QCI inspection for CGHS empanelment

The Union Health Ministry has chosen a new method of selection for CGHS empanelment this year, to deflect criticism of the process.

Falaknaaz Syed - Mumbai

Around 531 private hospitals and diagnostic laboratories in the country, which have filled tenders for being empanelled for the Central Government Health Scheme (CGHS), will be inspected by four certification bodies chosen by Quality Council of India (QCI), as per an order passed by the Ministry of Health and Family Welfare last month.

The order comes after complaints by a nursing home of alleged connivance between the quality audit team (comprising specialist doctors from government hospitals), and CGHS officers in empanelling hospitals for CGHS. An inquiry by the Directorate General of Health Services (DGHS) and CGHS team revealed that seven hospitals and two diagnostic centres not fulfilling empanelment criteria had been empanelled for CGHS. The Union Health Ministry has thus chosen QCI, an autonomous body under the Law Ministry working towards developing an accreditation system for hospitals in India, to submit its report of hospitals and diagnostic centres to be empanelled for CGHS this year, according to a senior CGHS official.

QCI has chosen four certification bodies to inspect the various private hospitals and diagnostic centres that have filed tenders for CGHS empanelment. The four certification bodies chosen by QCI are BVQI India, International Certification Services, Intal Quality Certification, and NVT Quality Certification. These bodies have offices across the country and are independent certification and inspection bodies accredited by the National Accreditation Board for Certification Bodies (NABCB) of QCI.

“We shall forward the status reports received from the certification bodies to CGHS, which will finally decide on empanelment. The basic purpose of this exercise is to have independent and professional assessment of hospitals with respect to the parameters listed in the CGHS tender document,” says Girdhar J Gyani, Secretary General, QCI.

The inspection team will comprise two system assessors, one doctor, and an observer from CGHS (must be a chief medical officer). The observer will not participate in the inspection process. The inspections have started from January 2 in several CGHS cities. The teams will submit their status report to QCI by March.

The Ministry has decided that the criteria prescribed in the tender document will form the basis of the checklist for inspection. The tender document states that private hospitals wishing to be empanelled should have a minimum bed capacity of 100. Besides various parameters such as equipment, rates of Intensive Care Unit and blood bank, the quality audit team will consider infrastructure and staff strength. Similarly, diagnostic centres should have more than one investigation facility such as cardio-respiratory, nuclear, imaging facilities (MRI, CAT scan, and ultrasound), and a large test menu, and indicate the number of CGHS patients who availed of these services last year. For instance, one of the four certification bodies, International Certification Services, will be surveying 50-70 hospitals in western Maharashtra and southern India. The body has identified doctors with experience in ISO audits, management experts and qualified auditors to inspect the hospitals. The cost involved in surveying the hospitals is Rs 80 lakh. The Ministry has decided to collect the cost of inspection from hospitals and diagnostic centres that have been shortlisted for the inspection. Rs 15,000 is the fee for hospitals while Rs 7,000 is the fee for diagnostic centres that have been shortlisted. Since eye/dental care hospitals and single speciality hospitals do not have 100 beds, a separate tender would be called for them, according to the senior CGHS official. CGHS is a comprehensive health insurance scheme covering more than 40 lakh government employees in 17 cities of India.

falak@expresshealthcaremgmt.com