Thursday, 6 October 2016

IMA and AHPI appeal government to clear payments of CGHS empanelled hospitals

IMA and AHPI appeal government to clear payments of CGHS empanelled hospitals

It is an irony that CGHS fixes the rates by calling tenders and then makes L1 as the industry standard, a practice unheard anywhere in the world; said Dr KK Aggarwal, President Elect, IMA and Dr Girdhar Gyani, Director General of association of Health Care Providers of India.

Addressing a press conference, the doctors said that most rates fixed by CGHS are illogical and unviable. They said that none of the hospitals that follow standard protocols should accept to be empanelled under these conditions.

Today hospitals are forced to accept these rates as most PSUs and even other central government schemes empanel hospitals, if they are empanelled with CGHS.  In a way hospitals get exploited by the CGHS.

World over quality and patient safety are driven by regulator and/or payers. It is ironical that CGHS does exactly the opposite. It shows the least respect for patient safety and purchases health services for its valued employees as if it was procuring POTATOs or ONIONs.

In the process, patient safety is bound to get jeopardized. The government should realize that it was duty bound to ensure that population get safe (first) and affordable (later) health services.

CGHS should adopt rates of medical procedures on a scientific basis.
The government should invite rates from NABH accredited hospitals, which are certified on highest possible standards of patient safety and after verifying their scope of services in terms of systems, processes, equipment, manpower etc. CGHS can later take the average and apply it across the country.

In spite of accepting unviable rates, least CGHS could do is to make payment to hospitals in time. It is ironical that CGHS as a government agency is not respecting/adhering to the written agreement to pay 70% of fee within 5-days.

Till date not a single bill has ever been paid in this stipulated time. On the contrary, it takes months and years before hospitals are paid their dues. The situation is so grim that hospitals have begun to bleed due to huge outstanding amounts. The system is so bad that at any point of time the total outstanding due to hospitals remain between 200-300 crores for months. One group of hospitals in NCR has an outstanding of 75 crores since the past 3 months. Similarly, one super specialist hospital has an outstanding of 25 crores. Outstanding of the hospital also includes the payments to be given to the treating doctors.  

How will a doctor or a medical establishment work if the payments are not given to them in time.  The doctors have provided all services without any delay and that too when the services are being provided for peanut worthy amounts.

The CGHS charges for Septoplasty are only Rs 6613, for tonsillectomy are 5750, for appendectomy are 9324, for Coronary Care with Cardiac Monitoring are 863 and Ventilator Charges per day are 611. In routine, one cannot cover this cost, so then how can one absorb the cost of interest and delayed payment.

Many hospitals are being pushed to the limit of unsustainability on account of huge outstandings from CGHS.

Similar schemes are being run by state governments like TN, AP, TELANGANA etc. These schemes are fully digitized and payments are made within 2-4 weeks. In case of CGHS, officers in the rank of Additional Secretary are running the scheme and yet we have not been able to make it objective, transparent or dynamic.

As per MCI Ethics Regulations, doctors are supposed to uphold the dignity and honor of the profession.  Their main object and the very purpose of their practice are to render services to humanity and any reward of financial gain has to be a subordinate consideration. They are supposed to give priority to the interest of the patient.  Their personal financial interest should not conflict with the medical interest of the patient.  I am supposed to announce my fee before rendering service and not after the operation or treatment. They cannot enter with a no-cure no-payment agreement with my patients.  They are supposed to provide my services without expecting any considerations. They have an obligation to the sick and I have to see to it that the patient is not neglected. 

They are not supposed to insist for any advance money for providing treatment to a road traffic accident in emergency and are supposed to provide free treatment to all patients with acid burn, rape and child sexual abuse. 

Their charges, as per Clinical Establishment Act, have to be reasonable and can be controlled by the state Govt.

The doctors all these years have been accepting and adhering to all this with humility, but they deserve to get their legal dues in time.

If they are required to be punctual while giving services to patients they are also entitled to get my reimbursements in time.  How can one survive if CGHS, ESI, PSUs or insurance companies do not clear my dues in time?

If they have some doubts and clarifications due, they can withhold that part of payment and clear the rest. Many hospitals pay the consultants all their dues if they agree to get 5% deducted from their payment. 

All payments given after the due agreed date should be reimbursed with the market interest rate.  When a Consumer Court awards compensation against a doctor and in favor of a patient, the doctors are required to pay the compensation along with the interest rate.  In the famous Anuradha Saha Case the Supreme Court decided a compensation of Rs 12 Crores and out of this 50% was the interest amount.

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