The Philippine Health Insurance Corporation (PhilHealth) will be using the Benchbook (Second Edition) by 2018 in assessing and implementing quality assurance among partner-hospitals and non-hospital facilities
PhilHealth is adopting the enhanced Benchbook to achieve a higher level of quality health care and to provide better financial protection to members. In preparation for its full use, PhilHealth officers and technical personnel convened in Cebu City recently for a five-day training.
“If we had standardized everything from A to Z in terms of forms, what the records look like... for hospitals, that would be very easy for everyone to check. But since that’s not the case, they will have to look at a range of possibilities,” reveals Dr. Mary Anne Evangelista, the Benchbook II training facilitator and resource speaker.
Formerly a PhilHealth medical specialist and the Benchbook technical consultant, Evangelista is independently consulting for EPOS Health Management. Her expertise in the field of health systems strengthening, health policy analysis and development, quality assurance and accreditation, and capacity building are made available to PhilHealth through the assistance of the European Union (EU).
“The material that we have now tries both to keep within the technical specifications of what the standards should be, and to have some flexibility in terms of finding them and interpreting them in the field,” she explained, when asked about the enhancements in the Benchbook.
Benchbook II introduces the tracer methodology to better observe and evaluate delivery of care, treatment, or service, as well as examine written policies and procedures in hospitals. A tracer follows the patient’s actual experience to see how hospitals comply with the standards. When visiting hospitals, surveyors will choose a patient, review the patient’s chart, and retrace all the areas of care, treatment, or service the patient had, while observing the hospital staff in the actual performance of their routine tasks.
Dr. Maria Eliza Batucan, one of the training participants and currently the officer-in-charge of PhilHealth’s Accreditation and Quality Assurance Section in Central Visayas, says they will scrutinize everything from the time patients were seen to, until they are discharged from the hospital. Batucan shares that inspections are going to be thorough such that, if laboratory procedures are performed, surveyors may look at how long patients waited for the results as against the facility’s turnaround time policy.
“If you say you have the policy, resources, manpower, may (with) monitoring system in place then you are performing, tapos tiningnan mo ang track record at two months pa lang ‘yan in place (but a review of your track record shows that it has only been in place for two months), then wala ka pang (you don’t as yet have) track record to speak of. So when we score the criterion, mababa ka pa rin (you will still get a low mark),” points out Evangelista.
Benchbook II assesses 13 performance areas that are organized into two standard clusters: patient-centred and facility-focused. Surveyors measure compliance to standards by giving a score to each criterion adhered to or complied with by the facility. But trainer-resource speaker Evangelista emphasizes that PhilHealth will now be looking at track records and not just whether elements are present or absent, adding that four (4) months is the minimum required to score for track record.
“So mas comprehensive ngayon ang pag-score sa criterion (scoring for each criterion will now be more comprehensive) because you are looking at performance and track record. It gives a better measure if nag-co-comply talaga sila sa (they are really complying with the) criterion,” continues Evangelista.
Hospitals that are PhilHealth-accredited currently enjoy basic participation in the National Health Insurance Program. This means they can provide the necessary health care services to members and be reimbursed for their services. However, accredited hospitals that comply with all the criteria and requirements set by PhilHealth, and pass the Benchbook II survey will be considered Centres of Excellence.
Although it is optional to attain Centre of Excellence standard, PhilHealth is in the process of designing incentives for hospitals of this calibre. Incentives may include longer accreditation period (from annual to three years) and faster turnaround time in the reimbursement of claims. (END) (Marie Beatrix S. Elias)
(Reference: Dr. Israel Francis A. Pargas, Head Executive Assistant and Concurrent OIC-Vice President for Corporate Affairs Group, Tel. 0917-8089399)