dedicated to fixed costs and to incentivize the hiring of nursing staff, OS, data analysts as they are more coherent with the development of the spoke structures. The transition to functional territorial autonomies organized in the PTS can be accompanied by a ceiling of choice of the individual doctor equal to 2000 patients of this threshold without economic penalization. The company can in any case make use of an Mmg cooperative for support activities and the containment of purchase costs. The National Collective Agreement must consequently be redesigned and financed ”.
“In particular – continues the study – the accreditation criteria must be updated both from a structural point of view (rooms for diagnostics, remote patient monitoring consoles, waiting rooms, emergency kits, compliance and safety) and organizational (personnel of study, nurses, social and health professionals). The sanctions themselves must be correspondingly revised. The basic requirements can be freely increased with certification methods and adequate incentives. The consideration for taking charge should exceed the current model based on the tripartite division between capital, variable and incentive payments. The fixed capital quota should be reduced and linked to the monitoring activities of all the patients, to those of prevention for specific programs, to vaccination campaigns. A second component could consist of the tariffs intended to remunerate a) the taking in charge of chronic conditions commensurate with the pathologies concerned b) the diagnostic activity not related to the taking in charge, evaluated according to the parameters of the outpatient specialist c) the comparison with the specialists and the activity in homes and community hospitals in analogy to the first visit “.
In this sense, “the variable part should finally be defined in each territorial area through rewards (or penalties) linked to the verification of the appropriateness of the services, the reduction of inappropriate hospitalizations in the emergency room, the correct prescription of drugs, the governance of the integrated home care and attention to socio-health and social situations. Finally, the GP could accrue, under certain conditions, time “debts” to the Community House, to be paid with corresponding hours of presence in it to guarantee 24 hours or for other activities “.
“This is a significant transformation of the GP’s activity – concludes the study – which corresponds to a significant increase in the costs necessary to support it. It is a necessary challenge for a category that some would like to eliminate by starting from the prejudice for which it would be unable to evolve. The same public incentives, evidently necessary for the transition to associated (and equipped) studies, would entail less burdens for the State and greater advantages for citizens in comparison with the direct public management of assistance and primary care through the spoke community houses. . On the other hand, even the purely hourly approach of the GP’s functions would still be less effective than their flexible and responsible activity for health projects of the Health Authorities, such as planning tools, verification and control of clinical and social-assistance coherence and taking in charge “.
February 10, 2022
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