Frequently asked questions

To be able to choose a referring doctor, patients must fulfil these two conditions:

·         they must have at least one long-term condition whose seriousness or chronic nature requires prolonged treatment and considerable coordination due to the intervention of several healthcare providers.

·         they must have an activated electronic health record (DSP) held by Agence eSanté.

Long-term conditions are defined in appendix 1 to the agreement between the CNS and the AMMD. The appendix lists 32 long-term conditions, including multiple sclerosis, Alzheimer's disease, Parkinson's disease, cystic fibrosis etc.

The referring doctor is the doctor who knows the patient best and is consulted first in the event of a health problem. He plays a central role in providing follow-up for the patients targeted by the referring doctor system (see question 1). His missions include:

• coordinating healthcare and ensuring the best possible follow-up;
• guiding patients to other healthcare professionals where necessary (specialists, physiotherapists etc.);
• managing the medical file, centralising all the information about his patients' care and state of health (examination results, diagnoses, treatments etc.);
• regularly monitoring the content of the electronic health record (DSP)

These missions are defined in article 19b of the Luxembourg Social Security Code.

The electronic health record ("dossier de soins partagé" or DSP), managed and made available by Agence eSanté, is the patient's secure electronic medical record, used by the healthcare professionals involved with the patient. The patient can control his DSP directly, and it is available to him free of charge. Access to the DSP is reserved solely for the patient and for the approved health professionals in Luxembourg who treat the patient and are granted access by the patient.

The primary goal of the DSP is to promote exchange between healthcare professionals and enable more coordinated patient care by centralising all the essential information about the patient's state of health. The DSP brings together the relevant health information necessary for optimum patient care, including the results of X-rays and/or biological tests, consultation and hospitalisation reports, prescriptions etc.

The DSP is a collaborative tool for health professionals and is available to the patient.

Agence eSanté has put stringent technical measures in place to guarantee a high level of security and data protection.

By agreement with the CNPD, the DSP was piloted from June 2015 with patients who had declared a referring doctor. Starting at the end of September 2015, Agence eSanté also offers DSPs to people with no referring doctor based on a voluntary request to open a record. The DSP will be rolled out to all patients once the pilot has been approved and the Grand Ducal regulation in application of article 60c and 60d of the Luxembourg Social Security Code, scheduled for early 2017, has taken effect.

For more information, see the information and documents on the Agence eSanté website (www.esante.lu), including the leaflet "The electronic health record (DSP) – Discover the essentials of your personal, secure electronic health record".

No, there is no obligation. The patient can continue to see his general practitioner or specialist without having to sign the declaration.

The referring doctor helps improve the quality of the care provided to the patient and the performance of the healthcare system as a whole.

By supervising the patient's route through the healthcare system, the referring doctor can:

• avoid interactions and/or duplication of medication and thus optimise drug consumption;
• avoid unnecessary consultations;
• limit the examinations and/or analyses to be carried out.

By signing up to a long-term relationship with the patient, the referring doctor helps to:

• emphasise the value of his role as a trusted doctor;
• promote the patient's health and safety;
• guide the patient through the healthcare system as his special advisor;
• give the patient appropriate long-term support for complex or prolonged health problems.

The doctor contacted by the patient can only accept the role of referring doctor if:

·         he offers primary care with a global approach outside the hospital setting, and

·         he has studied the medical disciplines of general practice or paediatrics.

No. The patient can see a specialist or any other doctor of his choice without seeing the referring doctor.

1.      Completing and signing the "referring doctor declaration" form

The referring doctor declaration is a document completed jointly by the patient and the referring doctor during a consultation. It declares the patient's membership of the referring doctor system in accordance with the amended Grand Ducal regulation of 15 November 2011 setting out the conditions for appointing, renewing and changing the referring doctor and replacing him if he is absent.

In order to be recorded by the CNS, the declaration must comply with the template appended to the agreement between the AMMD and the CNS.

If the patient is a minor or under legal guardianship, the legal representative or authorised person must sign the form.

2.      Informing the CNS

The referring doctor must send the completed, dated and signed form to the "referring doctor department" of the Caisse Nationale de Santé.

For further details, see the "Referring Doctor Declaration" explanatory note.

The referring doctor declaration

• Completed jointly by the patient and the referring doctor
• Approved, recorded and managed by the CNS
• Unique for each patient
• Once approved, it automatically triggers the relationship between the patient and the referring doctor in the patient's electronic health record.

The DSP

The electronic health record ("dossier de soins partagé" or DSP), managed and made available by Agence eSanté, is the patient's secure electronic medical record, used by the healthcare professionals involved with the patient. The patient can control his DSP directly, and it is available to him free of charge. Access to the DSP is reserved solely for the patient and for the approved health professionals in Luxembourg who treat the patient and are granted access by the patient.

The primary goal of the DSP is to promote exchange between healthcare professionals and enable more coordinated patient care by centralising all the essential information about the patient's state of health. The DSP brings together the relevant health information necessary for optimum patient care, including the results of X-rays and/or biological tests, consultation and hospitalisation reports, prescriptions etc.

The DSP is a collaborative tool for health professionals and is available to the patient.

Agence eSanté has put stringent technical measures in place to guarantee a high level of security and data protection.

By agreement with the CNPD, the DSP was piloted from June 2015 with patients who had declared a referring doctor. Starting at the end of September 2015, Agence eSanté also offers DSPs to people with no referring doctor based on a voluntary request to open a record. The DSP will be rolled out to all patients once the pilot has been approved and the Grand Ducal regulation in application of article 60c and 60d of the Luxembourg Social Security Code, scheduled for early 2017, has taken effect.
For more information, see the information and documents on the Agence eSanté website (www.esante.lu), including the leaflet "The electronic health record (DSP) – Discover the essentials of your personal, secure electronic health record".

The summary of services

• A summary of the services paid for by the health, maternity, accident and dependency insurance funds over the last three years, then every year at the anniversary date over one year.
• Prepared by the CNS and added annually to the DSP from the date when the referring doctor relationship takes effect, and by 01 July 2016 at the earliest.

The patient summary

• Prepared by the referring doctor and added to the DSP within three months of the referring doctor relationship taking effect (first day of the month following the validation of the declaration by the CNS) based on the medical information available to him: medical records and reports from colleagues involved in treating the patient etc.
• Available free of charge to the patient to guarantee continuity of care if treatment is provided by other doctors.
• Updated by the referring doctor at each contact, adding any new clinical or therapeutic information relevant to the patient's state of health that may be useful in coordinating the healthcare services provided by health professionals.

Starting on the date when the referring doctor relationship takes effect, and by 01 July 2016 at the earliest, the CNS updates the patient's DSP annually with a summary of the services paid for by the health, maternity, accident and dependency insurance funds over the last three years, then every year at the anniversary date with a summary over of one year.

Within three months of the referring doctor relationship taking effect (first day of the month following the validation of the declaration by the CNS), the referring doctor updates the DSP with a patient summary. If the patient requests it, the referring doctor explains the content of the patient summary and provides a free copy.

The referring doctor must update the patient summary in the DSP following every contact with the patient, adding any new clinical or therapeutic information relevant to the patient's state of health that may be useful in coordinating the healthcare services provided by health professionals.

The relationship takes effect on the first day of the month following the Caisse Nationale de Santé's approval of the referring doctor declaration.

As soon as it receives the referring doctor declaration, the CNS checks the information provided. Following its approval, the CNS generates a unique referring doctor declaration number and communicates it in writing to the referring doctor, the patient and, where relevant, the patient's legal representative or authorised person, together with the date when the referring doctor declaration takes effect. The existence of the referring doctor relationship is reported by the Caisse Nationale de Santé to Agence eSanté.

Example: a declaration approved on 10 November 2016 by the CNS will take effect on 1 December 2016.

The relationship with the referring doctor is of indefinite duration. The declaration remains valid as long as the patient and the doctor agree to continue the patient/referring doctor relationship.

In the following cases, the patient is no longer bound the by the referring doctor declaration and is free to choose a new referring doctor:

• if his referring doctor dies;
• if he revokes the referring doctor declaration.

During the first twelve months, the relationship can only be revoked by agreement between the referring doctor and the patient, with a two-month notice period.

To terminate the relationship jointly, the referring doctor and the patient complete the "Revocation of a referring doctor declaration by joint agreement" form. The referring doctor then sends it, dated and signed, to the referring doctor department of the Caisse Nationale de Santé.

Example:

A declaration received on 10 March 2016 by the CNS and approved during March 2016 by the CNS will take effect on 1 April 2016. If on 5 May 2016 the CNS receives a "Revocation of a referring doctor declaration by joint agreement" signed on 3 May 2016, the termination takes effect on 3 July 2016. A new referring doctor declaration can then be submitted to the CNS.

From the second year, the relationship can be revoked unilaterally at any time, by either the referring doctor or the patient, with a two-month notice period.

If the referring doctor decides to end the declaration, the doctor sends the form "Revocation of a referring doctor declaration by the referring doctor" to the patient, also sending a copy to the Caisse Nationale de Santé.

If the revocation is initiated by the patient, the patient sends the form "Revocation of a referring doctor declaration by the insured person" to the referring doctor, also sending a copy to the Caisse Nationale de Santé.

The referring doctor must enable the patient to communicate all the information needed to continue the referring doctor role to the new referring doctor.

For further details, see the "Revoking a referring doctor declaration" explanatory note.

Once the previous referring doctor declaration has been revoked, the patient can appoint a new referring doctor. To tell the Caisse Nationale de Santé who the new referring doctor is, the patient must complete a "referring doctor declaration" form with the new doctor.

Note: a new declaration can only be recorded (by the CNS) once the previous declaration has been revoked. It can only take effect after the legal notice period has ended (two months).

The referring doctor must enable the patient to communicate all the information needed to continue the referring doctor role to the new referring doctor.

The Grand Ducal regulation of 27 November 2015 abolished the previous MR01 and MR02 procedures and introduced a new MR03 procedure:

MR03

Fixed rate for the coordination of care in cases of serious or chronic illnesses or long-term care and for the regular monitoring of the content of the electronic health record (DSP) of the insured person suffering from at least one serious chronic illness described as a long-term condition whose seriousness and/or chronic nature requires prolonged treatment and considerable coordination due to the intervention of multiple healthcare providers;

1)      The MR03 procedure may only be charged by the following medical specialities: general practice and paediatrics.

2)      The MR03 procedure may be charged for the first time after six months from the date of effect of a referring doctor declaration as specified by article 19b of the Luxembourg Social Security Code.

3)      Only one MR03 position can be charged every six months.

4)      The serious chronic illnesses described as long-term conditions are listed in article 20 of this Grand Ducal regulation.

This fixed rate has a coefficient of 24.71 and the current pricing can be consulted here.

The new MR03 procedure is thus invoiced six-monthly, starting at the earliest six months from the date of effect of the referring doctor declaration. Invoicing is subject to the presentation of an "insured person's declaration that the patient summary is up to date (link)". The referring doctor sends the declaration as quickly as possible to the CNS. The declaration will no longer be necessary once the patient summary has been integrated into the DSP.

The long-term conditions defined in appendix 1 to appendix V to the agreement between the CNS and the AMMD can cause the MR03 position to be charged.

The links to the legislation and the different documents regarding the primary care doctor can be found here.