Review the relationship between doctors and hospitals

There was the activity of the private MRI in Grevenmacher, then the dismissal of a psychiatrist from the Rehazenter who refused to pay 20% of his salary to the establishment. Contractual relationships should be reviewed and rectified.

Between the Minister of Health, Paulette Lenert, and the liberal doctors, it is a story of lovelessness. Their professional association (AMMD), led by Alain Schmit, once again criticized the position of the ministry in the Rehazenter affair and the collaboration contracts between a hospital and a liberal doctor.

At the beginning of July, our colleagues from RTL revealed that Dr Marc Graas, a psychiatrist who has been working with patients at the rehabilitation center since 2018, was fired immediately after refusing to sign a contract with the establishment. The latter asked him to sign a clause stipulating that 20% of his salary should be donated to the centre. Because of the refusal, he was unable to enter the building for the rest of the night.

An agreement that “does not provide for financial compensation from the doctor to the hospital”

The two CSV representatives Laurent Mosar and Max Hengel immediately took the opportunity to question the minister on the dispute surrounding the contractual relationship between licensed liberal doctors and hospitals.

The opportunity came very well after the controversy surrounding the private radiology practice that acquired an MRI in Grevenmacher, without bothering to manage a hospital. The deputies want to explore the question of the so-called “collaboration” contract, a standard contract based on an agreement between the AMMD and the Federation of Luxembourg Hospitals (FHL) negotiated in 2004.

Since that date, no further negotiations have taken place. For the AMMD, which strongly responded to the eviction of the psychiatrist, “this agreement does not provide for financial compensation from the doctor to the hospital”. The agreement still remains strong, for now, because it does not conflict with the new hospital law of 2018. article 32 of the code of ethics”, said AMMD.

Administrative simplification

This article prohibits any sharing of fees between physicians and non-physicians and any sharing of fees between physicians, except in the case of associations. For the Minister of Health, the financial compensation is fully in line with the code of conduct taken as a reference. It is not a question of a sharing of fees between partners, says Paulette Lenert, “but of a participation of doctors in the direct and indirect costs for the use of the resources of the establishments of hospital such as consultation offices, administrative services, etc.,” he explained. He added that this is an “administrative simplification” that allows to have “a collective contract for all the services available in the hospital”.

There is no official release

However, this contract must be renegotiated if the law on ambulatory medicine can be implemented. The participation of doctors in the management of hospital branches will be regulated at the level of collaboration contracts. Each physician must be licensed in the hospital facility, but actively participate in the organization’s decision-making process. “This new concept emphasizes the importance of a strong relationship between all the actors involved as facilitators who deal directly with patients and meet their needs,” underline the authors of bill in question.

It remains to be hoped that this new standard contract will be the subject of an official publication. “It is clear that the agreement in question between AMMD and the FHL has not been published in Official newspaper of the Grand Duchy of Luxembourg”, says the ministry. What the Council of State already knows, indicating that it does not know “an official publication of such a standard contract that will bind the citizen in accordance with the requirements of article 112 of the Constitution”.

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