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By Nicolas Petros Kaparti
Based on 4 pillars, the fees of private hospitals in GESY will be based on 4 pillars in the new year, based on the proposal prepared by the Health Insurance Organisation after separate meetings on Monday with the Pancyprian Association of Private Hospitals and the Association of Small and Medium-Sized Hospitals.
According to the Cyprus Times, OAI yesterday afternoon finalised its proposal for the new payment framework for hospitals in the GHS and sent it to PASIN and the Association of Small and Medium-sized Hospitals to study it and enter into a dialogue in December until a new agreement is reached.
Recall that the agreement signed by the private hospitals and OAI will end at the end of the year and if a new agreement is not signed by January 1, 2023 then the existing agreement will be automatically renewed for another 6 months until a new one is signed. As we were told by a competent source from OAI, due to the delays resulting from the changes in the Board of the Agency, the agreement may not be signed before 1 January 2023 in order to allow more time for consultation with private hospitals, and the aim is to achieve this before February 2023.
What the OAI proposal
Beyond that, the OAI proposal - obtained by the Cyprus Times Times - for the new way of paying nursing homes aims to.
▪ To introduce quality criteria to promote quality and highlight comparative advantages between hospitals.
▪ To provide an incentive for hospitals to select difficult cases as well as pathological ones.
▪ To reward those hospitals that produce more (money follows the patient).
▪ To promote healthy competition and at the same time operate in a way that does not compromise the global budget.
▪ To define the framework for the integration of new hospitals into the System, in view of the announcements of the creation of new large hospitals.
In 4 axes for hospital fees
With regard to the fees of hospitals, these will be determined by: a) CY - DRG catalogue procedure weights, b) Z list of consumables, c) Hospital Base Rate and d) the number of hospital units (Casemix).
Specifically, the CY - DRG list has been revised on the basis of a more recent version of the G - DRG list (2018). The new list has a much larger number of processes enabling more accurate coding. The weights of each DRG are also re-evaluated to correct any initial misses and there is an emphasis on increasing the weights for pathology cases. While the Z list is continuously recalculated, since a number of consumables have also been recently removed.
Also, under the new proposal each hospital, existing or new, will have two instead of one base rate, one for non-specialized cases and one for specialized cases. All hospitals will start from the same base and the base rate will have a difference for specialized and non-specialized cases, to reflect their greater complexity/severity as well as the resources needed to handle them.
Hospitals through the quality criteria will be able to increase their two base rates by about 25% 30% (currently the difference between the different base rates of hospitals, before the implementation of the discount rates, reaches 53%).
Based on the OAI proposal, the basic qualitative criteria relate to the following:
▪ Category that a hospital falls into based on its infrastructure e.g. intensive care unit, number of specialties, availability of specific infrastructure, etc. - indicative weight X%
▪ Accreditation - indicative weight X%
▪ Correct completion of discharge - indicative weight X%
▪ Patient satisfaction via questionnaire - indicative weight X%
▪ Average age of patients - indicative weight X%
▪ % of patients with high comorbidity - indicative weight X%
▪ % of patients over 80 years old - indicative weight X%
▪ % of pathological procedures in relation to interventional procedures - indicative weight X%
▪ Provision of additional information (reporting) - indicative weight X%
▪ Drug dissolution unit; indicative weight X%
▪ Correct coding of cases - indicative weight X%
▪ Medicines Committee - indicative weight X%
▪ In-hospital Infections Committee - indicative weight X%
▪ Public Health - indicative weight X%
Note that, that in total they should give 100%, meaning that a hospital that fully meets all criteria will receive 100% of the maximum possible increase in base rate, which as mentioned above will be around 25% 30%.
What applies to specialised and non-specialised cases
With regard to specialised cases, the total number of units available to the Agency will not be allocated per hospital, but based on the actual data of previous years (2021 - 2022), a common budget will be determined for all hospitals, which will be divided into subcategories e.g.Therefore each hospital will be able to seamlessly participate in the common budgets according to the work it produces. This joint annual budget and the total number of units for specialty cases will be spread over the twelve months of the year. Each month, in the event of an overall overrun of units, there will be a corresponding percentage reduction in the base rate for specialized cases in the specific MDC category of each hospital (the same percentage reduction will apply to all hospitals) in order to maintain budget comprehensiveness.
With respect to non-specialized cases each hospital will have an agreed upon number of units. Its output up to that number will be remunerated at the set base rate for each hospital's non-specialist cases, and any excess units for that hospital will result in the application of discount rates for that hospital.
What differs in the new proposal compared to the existing one for non-specialist operations is the ending of static units for each hospital. The units of each nursing home will be determined on the basis of two parameters. One parameter will be derived from the capacity of the hospital in terms of the number of beds, the number of ICU beds, the number of intensive care beds and the number of non-invasive doctors.
It is clarified that the amount finally determined will result from the consultations and from the results of the simulation model being developed by the Agency.
The second parameter will take into account the percentage of participation of each hospital in the actual production of the previous year or years (for a new hospital, a predetermined minimum number of units will be counted, depending on the category it falls into tier 1, tier 2, tier 3, since there is no production precedent).
This percentage will be applied to the total number of agreed units of inpatient care for non-specialist cases that the Agency intends to allocate for the year.
The weight of participation of the above two parameters in the inclusion of the agreed units per hospital will vary around 60% (potential) 40% (production).
To avoid large variations in the allocation of units, maximum percentages of deviations from year to year are defined, which will be indicatively as follows:
Note that for a new hospital, this will not apply for the first year of participation in the System.
Finally, the financial parameters of the design will be presented in the near future during the Agency's consultations with private hospitals.
Contents of this article including associated images are belongs Cyprus Times
Views & opinions expressed are those of the author and/or Cyprus Times
Source[/URL]Cyprus Times[/SIZE]
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