launches multi-pronged approach to enhance services,
Empanelment & Disciplinary Committee constituted,
Stringent punishment to erring network hospitlas,
Plug all loopholes to make the scheme World Class: CM
HYDERABAD: Chief Minister Dr.K.Rosaiah asked the
Aarogyasri Trust to plug loopholes, if any, in the implementation of the unique
healthcare scheme for the poor and low income group and make it World Class for
other States and even other countries to replicate it. The Chief Minister
expressed satisfaction over the multi-pronged approach by the Trust to enhance
the quality of delivery of services in the Arogyasri scheme. The scheme which
caught the attention of the World Health organisation is now being replicated
in other States as well as some other countries to provide quality healthcare
to poor and low income people.
The Chief Minister was explained about the functioning of
the scheme and the steps taken to make it absolutely transparent,
people-friendly, accountable, responsive and responsible by the Minister for
Aarogyasri, Pithani Satyanarayana, Chief Secretary, Mr. S.V.Prasad and CEO of
the Trust, Mr. Babu. A and other top officials. Dr Rosaiah asked the Trust to
introduce stringent measures in order to ensure the best quality medical care
to the beneficiaries and to avoid unethical practices by Network Hospitals.
The Chief Minister, in this context, has recalled the most
valuable and memorable services rendered by the then Chief Minister
Dr.Y.S.Rajasekhara Reddy to the poor people of the State particularly through
Arogyasri, '108' and '104' services.
The officials explained to the Chief Minister that for
standardisation of empanelment of network hospitals, a post of Chief Medical
Auditor is created to continuously monitor the quality of medical care being
provided to the beneficiaries. The Trust constituted Empanelment & Disciplinary
Committee (EDC) under the Chairmanship of Chief Medical Auditor of the Trust.
The Committee will ensure that the hospital has the adequate infrastructure,
manpower, equipment etc. as per the standards for empanelment under the scheme.
The process of empanelment is made online to bring in absolute transparency in
The Hospital will submit online application. If
infrastructure is lacking as per basic requirement like bed strength being less
than 50, the application will be rejected at the scrutiny level itself. On
finding that the basic infrastructure is adequate but other information like
facilities and photographs are not uploaded, the application will be kept
pending giving reasons and advising hospital to upload the same. Once all the
required documents and necessary photographs are uploaded the application will
be registered and then the Trust will organise inspection of the hospital by
senior officials and specialists of the Trust and Insurance Company.
Inspection team will submit its report to the Empanelment and Disciplinary
Committee and the EDC will scrutinise the inspection report, photographic and
video graphic evidence along with online documents.
On confirmation of adequacy of infrastructure and services
available, EDC will recommend for Empanelment of the Hospital. In case of major
deficiencies and inadequacies as confirmed by inspection team, the hospital's
application will be rejected and in case of minor deficiencies and inadequacies
as confirmed by inspection team, the hospital will be advised to upgrade or
improve the infrastructure and notify the Trust for Re-inspection. The
Insurance Company will appoint and allocate Aarogyamithras and kiosk for the
Hospital, the Trust will organise a workshop for the MD, RAMCO (Rajiv
Aarogyasri Medical Coordinator), AMCO (Aarogyasri Medical Camp Coordinator),
Billing Executive of Empanelled hospitals to apprise them about the scheme,
online procedures, guidelines of the scheme, packages, responsibilities etc.
The networked Hospital will be given an access code, Manual and other material
to enable them to participate in the scheme. Thereafter the Network Hospital
can start registering the patients under the Aarogyasri Scheme.
The Empanelment and Disciplinary Committee (EDC) under the
chairmanship of Chief Medical Auditor of the Trust will also look into all the
complaints against the hospitals received from various sources viz., Complaints
from patients, complaints from 24 hour call centre, field staff, reports of
surprise inspections to the hospitals by the Trust/Insurance Officials, Press
Clippings and other sources and recommend follow-up actions against network
hospitals based on the severity of the complaints after due verification. Show
Cause Notice with Warning and order to withhold payments, Suspension,
Suspension with order to withhold payments, De-Empanelment and Delisting etc.
will be initiated as found necessary.
On approval of the recommendation of EDC by the CEO, the
necessary steps are being initiated by the Trust. All these are done in a
transparent manner through the online workflow. In case of hospitals suspended
from the scheme, their explanation will be considered case-by-case based on
merit. In case of delisted hospitals, the request made for re-empanelment will
be considered only after a minimum period of 6 months. In case of new
hospitals, which are applying for empanelment under Aarogyasri scheme, if the
application is rejected for the first time, their request will be considered
only after a period of six months and if the hospital is rejected during the
second time for empanelment, their request will be considered only after a
minimum period of one year from the date of second rejection.
The Social Audit Mechanism includes a letter from Chief
Minister which will be dispatched directly to the address of the beneficiary
soon after their discharge enquiring about their health after the treatment. It
provides details of the claim such as disease suffered, surgery/therapy done,
package amount approved etc. Enquiries about the satisfactory services rendered
and a self-addressed postage paid inland letter is attached to this letter to
get specific feedback from the beneficiary about the quality of services,
behaviour of Aarogyamithra and hospital staff and his opinion about the scheme
The claims can
be submitted by the network hospitals only 10 days after the discharge update
and in the meanwhile the response from the patient towards the Chief Minister's
letter will also be available for processing the claim. Thus the claim
processing in Aarogyasri is evidence-based, outcome-based and reflecting
satisfaction of the patient'.