Gujarat Cardiologists seek review of current rates for cardiac procedures, full-time CTVS surgeon, reimbursement under PMJAY

Ahmedabad: Highlighting the issues faced by cardiologists in the State to treat patients under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme, the Gujarat State branch of the Indian Medical Association (GSB-IMA) wrote to State Health Minister Rushikesh Patel.

IMA wrote to the Health Minister after the cardiologists across the State had approached the association for support while raising their concerns on the issue. 

In its letter directed to the Health Minister, IMA has urged the Minister to look for solutions regarding the issues that all interventional cardiologists in Gujarat. These issues are include- (i) need for urgent review and revision of the current rates of cardiac procedures to make them sustainable, (ii) requirement of a full-time on-site cardiothoracic vascular surgeon (CTVS) for elective PTCA procedures, (ii) no reimbursement for High-Risk/Emergency PCI, (iv) non-reimbursed Intra-Aortic Balloon Pump (IABP), (v) reduced reimbursement for concurrent procedures, and (vi) need to implement incentive calculation as per HBP 2.2 manual by central government Ayushmann guidelines.

The PM-JAY scheme was launched on 23rd September 2018 by Prime Minister Narendra Modi. It is a health assurance scheme aiming to provide a health cover of Rs 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crores poor and vulnerable families (approximately 55 crore beneficiaries) that form the bottom 40% of the Indian population.

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Referring to the PM-JAY scheme as a "flagship health insurance scheme that has had a remarkable impact in providing affordable healthcare to millions of citizens across India," IMA mentioned in the letter, "This initiative has transformed healthcare access for many, particularly for vulnerable sections of society, by making healthcare services more inclusive and accessible. As you are aware, the PMJAY has been a crucial driver of healthcare reform in India, especially for low-income households. However, we would like to draw your attention to an area that requires further focus, particularly in Gujarat, where cardiologists and healthcare professionals have been working tirelessly for many years to improve the health outcomes of the community."

"Despite their consistent efforts, there are genuine demands for better resources and support to improve healthcare outcomes, especially in tier-2 and tier-3 cities across the state. The challenges in these regions include limited infrastructure, insufficient availability of specialized care, and a growing demand for treatment in cardiology," the association further mentioned.

Pointing out these issues faced by the cardiologists to treat patients under the PM-JAY scheme, IMA urged the Health Minister to find solutions so that the cardiologists "can perform more freely and effectively".

Medical Dialogues had earlier reported that Gujarat recorded the highest number of private hospitals withdrawing from the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), with 233 private hospitals opting out since the scheme's launch in 2018.

The state accounts for nearly 38% of the total 609 private hospitals that have exited the scheme due to issues such as low reimbursement rates, delayed payments, and operational challenges, according to data shared by Minister of State for Health and Family Welfare Prataprao Jadhav in the Rajya Sabha.