Ayushman Bharat: IMA signs partnership agreement with govt

Difference over pricing rates of Ayushman Bharat package rates still a point of contention among the two

Ayushman Bharat: IMA signs partnership agreement with govt

IMA signed a partnership agreement with the Government on Ayushman Bharat. IMA National President Dr Ravi S Wankhedkar and Honorary Secretary General, Dr R N Tandon led the team.

After three hours of hard negotiations IMA agreed to take up the major responsibility of facilitating the empanelment of small and medium private hospitals. The differences over the package rates remain.

The government have agreed to revise the rates in a periodic fashion with full involvement of IMA. IMA will be part of the costing mechanism. Monthly feedback mechanisms with IMA have been put place. All registered hospitals with 10 and more beds will be empanelled. NABH accreditation/ certification will not be mandatory.

Hospitals with National Accreditation Board for Hospitals (NABH) certification and accreditation will get 10 and 15% more. Hospitals in difficult areas will be paid 10% extra.

Hospitals with Diplomate in National Board (DNB) courses will get 10% more.  States will have the discretion to enhance another 10%.  Moreover, where state schemes are paying more than NHPS rates, the same will be retained.

Concerns on Human Resources of hospitals will be addressed. Settlement of bills and Grievance Redressal are other areas where IMA’s concerns were accommodated. IMA will be the Public Private Interface for NHPS. IMA is willing to shoulder major responsibility in giving input regarding costing mechanism and doing costing field studies.

The major breakthrough today came when the government agreed to base revision of packages on costing studies. IMA will shoulder this responsibility diligently.

Key discussion points:

  • It was clarified that NABH is not mandatory for the hospitals to health empaneled. However, NHA will encourage hospitals to get NABH (National Accreditation Board of Health) pre-entry level accreditation/NQAS (National Quality Assurance Standards) for achieving quality milestones
  • The hospital with NABH / NQAS accreditation can be incentivised for higher package rates subject to Procedure and Costing Guidelines.
  • The participation of private sector was discussed in detail.  It was clarified that the private sector hospitals are included and welcome to participate in the mission.
  • AB-NHPM has been designed to allow beneficiaries to purchase secondary and tertiary health care services from both, private and public sector facilities.  It would be state’s discretion to restrict packages to public or private sector.
  • The package rates have been developed by a DGHS led committee based on the experience of existing states schemes as well as the previous national scheme, namely, RSBY.
  • The same has been reviewed by NITI Aayog and their comments have been incorporated.
  • States have flexibility to adjust the rates based on their prevailing cost structure in their states.
  • Package rates are an evolving process and Department of Health Research under the aegis of Niti Aayog which will form a Consultative pricing group to fix costing methodologies and undertake studies of the most utilised packages which will be used as a basis of revision of package rates.  There will be a periodic process adopted for AB-NHPM.
  • First of such meeting will be conducted on July 26 at DHR.  Two representatives from IMA will be part of the process.
  • In order to allow greater involvement of IMA, a mechanism will be established to allow periodic feedback by conducting monthly meetings with IMA. Further IMA will partner with NHA for implementation of AN-NHPM.
  • It was discussed that the basic empanelment criteria has been developed to encourage the participation of small and medium sized hospitals.  The Mission allows empanelment of a hospital with a minimum of 10 beds; with the flexibility provided to the states to further relax this if required.
  • It was also agreed that the software for online communications and transaction will be supplied by the government free of cost.

IMA National President also said that a dedicated team led by Dr A Marthanda Pillai, Dr Vinay Aggarwal, Dr V K Monga,  Dr RV Asokan , Dr Ravi Kumar , Dr Anil Goyal and Dr Narasinga Reddy worked hard for the past 3 months on the technical front including costing. IMA had engaged the Government in multiple meetings to finally sign an agreement.