Outstanding and Receivables: A Long overdue problem faced by service providers

Outstanding and Receivables: A Long overdue problem faced by service providers Doctors are not a happy fraternity today. There are several reasons for this. • Practicing doctors live in fear of criminal prosecution or violence. • Specialists are unhappy because of the unrealistic targets they are expected to meet. • Corporate hospitals are unhappy because they are denied their due reimbursements in time. • Service doctors and medical faculty are unhappy because their salaries are not at par and the new 7th Pay Commission has reduced the non- Practicing Allowance (NPA). • MBBS doctors are unhappy because they do not have opportunities to get a postgraduate degree. The medical profession provides services to Central Government Health Scheme (CGHS), Employees Health Scheme (EHS), Public Sector Units (PSUs), Ex-servicemen Contributory Health Scheme (ECHS) and similar organizations at highly subsidized rates. Yet the due reimbursement is delayed for months together and is given without any interest. This was among the several issues that I had touched upon in my Presidential address. Therein I had said, “The constitutional right “equal pay for equal work” should be implemented in medical profession. All service doctors and resident doctors should get full 7th Pay Commission, obligatory research grants, uniform age of retirement and uniform nationwide pay scales, legitimate leaves, and working hours and conditions.” Then again, “Uniform service conditions for doctors and faculty” and “Reimbursement of emergency services for private sector” were a part our major demands in the Dilli Chalo movement. Let’s review here the problems faced by service providers. • Service providers empanelled with the above organizations are in a very vulnerable position. Providers cannot deny services to these patients as the number of beneficiaries is large and ceasing services will cause a public disaster. • With services being continued, the government has gone into a state of inertia and apathy. • The service providers are struggling with operations and continuation of service due to the following main challenges: o Delayed reimbursements: The current situation of outstanding is alarming with payments worth hundreds of crores pending. For example, the outstanding amount from CGHS includes up to 75 crores of Max Healthcare, over 20 crores of empanelled hospitals of Fortis in the north, in Bangalore and Maharashtra and about 5 crores of Dr Lal’s Path Labs. This excessive delay is affecting the very sustainability of the operations for the service providers. As a cascading effect, lab providers face delay in other payments from hospitals as they do not have enough funds to pay the labs because of delay in receiving reimbursements. While the service agreement provides for 70% of payment within 5 days, payments are delayed by months. An intervention from the Finance Ministry is also required to rectify the current problem as delays are also caused due to misalignment between Ministry of Finance, Ministry of Health & Family Welfare and the payment partner- UTI o Wrongful Deductions: - Even though service providers are deliver services as per rates given by the Government, illogical deductions are made from the claims with no intimation to the service providers. The quality of service and costs involved are judged by inadequately qualified persons during claim processing. o Reconciliation Issues: Several gaps exist in the current system of dispute resolution and arbitration for such cases. There is a need of validation of the system by an independent body, maybe FICCI Indian Council of Arbitration (ICA). Grievance redressal for service providers should be relooked into and streamlined o Contract Renewal and Extensions: The agreement, which is valid for 2 years, has been extended up to 4 years by the Government, without citing any rationale for the extension. The current contract due to expire in October 2016 was extended up to end of June 2017 and still there is no sign of new agreement. o Terms of Agreement: Agreements should be restructured before upcoming renewals to account for the following: - Organizations like CGHS should have a mechanism to accommodate inflation like in case of the Pharma Industry where price hike of up to 10% every year is allowed. - The Andhra Pradesh state Government order has been linked to Consumer Price Index (CPI), these organizations should also have similar considerations. - The rates of organizations like CGHS should be based on a scientific rationale. - Experts from the private healthcare sector should also be a part of the rate fixing exercise. - A unilateral scheme with all specifications in favor of the government is not acceptable to the industry (Source: FICCI Health meeting held on 13th June chaired by Dr Girdhar Gyani) Dr KK Aggarwal National President IMA & HCFI Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO) Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)

First of its kind national study by IMA, HCFI & Eris Lifesciences through the ABPM method reveals high incidence of hypertension amongst the medical fraternity

First of its kind national study by IMA, HCFI & Eris Lifesciences through the ABPM method reveals high incidence of hypertension amongst the medical fraternity Record attempt of collecting 20,000 ambulatory blood pressure readings of over 500 doctors in 1 day Over 50% physicians found to be suffering from uncontrolled hypertension despite taking hypertensive medicines; 56% from irregular BP at night and 21% from masked hypertension New Delhi, May 16, 2017: In what can be called as a massive feat, the Indian Medical Association, in partnership with the Heart Care Foundation of India(HCFI) and Eris Lifesciences in the form of an unconditional educational grant attempted to record the maximum number of ambulatory blood pressure readings amongst the medical fraternity in a single day. About 20,000 readings were taken of 533 doctors including those of the IMA leadership spanning 33 Indian cities. The aim being to raise awareness about the benefits of ambulatory blood pressure monitoring (ABPM) in the timely and correct diagnosis of hypertension on the occasion of the World Hypertension Day 2017. Hypertension is one of the most common lifestyle diseases prevalent today with one in three Indian adults suffering from it. The incidence of hypertension is equally high amongst the medical fraternity owing to high-stress levels. Often hypertension is misdiagnosed given the difference in blood pressure readings at home and in a clinic. Ambulatory Blood Pressure Monitoring (ABPM) can help in getting a more accurate picture of a person's BP pattern in a span of 24 hour. “The IMA National study on ambulatory blood pressure measurement amongst doctors conducted in partnership with HCFI and Eris Lifesciences revealed that 21% of the doctors surveyed had masked hypertension or isolated ambulatory hypertension. In simple terms, their BP readings were normal when evaluated through the conventional clinic measurement technique but high through the ABPM technique. Masked hypertension is associated with an increased long-term risk of sustained hypertension and cardiovascular morbidity. In addition to this, 56% of the doctors evaluated suffered from irregular BP pattern at night making them prone to future adverse cardiac events. 37% doctors had nocturnal hypertension, which can never be diagnosed through in clinic BP measurement. Over 50% physicians had uncontrolled hypertension despite taking hypertensive medicines,” said Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA. Evaluating both daytime and nighttime blood pressure is crucial for predicting all cardiovascular events. It is a fact that a blood pressure reading obtained during one’s sleep is more accurate in helping predict all causes of mortality when compared to those obtained during waking hours. Ambulatory Blood Pressure Monitoring is globally accepted as the gold-standard method towards detecting hypertension. It evaluates the patient's BP continuously over a period of 24 hours and helps diagnose masked or white coat hypertension, conditions in which a patient's BP readings are inaccurate due to certain environments. Dr Shashank Joshi, President Hypertension Society of India opined, "Your doctor may suggest ABPM for the following reasons: to find out if your blood pressure readings are higher in the clinic than at home; to see the efficacy of your medicines in controlling blood pressure throughout the day, or to note whether your blood pressure increases at night. Since there are no visible signs of masked hypertension, it is always good to let your doctor know if you have a family history of high blood pressure. I congratulate IMA, HCFI and Eris on this initiative and believe that a collaborative effort towards raising mass level awareness on the prevention of hypertension, it's timely diagnosis and management is crucial in our country where every third person has high BP”. ABPM involves attaching a small digital blood pressure machine to a belt around your body. This is in turn is connected to a cuff around the upper arm. It does not cause any inconvenience, as it is small enough for you to carry on with your routine. This machine notes blood pressure readings at regular intervals during a 24 hour period: typically, every 15 to 30 minutes during the day and 30 to 60 minutes at night. Increasing your intake of fresh fruits, vegetables, olive oil, and omega-3 foods can help lower your high blood pressure levels. It is also a good idea to consume sprouted or 100% whole grains. Try to reduce your sodium intake, which does not necessarily come only from table salt or salt added while cooking. Processed and ultra-processed foods are the real culprits behind increased sodium intake. Disclaimer: This project is undertaken by the IMA under an unconditional education grant from Eris Lifesciences Ltd. Contents of this program are a copyright of IMA and are not influenced by any third party.