News
PhilHealth Launches Peer Review Digest - March 2007
THE Philippine Health Insurance Corporation (PhilHealth) today launches the first volume of the Peer Review Digest developed by its Quality Assurance Research and Policy Development Group (QARPDG).
According to Lorna O. Fajardo, Acting PhilHealth President and CEO, the Digest was developed and approved by the PhilHealth Board in 2001, afterwhich a series of meetings and discussions were initiated by the Peer Review Committee to ensure the completeness and accuracy of the information in the digest. The Committee is composed of representatives from PhilHealth, Philippine Medical Association (PMA), Philippine Hospital Association (PHA), Professional Regulation Commission (PRC), Philippine College of Physicians (PCP), Philippine College of Surgeons (PCS), Philippine Obstetrical and Gynecological Society, Philippine Pediatric Society, Philippine Academy of Opthalmology, Philippine Academy of Family Physicians and Philippine Society of Anesthesiologists.
The Peer Review Digest is a 24-page compilation of the works and decisions of the Peer Review Committee. It covers issues on compensability, case typing, determining the Relative Value Unit (RVU) of certain surgical procedures, emergency nature of illnesses and other medical practice issues.
In a recent interview, Madeleine R. Valera, MD, MscIH (Heidelberg), PhilHealth Vice President for QARPDG and Officer-in-charge of Health Finance Policy and Services Sector (HFPSS), said that they wanted to have a material that will serve as a guide to members and health care providers to determine the compensability of certain drugs and procedures, appropriateness of care and emergency nature of care, among others. "What prompted us to come up with the Digest is to let our providers and our members be aware of the decisions that were made in order to improve the quality of service of our accredited providers," she said.
According to Valera, the hospitals and providers are the primary readers of the Digest. She said that even non-medical personnel can easily understand the Digest's contents because these are written in almost layman's terms. "It will also guide PhilHealth personnel on how to decide appropriately in cases that are similarly written in the Digest," Valera said. It was also created to help the doctors and PhilHealth members familiarize themselves with the illnesses or surgically treated resolved cases that may be paid for by PhilHealth.
Aside from the journal, PhilHealth also continues to promote the implementation of the Benchbook, a set of standards upon which the quality of care of hospitals is assessed. To strengthen PhilHealth's quality assurance efforts, a seal of excellence and quality awards will also be given to hospitals to inspire them to continue improving on their services.
Valera is optimistic that the Digest will be a great tool in helping doctors familiarize themselves with the illnesses or surgically-treated resolved cases that may be paid for by PhilHealth. "It will also help our members know which procedures are compensable, and of PhilHealth's policies in terms of reimbursement," she added.
The Peer Review Digest will soon be distributed to PhilHealth Regional Offices and accredited hospitals and will be available at www.philhealth.gov.ph.