IMEE: HOSPITALS MAY SHUT DOWN SOON UNLESS PHILHEALTH PAYS DEBTS

Senator Imee Marcos has warned that Philhealth's delayed reimbursements to government and private hospitals will weaken their capacity to deal with the mutating Covid-19 virus, if not risk their outright closure.

"Complaints reaching our office show that at least Php26 billion remains unpaid to private hospitals alone, while government hospitals are still owed hundreds of millions. Let's not wait for them to shut down nor leave them ill-prepared to deal with the possible spread of the dreaded Delta variant," Marcos said.

Philhealth recently announced that it had released some Php6.3 billion through a new system of settling hospital claims, known as the Debit Credit Payment Method (DCPM) put in place in April.

However, Marcos said hospitals were being shortchanged because the DCPM did not cover still unpaid hospital claims for Covid-19 treatment last year.

"Nor was the DCPM fully settling the 60% of hospital claims for reimbursement as directed in the government agency's own circulars in April and May," Marcos added.

Marcos cited the case of one private hospital that was reimbursed only Php430 million out of the Php1.2 billion it is claiming, "which is 60% of 60% - in effect, only 36% - of what Philhealth said it would pay through the DCPM."

Even government hospitals have not received the full 60-percent reimbursement that Philhealth should have released, Marcos added.

As of May 31, the Philippine General Hospital has only received a reimbursement of 0.0042% or only Php2.56 million of its claims for Covid-19 cases totaling Php615.7 million.

The Lung Center of the Philippines said it has only been paid 40% of its receivables from Philhealth, with Php304 million still due.

The Philippine Heart Center says only 49% or Php99.47 million has been reimbursed by the state health insurance corporation, leaving a balance of more than Php100 million for claims up to March 31.

"Philhealth is fudging its numbers," Marcos said, pointing to an online ledger known as the Reconciliation Summary Module (RSM), to which both Philhealth and hospitals have access.

"Hospitals are complaining that the RSM shows Philhealth has paid but the said payments have not yet been deposited in their bank accounts," Marcos explained.

"Many Northern Luzon hospitals cannot increase bed capacity because they have not been reimbursed," Marcos specified, adding that complaints from hospitals in the Western Visayas have also surfaced in the news.

The Private Hospitals Association of the Philippines (PHAPi) confirmed that partial reimbursements to its members via DCPM were concentrated in the National Capital Region (NCR) Plus bubble of Metro Manila and its neighboring provinces.

So far, only about 210 hospitals have agreed to participate in the DCPM, out of the 350 hospitals in the NCR Plus bubble and 1,270 health care facilities all over the country.

The PHAPi, which has 700 members, said that the fear of retaliation is complicating the delay in Philhealth reimbursements, as many private hospitals hesitate to be more vocal and risk waiting longer to be paid.

"Philhealth must give a clearer breakdown of reimbursements and explain the discrepancies between what has supposedly been paid and what has actually been received by our hospitals. Let's not wait for the Delta variant to spread before kicking butt," Marcos said.

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(Tagalog version)

IMEE: MGA PRIBADO AT GOV'T HOSPITAL, NAMEMELIGRONG MAGSARA DAHIL SA UTANG NG PHILHEALTH

Nagbabala si Senador Imee Marcos sa Philhealth na ang patuloy na pagka-antala ng pagbayad sa mga government at private hospital para sa ginastos nila hinggil sa Covid-19 ay magpapahina sa kanilang kapasidad na puksain ang pandemya at maglalagay pa sa kanila sa peligrong tuluyang magsara.

"Base sa mga reklamong nakakarating sa aming tanggapan ay halos nasa Php26 billion pa ang hindi nabayarang utang ng PhilHealth sa mga pribadong ospital pa lang, habang sa mga government hospital nama'y nasa daan-daang milyon pa. 'Wag na nating hintayin pang maging sanhi ito ng kanilang pagsasara o pabayaan silang hindi maging handa sa posibleng pagkalat ng kinatatakutang Delta variant," pangamba ni Marcos.

Kamakaylan lang, inanunsyo ng PhilHealth na naglabas na ito ng nasa Php6.3 billion sa pamamagitan ng bagong sistema ng pagbabayad sa mga ospital na mas kilalang 'Debit Credit Payment Method' (DCPM) na sinimulan noong Abril.

Pero, sinabi ni Marcos na kulang pa rin ang bayad ng PhilHealth sa mga ospital dahil hindi nasama sa DCPM ang mga di pa rin nababayarang gastos ng mga ospital para sa Covid-19 treatment nitong nakaraang taon.

"Hindi nasusunod ng DCPM ang pagbayad ng 60% ng mga sinisingil ng mga ospital, ayon sa direktiba mismo ng ahensya noong Abril at Mayo," diin ni Marcos.

Tinukoy ni Marcos ang isang kaso ng pribadong ospital na nasa Php430 million lang ang naibalik o nabayaran ng PhilHealth mula sa utang nitong nasa kabuuang Php1.2 billion, na "60% ng 60% - o lumalabas na tanging 36% lang - ang binayaran ng PhilHealth gamit ang DCPM."

Maging ang mga government hospital ay di pa nakatatanggap ng kabuuang 60% na bayad, na dapat sanang inilabas na ng PhilHealth, dagdag pa ni Marcos.

Nitong May 31, ang Philippine General Hospital ay nakatanggap lang ng reimbursement o bayad na Php2.56 million o 0.0042% ng kabuuang Php615.7million na dapat bayaran ng Philhealth.

Ang Philippine Heart Center naman ay nagsabing 49% pa lang o Php99.47 million ang nababayaran ng Philhealth, at mahigit pang Php100 million ang kulang.

Umaabot naman ng Php304 million ang kulang na bayad sa Lung Center of the Philippines, dahil 40% pa lang ang nabibigay ng Philhealth.

"Iniimbento lang ng PhilHealth ang mga numero," ani Marcos, na tumutukoy sa online ledger na tinatawag na Reconciliation Summary Module (RSM), kung saan pawang may access ang PhilHealth at mga ospital.

"Nagrereklamo ang mga ospital dahil ipinakikita sa RSM na nagbayad na ang PhilHealth, gayong hindi pa ito naidedeposito sa kanilang mga bank account," paliwanag ni Marcos.

"Maraming ospital sa Northern Luzon ang hindi magawang damihan o taasan ang kanilang 'bed capacity' dahil hindi pa sila nababayaran ng PhilHealth," ani Marcos, dagdag pang binanggit ang mga nababalitang reklamo ng mga ospital sa Western Visayas.

Kinumpirma naman ng Private Hospitals Association of the Philippines (PHAPi) na ang pagbayad sa kanilang mga miyembro ay nakasentro lang sa National Capital Region (NCR) Plus bubble ng Metro Manila at karatig probinsya.

Sa ngayon, ang mga pumayag na sumali sa DCPM ay umaabot pa lang sa 210 mula sa kabuuang 350 mga ospital sa NCR Plus bubble at 1,270 health care facilities sa buong bansa.

Ayon sa PHAPi, na may 700 miyembro, nakadagdag pa sa delay ng reimbursement o pagbabayad ng PhilHealth ang pagsasawalang-kibo o hindi pagrereklamo ng mga ospital na hindi pa rin nababayaran dahil sa pangambang bweltahan sila ng ahensya.

"Kailangang klaruhin ng Philhealth ang hindi pagkakatugma sa sinasabi nilang nabayaran na at ang aktwal na natanggap ng mga ospital. 'Wag na nating hintayin na kumalat ang Delta variant bago pa tayo kumilos," giit ni Marcos.