LGU Baguio helps private hospitals iron out PhilHealth accreditation issues
The city government of Baguio mediated in ironing out the concerns of private hospitals on the impending move of the Philippine Health Insurance Corporation (PhilHealth) to revoke their accreditation over the hospitals’ alleged failure to include senior citizen discounts in the computation of bills, among other issues.
Alleged lapses were found in the post audit of claims by PhilHealth way back 2014 where senior citizen discounts were not included in the computation of bills as well as differing interpretation of diagnosis and the standard medical care provided, among other things.
These issues were brought to the attention of Health Secretary Maria Rosario Vergeire during her visit to Baguio city last week wherein a dialogue was suggested to find win-win solutions for the stakeholders involved.
A meeting was held Wednesday, September 28, led by Atty. Althea Alberto, Executive Assistant IV of the City Mayor’s Office together with Councilor Betty Lourdes Tabanda, chairperson of the Committee on Health and PHIC representatives led by Regional Vice-President Dr. Dominga Gadgad, Atty. Eric Mandiit, Dr. Glenn Cornelio Lamsis and Ms. Janet Palaez of PHIC Baguio.
Hospital administrators and legal counsels of the four private hospitals present during the meeting were: Sr. Corazon Bunagan for Notre Dame De Chartres Hospital (NDCH); Dr. Paul Adlai Quitiquit for Saint Louis University Inc., Hospital of the Sacred Heart (SLU-HSH); Dr. George Pangwi for Pines City Doctors Hospital (PCDH) and Dr. Dionisio Claridad for Baguio Medical Center (BMC).
The four private hospitals formed as Cordillera Private Hospitals Association summarized their issues and concerns relative to PhilHealth’s notice of suspension of accreditation and listed possible consequences if the same is implemented.
Dr. Paul Quitiquit, speaking on behalf of the group said the four private hospitals in Baguio have a total of 318 authorized bed capacity and total maximum bed capacity of 511.
In the past five years, the four hospitals were able to admit a total of 103 patients; 107,000 serviced through the out-patient department; 156,000 given emergency room care; and, over 33,000 serviced in the operating room and deliveries.
“If our PHIC accreditation will be suspended or revoked, these will be the number of patients that will not be accommodated in private hospitals. These numbers of patients cannot all be accommodated at the Baguio General Hospital and Medical Center,” Quitiquit said.
For the PhilHealth claims covering the period 2018 to 2022, the four hospitals have transmitted an accumulated claim of 125,000. BMC was able to get back P79 million out of its P103 million claim; NDCH with over a billion of claims received P64 million while SLU-HSH with P607 million received P577 million.
Quitiquit said he was not able to get data from PCDH.
Out of these transmitted expenses, P36 million worth of claims are in process while more than P17 million were already denied by PhilHealth. This data was computed from the past five years, Quitiquit explained.
“We consider the denied claims as losses since services were already provided and the patients have already recovered,” Quitiquit said.
Quitiquit said suspension or revocation of PhilHealth accreditation will affect the implementation of the Universal health Care Law and that affected private hospitals will not be able to provide health care services to indigent patients due to non-coverage of PhilHealth packages.
“Number of employees will drop with the decrease in the number of patients utilizing the authorized bed capacity of hospitals. Trainings of medical students will also be affected,” Quitiquit said.
On the part of PhilHealth, Gadgad assured that the agency is in the process of reconciling claims from 2016 to 2020 for possible rectification bound by existing rules and policies.
Atty. Alberto and the four private hospitals together with PhilHealth were able to come up with four key agreements as immediate solutions to the issues as follows: 1. PhilHealth adjudicators to inform or issue notice to hospitals and give chance to rectify records prior to legal actions; 2. PhilHealth to give copies of updated policies to guide hospitals; 3. Close coordination with hospital doctors and PhilHealth doctors on the standard medical care; and, 4. Legal counsels of hospitals to submit position papers and policy recommendations on PhilHealth rules and procedure particularly on the Performance Commitment for Health Care Institutions.
“Let us target a zero denied claims for all PhilHealth accredited hospitals but be mindful also of your hospital clerks and police your own doctors,” Gadgad said.
PhilHealth and the four hospitals reiterated their commitment to collaboration in providing the best health care services to their patients. – JMPS
