The Brazilian College of Radiology has encouraged and supported the various movements of its state associations with regard to professional defense, and encouraged that those who had victories in their movements share them with their colleagues in order to support negotiation strategies. Below is a report of an important achievement of the Pernambuco Radiology Society (SRPE), with the work of its Director of Professional Defense, Dr. Álvaro Campos, and the chairman of the Honorary Commission of the State of Pernambuco, Dr. Mário Lins, with support of the president of SRPE, Dr. Maria de Fátima Viana Vasco Aragão:
Here we bring a report on a topic that is very interesting to radiologists.
As may be well known to many, we have been taking action in recent years to defend the fair remuneration of doctors, brought by the various Medical Honorary Commissions, whose main axis is the strength of the Doctors Union, doing this work. together with the various categories through their Societies.
The Pernambuco Medical Fees Commission has a very close partnership with the Pernambuco Radiology Society, which has brought promising results in the various negotiations with Health Plan operators since 2013.
All this work and achievements were only possible due to the understanding of colleagues that only united would have the strength to demand fair remuneration for their work, with periodic adjustments, as provided by Law 13.003 / 2014, which deals with the rules of contracting between providers and operators. .
Amid all this context, we have reported another victory of the Pernambuco Medical Fee Commission / SRPE, which may eventually serve as a subsidy to the work of other committees.
About a year ago, a large health insurance company discredited one of the most traditional imaging services in Recife.
With this news, radiologists sought the Commission of Honorary Physicians of PE, which questioned this operator about why disqualification, as this would be closing various jobs.
The operator claimed that this imaging service was doing more “married” ultrasound and mammography exams than the statistics showed in other clinics in Brazil.
The CEHM then requested a meeting to clarify the facts and requested that there be no disqualification until that topic was fully clarified. It was argued that such a company was a pioneer and specialized in the field of breast cancer, and that it was only natural that there was a direction from mastologists in ordering exams. And yet, that radiologists only perform tests that are required of them, not prescribing these requests.
The operator then imposed a reduction in the amount of plans that could be met by this team while following the negotiations.
This reduction led to an 85% drop in patient care of this operator by this team.
Thus, a meeting was scheduled with the management of the plan, in São Paulo (SP), where the representatives of CEHM-PE were received by the medical technical director. This put forward several arguments that, in its view, would justify the disqualification of the service. According to CEHM-PE, such justifications would not fit, since radiologists do not request exams, they just perform them.
After this meeting, it was agreed that a kind of audit would be carried out on the service concerned and that after six months we would sit down again and, in the light of the analysis, seek consensus.
This case was even the subject of discussion in several radiologist forums at state and national levels, which led to a common feeling that there was an inappropriate attitude from the operator, leading to serious discontent among doctors, reflected in notes supporting the actions of the company. CEHM-PE, and solidarity in service.
The CBR was consulted and issued an opinion regarding breast imaging exams, which can be seen below.
After several conversations and meetings, CEHM-PE understood that, since nothing was presented that would disprove the conduct of the medical group in question, it would be mandatory as a class representation and as CEHM-PE claim that the plans previously fulfilled under the responsibility of that group. medical group to go back to the original constitution of the desk, so that the doctors could get back the now lost jobs.
As the expected response from the operator did not occur, it was understood that it was up to CEHM-PE to urge the full return to the situation prior to the disqualification, since the agreed deadlines were met, without any measure or further pronouncement by the operator and without any finding of pointed irregularity.
Almost a year passed. The operator neither made the follow-up nor brought any new fact about the subject. The negotiation would be coming to a halt.
CEHM_PE once again sought dialogue with the operator, informing of the great dissatisfaction of physicians of all Recife imaging services with the treatment that was being given to them, facing an act that they understand totally misplaced and completely fleeing the high level. mutual respect of providers and insurance institutions. It considered that it should also inform the decision taken at the assembly of the category to position itself and express its repudiation of the act mentioned, making known to the population, by all available means, facts about the impasse that occurred, with consequent indication of stoppage.
We understand that the arguments presented were understood to be well founded and the previous circumstances of accreditation were fully restored, reflecting the spirit of understanding that ultimately prevailed, restoring the dialogues to the level we always wanted to maintain.
From this we want to get the message that the search for dialogue must be permanent and that the union of the category must always be sought for the highest appreciation of it.
Let's move on,
Mário Fernando Lins / Maria de Fátima Aragón / Álvaro Campos
Pres. CEHM-PE / Pres. of SRPE / Dir. Def. from SRPETags: cbr, diagnostic imaging, exam, doctor, Pernambuco, radiology, radiologist