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Apex body of TPAs on the anvil, city healthcare providers to follow suit
Falaknaaz Syed - Mumbai
The growing discontentment between the healthcare providers
and the Third Party Administrators (TPAs) has taken a new turn with the TPAs
across the country all set to form an association by the end of this month.
Close on their heels are the healthcare providers of Mumbai who too are holding
talks for forming an umbrella body of healthcare providers.
These events have come about after the recent initiative
of the TPAs under the aegis of the General Insurance Council and the IRDA to
grade hospitals and nursing homes, and introduce package charges for various
medical services accordingly. The initiatives currently introduced in Mumbai
and Delhi are to be replicated in other parts of the country and have been vehemently
opposed by the medical community at large.
To be named as ‘Association of TPAs’, this apex
body of the TPAs will be a national body duly represented by the 23 registered
TPAs across the country. The Association of TPAs will be registered under ‘The
Societies Registration Act 1860’.
Says Pawan Bhalla, general secretary of the Association of TPAs and CEO, M/s
Raksha TPA Pvt Ltd, Haryana, “The MoU has been circulated and TPAs across
the country holding a license have been invited to join the panel. TPAs have
agreed on the MoU.” Of the 23 licensed TPAs in the country, 18 have already
joined the panel while the remaining five are expected to join in due course.
“We are in the process of filing the papers and the association will be
registered by the end of this month,” he added
TPAs, are the intermediaries for the insurance companies
to the hospitals and medical providers.
Though the association’s charter has not been finalised, the Association
of TPAs will look into various issues such as providing medical care at economical
cost, implementing uniform rates and processes across all hospitals, data collection
and innovation in rural products etc. It will be involved in both medical and
insurance aspects and in due course hire an agency to investigate claims reimbursement.
The Association has the support of all public sector insurance
companies and is confident of getting support of private insurance companies
too. “Private companies will too support the association due to economics
of cost and pricing. Formation of the Association of TPAs will be beneficial
even for the healthcare providers,” opined Bhalla.
Association of TPA members will pool in the funds and resources required for
functioning of the association.
On the other hand, healthcare providers of Mumbai namely
Association of Medical Consultants (AMC), a body of 5000 consultants; Association
of Hospitals (AoH), a body of 42 trust-run-hospitals in Mumbai; Bombay Nursing
Home Association (BNHA), a body of private nursing homes are holding talks of
coming together and forming a body which will work on common goals and address
problems faced by the healthcare providers at large.
Informs Brig Joe Curian, president and chief spokesperson
of AoH, “The project is still at its conceptual stage. The body formed
will work on common issues. For instance, our problems with the TPAs is one
such issue, setting up norms for accreditation of hospitals, medical ethics,
issues related to healthcare delivery, communication arrangement, bringing transparency
and credibility in our work will be addressed. The association will keep patient
benefit at the forefront, and promote domain knowledge. The body formed will
retain the federal structure of all the three associations.”
Referring to the introduction of package charges and gradation of hospitals
and nursing homes introduced in Mumbai by Paramount Healthcare Services Pvt
Ltd, Brig Curian said, “TPAs are basically agents with no risks but all
benefits. In search for cheaper quotes, TPAs are putting patient safety at risk
and their own profitability at forefront. How can there be standard rates for
all hospitals? Cost inputs of each hospital vary therefore price range will
also vary. Most charitable hospitals and nursing homes operate with thin margin.
For example, HMOs in US decide stay, cost, which is a big danger in interest
of patients.”
“TPAs don’t have the expertise and the domain knowledge
for accreditation. How can they grade hospitals and nursing homes? We service
providers, namely AMC, AoH, BNHA, have decided to come together and based on
the norms prepared after intense discussions and deliberations have already
formed a peer evaluation committee to accredit hospitals,” he informed.
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We are seriously considering
of grading TPAs. Patients coming through TPAs with lower grades would
stand to lose cashless service
Brig Joe Curian, president and chief spokesperson of AoH
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“TPAs are creating a divide between the medical providers. I have been
told that TPAs are entering into an MoU with nursing homes for consideration
other than merit. They are tying up with particular providers while not empanelling
some. We providers have decided to act together. Normally, a TPA gets a cut
in each bill from the insurance companies. Henceforth, we have decided not to
give them discount. We have asked them to tie-up with all members of AoH and
not just with some.”
“A TPA can’t arm twist a healthcare provider to
charge a particular amount nor can the TPA arm twist a patient to go to a particular
hospital,” he added.
“We are also seriously considering of grading TPAs. Services to TPAs will
be provided as per their grade. Patients coming through TPAs with lower grades
would stand to lose cashless service,” he informed.
“The sad part is that TPAs want the association to meet
their own personal objectives so is the case with the healthcare providers.
Forming associations won’t help. Hospitals and TPAs should form an association
together, which is like minded. The association charter should be long term,”commented
an industry expert.
falak@expresshealthcaremgmt.com
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