Private hospital opposes removal of payment clause in proposed CGHS empanelment pact

New Delhi: The private hospitals oppose the removal of payment terms in a proposed agreement related to the Central Government Health Scheme (CGHS) empanelment stating that these clauses would affect their ability to provide seamless services.  

The CGHS scheme allows 40 million serving and retired Central government employees to seek medical services at government clinics and empanelled private hospitals and diagnostic centres by paying a nominal monthly amount. However, in the latest pact, there is no mention of a payment clause for empanelled private hospitals, which has caused reservations amongst the hospitals.

Also Read:25000 Ayushman Bharat Hospitals to soon treat CGHS beneficiaries

Due to delayed processing of their reimbursement claims and long-pending dues, the private hospital had already stopped cashless facilities for CGHS patients. Girdhar Gyani, coordinator of the CGHS working group for private healthcare providers, said, "The newly proposed agreement has sought extension of empanelment and added new clauses which are of deep concern to hospitals," adding, "The government has very detailed clauses on the hospital's terms of operation, termination, penalty and performance clauses. However, there are no payment terms in the agreement." 

The previous CGHS agreement with hospitals allows 70 percent of the claimed amount to be paid within five working days upon the submission of bills and the balance amount after due scrutiny within 30 days. Also, the revised memorandum of agreement dated September 13 does not mention the terms of employment for private hospitals that wish to continue their empanelment with the CGHS for the next two years.

Speaking to Moneycontrol, Gyani said, "There is also no clause that allows hospitals to contest arbitrary deductions or denials," adding, "All healthcare groups indicated that CGHS takes nine months to one year to clear their bills. This places working capital stress on hospitals as they need to pay salaries monthly and their vendors in 45 days." 

The healthcare institutions which are already on the CGHS panel are required to submit a letter of acceptance for the revised agreement within 15 days in order to continue the CGHS panel for another two years, until September 30, 2024. If not, it would be considered as they are not interested and will be removed from the panel. 

According to various representatives from Medanta, Max Healthcare, Fortis Healthcare, Narayana Health, and Yashoda Hospitals, the proposed changes would severely affect their ability to deliver seamless services to CGHS beneficiaries. 

The Comptroller and Auditor General of India had observed that 632,000 claims amounting to Rs 527.62 crore were outstanding as of March 31, 2021. The discussions for new provisions were held on September 21 by the CGHS coordination committee representing healthcare associations including the Indian Medical Association, Ficci, Assocham, Healthcare Federation of India (NATHEALTH), and Association of Healthcare Providers. 

Expressing their concerns, the committee had also written to the Union health minister Mansukh Mandaviya and health secretary Rajesh Bhushan. The letter noted, "Representatives from key hospital groups expressed serious reservations about some of the new provisions… These changes will have a major impact on the ability of hospitals to deliver seamless service to CGHS beneficiaries without impacting the quality of healthcare." Opposing the continuation of previous CGHS rates, they stated that the rates have not been revised since 2014. 

The letter to the health secretary stated, "In the past eight years since these packages were introduced, hospitals continued to pay annual increments to doctors and nurses, deal with rampant increases in the cost of medicines and consumables, and pay more for all operating overheads. It is impossible for hospitals to maintain acceptable standards of clinical quality at these rates." 

Shravan Subramanyam, president of NATHEALTH, said, "In addition, the additional discounts and payment gateway tariffs being imposed will make the programme further unviable," adding, "It is important to engage in a dialogue to address the challenges in the scheme and make the supply pool grow where quality and appropriate care is provided to CGHS beneficiaries seamlessly in a viable contractual framework." 

Also Read:Union Health Minister addresses inaugural ceremony of training programme for CGHS senior administrative medical officers