Filenews 9 May 2023 - by Marilena Panayi
An end to selective patient service and the rejection of those cases deemed financially unprofitable by GHS hospitals. The Health Insurance Organization has already started recording data from the software and with the implementation of the new contracts, within the next few months, by the hospitals of the system, both the age of patients and the complexity of the cases served by each hospital will be counted in the compensations. The recording of data for preparation purposes by the HIO began last week and will be continuous, while for the amount of compensation to hospitals, four relevant parameters will be taken into account, among others.
As stated in the circular sent to all GHS hospitals, "following the consultations conducted for the introduction of quality criteria in inpatient health care in order to improve the services provided, the Health Insurance Organisation informs providers that as of May 1st, the evaluation of the following data, which are available in the IT system per hospital, has begun:
>> Mean age of patients.
>> Percentage of patients with more than five comorbidities.
>> Percentage of patients over 80 years of age.
>> Percentage of pathological cases.
These data, as stated by the HIO, "form the basis of the evaluation of hospitals regarding the qualitative criterion "patient profile and case mix" that will be applied by the organization within the next period and which will be related to the reimbursement of hospitals providing inpatient care services to the GHS.
As the director of the HIO, Andreas Papaconstantinou, explained to "F", "in general, the aim of the HIO is to proceed with moves that will improve the services offered to GHS beneficiaries. A few weeks ago we launched the questionnaire through which beneficiaries receiving inpatient care services from the hospitals of the system will evaluate these hospitals. Now, we have made another move, which is also taking place in the context of the new way of compensating hospitals and the inclusion of quality criteria in the calculation of remuneration."
The data recorded "will help us get a better picture of how our providers behave within the system. That is, with these four parameters we will see how many elderly people they serve, how many elderly people. Do they serve complex cases, patients with comorbidities whose hospitalization may be prolonged?" All these, Papaconstantinou said, "are issues that often see the light of day. We may not have evidence that some providers may avoid serving elderly and pathological cases, but I think that to some extent and as far as some hospitals are concerned, it may be so."
"With the four criteria that have been included in the compensation system, we believe that we will deal with some phenomena that are currently observed and we will know with data now whether some of the providers actually avoid specific incidents. Those with high rates of service for the elderly, elderly, pathological or complex cases will be able to increase their compensation from the organization."
It is recalled that in recent months, several complaints have come to light from citizens who have reported either publicly or through the OSAC Patient Observatory or the Elderly Observatory that GHS hospitals, on the pretext of lack of beds, refused to serve mainly elderly people, who were pathological cases.
Regarding the implementation time of the new way of reimbursement of GHS hospitals, Mr. Papaconstantinou said that "the final processing of our data has taken place, we have completed it and now we will get the approval of the organization's board of directors and send our final text to the hospitals of the system and the associations representing some of them. When this process is completed, always in cooperation with the hospitals, the time will be set when the implementation of the new way of compensation and the calculation in the reimbursements of hospitals and the quality criteria that have been set will officially begin."
It is mentioned that in addition to the evaluation questionnaire by patients and the criteria relating to the care of elderly and pathological cases, the qualitative criteria included by the HIO in the new way of reimbursement of hospitals include, among others, the range of services offered by each hospital, the number of beds available, whether the hospital is accredited, whether it has a Committee on Medicines and Infectious Diseases, etc.
