Telangana Specialty Hospitals Association (TSHA) to withdraw cashless healthcare services

Hyderabad, October 28, 2017......Telangana Specialty Hospitals Association (TSHA) to withdraw cashless healthcare services to the ESI Beneficiaries w.e.f. Wednesday, the,1st Nov,2017due to inordinate delay in reimbursement to hospitals by the ESI. The dues are as old as the year 2012 disclosed the press note issued by the Association. TSHA in that press note informed that there has been inordinate delay by the ESI in reimbursing to the hospitals. And the bills are pending for a very long time. Hence, ESI beneficiaries are requested to make a note of the same. However, they can avail services at the same rates by paying cash till the matter is resolved, informed the release. Keeping in mind beneficiaries, their needs and difficulties, even though the rates are low and requires re-structuring, TSHA hospitals have come forward to provide services only against cash payment. And no cashless treatment/credit treatment will be entertained, the release stated.

Over 50 hospitals,all most all the specialty hospitals which are empanelled withESI  that have been providing cashless service to the ESIbeneficiaries will withdraw their cashless healthcare services from the abovementioned date.  Several attempts made byTSHA member Hospitals to ESI authorities have failed and lastly, TSHA memberHospitals have no other option than to withdraw cashless services from 1stNov, 2017 to ESI employees and their dependent with request to release allour pending payments, which are  as old as  2012 yearonwards, the release stated.

 

Inordinate Delay in reimbursement to hospitals:

There has beeninordinate delay in reimbursement to hospitals. The dues are as old as 2012,which is almost five years.  Reimbursement to hospitals is the majorconcern. Hospitals have signed agreement based on the terms and conditionsdefined by the CGHS, which has provision to make 70% payment within 5-workingdays of submission of bills by hospitals. In none of the cases payments havebeen made within such a stipulated time. Hospitals have to wait for months andyears to get the dues.  Arrangement with UTI has been completefailure. This results in pushing hospitals to state of un-sustainability.Hospitals are forced to avoid/refuse beneficiaries for treatment, who are beingput to great hardship.

 

Improper empanelment & costing procedure:

There is an improperempanelment and costing procedures.  The  ESI rates (As  per CGHS rates)  are not based on any scientificconsiderations. In fact none of us in the country, including the governmenthave authentic data on costing of medical procedures.  The rates formedical procedures by ESI are fixed by calling tenders from hospitals &nursing homes having 50-beds and above. The tender conditions are same,irrespective of category of hospitals. There is no prior verification done,whether the hospitals, submitting tenders comply with minimum patient safetyprotocols or whether they have the facilities competence to carry out thequoted procedures. The lowest quoted rates are fixed as industry standard andapplied for all including the tertiary care super-specialist hospitals. In theprocess many rates come out to be highly illogical and unviable. It amounts tocompromising with the safety of patients more so when studies have shown thatmillions of patients were losing life globally as well as in India, due toabsence of safety protocols in hospitals.

 

Ensuring patient safety:

World over, qualityand patient safety in healthcare is driven either through regulation or byPAYERS. ESI being government run scheme, it should be imperative that PatientSafety must be key consideration while empanelling of hospitals. ESI as a ruleshould not empanel any hospital unless it has been verified based onestablished minimum criteria on patient safety. NABH ENTRY level standard providesminimum requirements on patient safety. ESI should make it as mandatorycriteria before empanelment of hospitals. Even IRDA has made it mandatory forhospitals to have NABH Entry Level certification before these could beempanelled by insurance companies.

 

Unauthorised deductions:

Over years ESI hasbeen unilaterally deducting our bills without any reason whatsoever and inaddition to having most unworkable rates, heavy deductions has resulted inheavy cash losses and a situation has arisen that empanelled hospitals has noother option than to stop taking ESI patients on cashless services, lestHospitals would have to close down permanently.

 

Telangana SpecialtyHospitals Association (TSHA) is a Federation/Association of all the Specialty,Multi Specialty & Super Specialty Hospitals providing tertiary healthcareservices in the State of Telangana with high quality & safe healthcareservices. With National Accreditation Board for Hospitals (NABH) accreditation,have high standards of International repute.

 

TSHA Hospitals havebeen extending excellent healthcare services to ESI beneficiaries and theirdependents over a few decades to the best satisfaction of the stake holdersincluding attending to emergency and critical services like OrganTransplantation etc. In a way it is a government health insurance scheme, underwhich beneficiaries receive cashless health care from empanelled privatehospitals and which are reimbursed by the government as per documentedagreement. Over the years, the scheme is losing its sheen, both among thehealthcare providers as well as the beneficiaries. It is time that Ministry of Health and Family Welfare(MOHFW) takescognizance of the problems in consultation with  stake holders i.e.providers and beneficiaries and come out with long lasting solution.  


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