José de Mello Saúde formally on Monday suspended the agreement with ADSE on providing medical care to its beneficiaries throughout the CUF network, which could develop into a total denunciation of the agreement.
According to an internal note by José Mello Saúde (JML), signed by President Salvador Mello to which the newspaper Expresso had access, the suspension of the agreement with the ADSE will take effect on April 12.
"This suspension could develop into a total denunciation of the agreement," on March 1, if not "balanced solutions that protect the top interests of ADSE beneficiaries," he said.
The note states that "all acts that may be marked, as of today [segunda-feira], For a later date [a 12 de abril], Will no longer be possible under the agreed regime. "
"All signs, new or existing, for actions to be carried out so far, remain under the agreed regime," he stressed.
According to the note, existing signs are guaranteed, including all long-term treatments as well as deliveries, even if planned after April 12.
In the case of beneficiaries interested in scheduling the medical treatment after April 12, it was stated that "CUF will become available for a particular price list, these acts being subject to the application for ADSE reimbursement under the free regime."
In a statement, Salvador Melo said that "there is a combination of factors that personally, but mostly cumulatively, make it intolerable to keep the Convention under penalty of raising the question the standards of quality and safety" flag.
"In 2014, ADSE introduced the retroactive settlement rule based on the minimum price practiced by each supplier." In the first place, ADMS intends to receive the right to retroactively reduce the prices at which the services are provided By applying a "flat rate" at the minimum price, regardless of the clinical complexity of the patient and the use of distinct procedures with proven clinical value. "
In December 2018, according to the note, "ADSE surprised the operator operators in the procedures arrangements for the years 2015 and 2016. Not be limited to this measure for 2015 and 2016 means that so far, JMS does not know, and can not know, at the time of treatment, at what price is Provides services to ADSE beneficiaries in all lines covered by the public. "
Salvador Mel also notes that since the beginning of 2018, units of the CUF network are obliged to pay all actions to ADSE within seven days, with a payment period of 120 days (…). However, in practice, the average payment period for CUF units is now at 283 days, after clinical action is given to the beneficiary. "
The third reason cited in the suspension of the agreement is "pricing of medical products and medical devices."
According to Salvador Melo, "ADSE price charts are completely out of line with the real cost of medical acts, and in some cases they have remained unchanged for more than 20 years."
Last week, EspressoHospital said that a number of private groups, including the Jose de Melo Soda and Lose Saud, were slated to suspend agreements with ADSE, the public health system, starting in April.
At the end of December, the Portuguese Association for Private Hospitalization revealed that some suppliers admitted that there is no contract with ADSE, after it demanded 38 million euros for excess billing by 2015 and 2016, wishing to cancel this process to the government.
The ADSE Board of Directors will meet today to discuss possible suspension of agreements between private groups and the health system of civil servants.