Up to hospitals, docs whether to cut ties with PhilHealth – PHAPI

MANILA, Philippines — The country’s biggest hospital associations on Wednesday said they would leave it to hospital members or doctors to decide whether to continue ties with the Philippine Health Insurance Corp. (PhilHealth), as the state insurer implements a policy to temporarily suspend payment on allegedly questionable claims.

The current PhilHealth accreditation of over 2,000 public and private hospitals will expire in December and the application for renewal usually starts as early as October, said Dr. Jose de Grano, president of the Private Hospitals Association of the Philippines Inc. (PHAPI).

PHAPI has about 700 members, the majority of them PhilHealth-accredited.

On Aug. 13, PhilHealth issued Circular No. 2021-0013 to update its guidelines on the temporary suspension of payment claims (TSPC). It said the TSPC was just a revision of its 2016 and 2018 circulars on the conditional suspension of payments of supposedly fraudulent claims.

Heightened rift

Since 2019, PhilHealth has issued TSPC to over 20 health facilities, dialysis and maternity clinics, and doctors.

The new circular was criticized by healthcare providers and heightened the rift between the government and the hospitals over the billions of pesos in unpaid claims for COVID-19 cases since 2020.

PHAPI, the Philippine Hospital Association (PHA) and the Philippine Medical Association on Wednesday said in a joint statement that “any member hospital or health-care professional, who shall be affected adversely by the circular, may review independently its engagement with PhilHealth and decide which is best for their situation.”

The hospital groups said they were “naturally piqued” by the circular which came in the middle of their “sufferings.”

Only P12.9B owed

They cited the fatigue and exhaustion they experienced as they addressed the pandemic, the financial hardships resulting from unsettled claims amounting to P86.1 billion from January 2020 to June 2021, and “heartaches” caused by their failure to adequately raise workers’ pay.

PhilHealth spokesperson Dr. Shirley Domingo said the state health insurer only owed hospitals P12.9 billion, not P86 billion, as of June 30.

She said P9 billion worth of claims were returned to hospitals because of documentary deficiencies and P6 billion were denied, and “therefore, it’s not accounts payable from our point of view.”

The joint statement said many PHA members had expressed their intention to close down due to mounting losses and others plan to stop admitting patients to prevent more losses.

“They thought that they do not have financial risk protection from PhilHealth,” the statement said.

“Could [the TSPC] be a delaying tactic or an escape strategy from paying [hospitals] because of lack of funds of PhilHealth?” it said.

‘Eventual loser’

In a recent television interview, Health Undersecretary Leopoldo Vega said patients would be forced to pay “out of pocket” to hospitals not accredited by PhilHealth.

PHA president Jaime Almora, in a phone interview, said non-PhilHealth-accredited hospitals would never turn patients away but would ask them to get reimbursement for their expenses from the state health insurance company.

Dr. Cesar Espiritu, president of The Medical City South Luzon, in a text message said the TSPC would be “extremely unfair to hospitals [which] are already saddled by delayed or even nonpayment of claims.”

He said it could affect hospital operations but “the eventual loser will be [the] patients who will have to pay the full amount of their [hospital] bills.”