Filenews 14 March 2025 - by Marilena Panayi
Hospitals will need to limit patient time in Accident and Emergency departments to under four hours and ensure specific medical specialists are available to qualify for up to 18% higher reimbursements under new quality standards.
The Health Insurance Organisation (HIO) presented its financial proposal to hospitals yesterday, offering a base reimbursement of €110 per case with an additional €20 available for facilities that fully implement the quality criteria.
“For example, if an A&E department scores 80% on the quality criteria, the additional reimbursement will amount to €16 for each case,” the HIO explained in its announcement.
During the first four months of implementation, while necessary data is being collected to calculate actual performance scores, all A&E departments in both the State Health Services Organisation (SHSO) and private sector will receive additional payments based on an assumed 80% compliance rate.
After this initial period, “the actual score for each A&E department will be calculated for every quality criterion, which will be used to determine additional reimbursements until the end of 2025,” the HIO stated.
The quality criteria include:
- Patient satisfaction surveys specifically for A&E services
- Triage waiting times, with 90% of cases requiring assessment within 10 minutes
- Time from triage to treatment, varying from 5 to 240 minutes depending on case severity
- Total case processing time, with 90% of cases needing completion within 4 hours
- Ambulance release times, measured from arrival to patient handover to A&E staff
Other factors include the percentage of patients leaving A&E without treatment and the rate of patients returning to any A&E within 72 hours of their initial visit.
A&E departments will also receive points for documenting training of their triage team.
Each criterion carries different weightings that will determine hospital reimbursements.
Additionally, regardless of quality criteria, the HIO requires A&E departments to have specialists in internal medicine, (interventional) cardiology, general surgery, orthopaedics and radiology on call daily, plus one doctor from either neurology, paediatrics, intensive care, or radiology.
