The Maharashtra government will refer both COVID and non-COVID patients to private hospitals under the 80 percent portion. Rates for treatment have also been prescribed.
The Maharashtra government has brought 80 percent of beds in all private hospitals across the state under its purview till August 31 this year.
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Brought into force by an order passed under the Epidemic Diseases Act, the government will now regulate the usage of private hospital bed capacity and has also capped the prices of treatments that can be billed to patients. Hospitals are allowed to charge their own rates in the remaining 20 percent beds.
The order mandates private hospitals in the state to increase the number of operational beds and accommodate maximum number of patients for both COVID-19 and non-COVID-19 patients.
The government and civic bodies will also refer patients for admission under the regulated portion of hospitals' capacity for both COVID and non-COVID treatments.
The state government’s move is aimed at expanding the bed capacity it directly oversees while also redressing complaints of exorbitant hospital charges levied on patients who do not have medical insurance.
While an April 30 order had fixed rates for COVID and non-COVID treatments based on the lowest rates as per agreements with insurance companies, many patients complained of inflated bills from private hospitals.
Mumbai-based Nanavati Hospital faced severe criticism after it billed Rs 16 lakh for a 15-day treatment of a COVID-19 patient. The patient later died.
The hospital was also accused of charging patients Rs 8,000-9,800 for a PPE unit, almost 10 times the procurement price.
Under the state government's most recent order bringing most of private hospital capacity under its oversight, routine ward and isolation bed rates have been capped at Rs 4,000. For ICU beds without ventilators, rates have been fixed at Rs 7,500 per day while an ICU bed with ventilator support will be billed at Rs 9,000.
The government also capped package rates of nearly 270 procedures and surgeries, including cancer treatments.
The cost for an angiography procedure has been capped at Rs 12,000 and an angioplasty will be charged maximum Rs 1.2 lakh.
A normal delivery at a private hospital cannot charged more than Rs 75,000 while delivery through a basic caesarean section has been capped at Rs 86,250.
The capped prices are applicable for patients who do not have medical insurance and those who have exhausted their medical insurance cover.
Healthcare providers in Mumbai, Pune, Navi Mumbai, Panvel and Thane, who have agreements with insurance companies, cannot charge more than the lowest bed category rates agreed.
The package rates fixed by the government will be an all-inclusive rate including doctors’ fees, OT charges, room rent, investigations, implants, drugs among other charges. PPE costs are not included in the package rate. High-end drugs being tried in COVID-19 treatment, like Meropenem, immunoglobulin, Tocilizumab, etc have to be charged at MRP.
Hospitals also cannot charge more than 10 percent mark-up on the net procurement cost of items and services such as medical implants, lenses, pacemakers, prosthesis, PPE kits etc, which do not fall part of GIPSA-PPN or insurance package rates.
High end tests such as CT, MRI scans, Radiation, Stress test, Liver profile, among others will be charged as on actuals based on tariff as on December 31, 2019. Blood and blood products charges are also not capped.
Most private hospitals, though unhappy, say they will have to follow the orders despite incurring losses under the prescribed rates.
The CEO of a leading South Mumbai hospital said the rates offered for ICU beds are very low.
"Our revenues have anyway dwindled owing to elective surgeries being not allowed. Costs have also gone up to account for more safety gears and management of COVID centres," the CEO said.
"The need is to incentivise COVID hospitals rather than disincentivising them at this time,” he added.
First Published: IST