For hospitals that are not covered under the GIPSA-PPN, lowest package rates agreed with different third party administrators (TPAs) would apply
The order comes in effect on an immediate basis and would remain in operation till 31 August, the government said
The government of Maharashtra, on Friday, said it has allowed municipal commissioners and district collectors of Mumbai, Navi Mumbai, Pune, Panvel and Thane to take charge of 80% of total operational beds in the private hospitals, while capping treatment costs to lowest rates applicable in their respective GIPSA-PPN (General Insurance Public Sector Association-Preferred Provider Network) agreements, irrespective of the bed category the patient is admitted in.
The order comes in effect on an immediate basis and would remain in operation till 31 August, the government said.
The remaining 20% beds may be charged as per the hospital’s rack rates, the order said. The notification, however, clarified that there will be no differential treatment between patients getting admitted under the 80% bed category reserved by the government and those paying under remaining 20% category.
GIPSA is a group of four public-sector general insurance companies— New India Assurance Company, United India Insurance Company, Oriental Insurance Company and National Insurance Company, which have restricted their cashless service only to hospitals that accept standardised price bands for over 100 specified procedures and therefore agreed to join what they termed as their PPN.
While the treatment costs for covid-19 patients and suspects have been notified in a separate schedule, non-covid patients will be charged based on the location of the hospital and bed capacity. For instance, a 100-bed hospital in Mumbai, Navi Mumbai, Thane and Palghar with over 100 beds can charge can charge only up to the maximum ceiling on prices, but hospitals in Pune can charge only up to 85% of the pricing cap.
For hospitals that are not covered under the GIPSA-PPN, lowest package rates agreed with different third party administrators (TPAs) would apply.
As per the order, charges for routine/isolation ward for covid-19 patients and suspects have been fixed at ₹4,000 per day, charges for ICU without ventilator along with isolation are fixed at ₹7,500 per day, and ICU with ventilator and isolation costs are capped at ₹9,000 for each day. This includes diagnostic tests including X-ray and ECG, monitoring, consultations, bed charges, drugs, meals and procedures like Ryles tube insertion and urinary tract catheterization. However, this excludes covid-19 testing, personal protective gear, any other interventional procedures, expensive drugs like Tocilizumab and high-end investigations such as CT scan and MRI.
Further, hospitals will not be allowed to charge more than 10% mark-up on net procurement costs for items/services such as intraocular lenses, pacemakers, stents, medical implants and personal protective gear, which are not covered under GIPSA/TPA agreements.
The order comes after the state government, on 1 May, issued an order to cap the prices of a host of medical procedures in private and charitable hospitals in the state to prevent healthcare providers from hiking their charges during the covid-19 pandemic. However, the order was not implemented by private hospitals then as they approached the government to re-consider its order citing potential losses and impact on the salaries of healthcare workers.
The reduction in prices for private healthcare providers comes at a time when they are dealing with lower hospital occupancy rates, as patients opt to postpone planned medical procedures for after the pandemic, and increased expenses in providing personal protective equipment for all doctors. Hence, hospitals are unhappy with the government directive, which will directly affect their revenue.
“The government's prices are in some cases 40-50% lower than our standard rates. Because of the lockdown, we're not doing too many procedures, only whatever comes to the emergency department. So we haven't had to implement the new schedule yet. We are still examining the implications of this notification for us," Vandana Pakle, chief financial officer at Nanavati Super Specialty Hospital in Mumbai had told Mint on 4 May.