E-Paper
PM-JAY: Pilot project to improve reimbursement system commences in Ambala’s Mullana
Under the project, which is underway in five states, including Haryana, diagnostics data will be collected from various private hospitals and submitted to the National Health Authority (NHA). After conducting research of the data, NHA will revise reimbursement rates to the hospitals to further improve objectivity and transparency
Health officials on Friday commenced a pilot project to improve the system of reimbursement under Pradhan Mantri Jan Arogya Yojana (PM-JAY) at Maharishi Markandeshwar Institute of Medical Sciences and Research in Ambala’s Mullana.
Under the project, which is underway in five states, including Haryana, diagnostics data will be collected from various private hospitals and submitted to the National Health Authority (NHA). After conducting research of the data, NHA will revise reimbursement rates to the hospitals to further improve objectivity and transparency.
Hospitals have been requesting that package rates be revised as it doesn’t cover additional cost for any complications or comorbidities which may need to be addressed during a patient’s treatment.
“Due to the inefficiencies of the current payment system, hospitals deliberately resort to increasing the length of stay (for medical packages) and include additional costs by playing up patients’ illnesses. Further, cherry picking of certain packages or denying care or referral to public hospitals citing various reasons, leads to grievances among beneficiaries,” as per a statement issued by the Ambala civil surgeon’s office.
To avoid such scenarios, a case-mix tool that catalogues patients based on similar clinical and cost characteristics will be used, where most common case-mix tools are based on groups of diagnoses and procedures called diagnosis related groups (DRGs).
DRG will classify patients into groups using the international classification of diseases (ICD) developed by the World Health Organisation and other important information such as age, gender, weight at admission, length of stay (LOS), discharge status, comorbidity, complication, and hospital expenditure of individual patient admissions will be adjusted using established relative values.
DRGs can be used to distribute money according to objective and measurable information, create efficiency incentives and monitor service delivery, variation, quality, fraud/abuse, etc.
The inauguration of the project was attended by Dr Shankar Prinja, executive director and division head from the National Health Authority (NHA), Dr Monika from State Health Authority (SHA) and officials from the office of Ambala civil surgeon.
