ILOILO City – With depleted finances, private hospitals in this southern city warned they may not be able to continue operating.
Describing themselves as on “survival mode”, the Iloilo Mission Hospital, St. Paul’s Hospital Iloilo, Iloilo Doctors’ Hospital, Medicus Medical Center, The Medical City of Iloilo, Qualimed Hospital Iloilo, and the Metro Iloilo Hospital and Medical Center Inc. urged the Philippine Health Insurance Corp. (PhilHealth) to pay up.
As they struggle with rising cases of coronavirus disease 2019 (COVID-19), these hospitals also have to deal with operating expenses, purchases of medical supplies and equipment, payment of utilities, and salaries of nurses, medical technologists and other hospital staff who have been stretched thin.
In a letter to Health secretary Francisco Duque III, the private hospitals asked for two things:
* immediate reconciliation and payment of PhilHealth payables by the end of October 2021
* immediate suspension of the policies for no co-payment and no balance billing
If these are not met, the hospitals said they would take “drastic measures”, includeing dropping their accreditation with PhilHealth.
“We will still accept patients with PHIC accreditation but will not process PHIC collection and reimbursement. The patient will be given their statement of accounts and they will process their reimbursement with PHIC,” according to the hospitals.
They will also charge co-payment and balance billing appropriately.
“We have decided to take drastic but necessary actions for our own self-preservation and to enable us to provide better medical care to our patients,” they said.
Dr. Elmer Pedregosa, hospital administrator of Iloilo Mission Hospital and president of the Private Hospitals Association of the Philippines – Western Visayas Chapter, said even before the pandemic the delayed and unpaid claims were already a problem with PhilHealth.
“We are giving services while waiting sa payment. Indi man na guro fair kay partners sila namon in terms of healthcare system,” said Pedregosa.
“Part sang income namon is from PhilHealth tapos gahulat kami. It’s difficult to comply kun kulang ang financial. We are now trying our best,” Pedregosa told Super Radyo Iloilo.
The group said their concerns on unpaid claims was compounded with accusations of unfounded violations of PhilHealth Circulars, their being subjected to a barrage of investigations; denials of claims that were submitted as far back as 2010; suspension or termination of payments without due process; and empty promises and assurances.
The private hospitals also stressed that the imposition of no co-payment and no balance billing are “very detrimental” to the cash flow of the private hospitals.
The patients’ expenses exceed more than what the PhilHealth covers, they pointed out.
“If this situation will not be corrected, we are afraid that the healthcare system in Iloilo City will collapse,” they warned.
As members of the Private Hospital Associations of the Philippines and the Philippine Hospital Association, the hospitals here said they act as one in accordance with the positions taken by their national organizations.
They were gearing towards these goals:
* Avoiding biased and unfair evaluation of reimbursement claims by using qualified and knowledgeable claims evaluators. In the investigation of alleged fraudulent claims, it would be desirable that PhilHealth commission qualified medical experts in active practice to do the investigation of claims;
* Refraining from oppressive or abusive use of Quasi-Judicial power. Due process is better served by submitting cases for arbitration to a “third party” which is impartial and unbiased;
* Exercising restraint on unfounded accusation of fraud and unethical practice because this will undermine and destroy the trust and confidence of patients towards their doctors and healthcare in general;
* Removing policies that create too much financial risk for hospitals so that they can proceed to improve and upgrade their services without fear of suddenly losing their huge investment;
* Installing a representative of healthcare providers in the Governing Board, endorsed by their national associations as provided for in Section 13.1.c of the IRR of the Universal Healthcare Law;
* Increase in the “Case Rate” as provided for in Section 10.4 of the Universal Healthcare Law which state that: “For every increase in the rate of contribution of direct contributors and premium subsidy of indirect contributors, PhilHealth shall provide for corresponding increase in benefits, subject to financial sustainability provided that PhilHealth shall coordinate with the IBM on the budgetary requirement for such an increase”; and
* Pay immediately COVID reimbursement claims not later than the start of filing for renewal of accreditations of hospitals and doctors this Oct. 1, 2021./PN
