Explained: Why Telangana was asked to make hospitals display Covid-19 treatment rates

What are the rates stipulated in the government order?

The state fixed the charges for routine ward and isolation at Rs 4,000 per day. The charges for ‘ICU isolation beds without ventilator’ and ‘ICU isolation beds with ventilator’ were pegged at Rs 7,500 per day and Rs 9,000 per day, respectively. These packages also include charges for monitoring and investigations like CBC, Urine routine, HIV spot, Anti HCV, HbsAg, Serum Creatinine, USG, 2D Echo, X-ray, ECG, Drugs, Consultations, Bed charges, and meals. Procedures like Ryle’s Tube insertion, urinary tract catheterisation are also included.

However, according to the order, the charges for these packages do not include the cost of “PPE, interventional procedures like, but not limited to, central line insertion, chemo port insertion, bronchoscopy procedures, biopsies, ascitic/pleural tapping, etc, which may be charged at a rack rate as on December 31, 2019”. Also excluded from the package charges is the cost of COVID-19 testing at Rs 2,200.

The order said high-end drugs like immunoglobulins, meropenem, parental nutrition and tocilizumab would be charged at MRP while investigations like CT-scan, MRI, PET scan or any lab investigation not included in earlier mentioned procedures would be as per rate at end of last year.

The private hospitals were then also told asked to display the government-prescribed rates at prominently.

What was the nature of the complaints?

Over the last several weeks, complaints against private hospitals have been on the rise. Relatives of parties have been flagging issues on social media prompting the government to announce a WhatsApp number (9154170960) for complaints against private hospitals and laboratories.

Hearing a batch of PIL petitions on July 7, the Telangana High Court sent out notices to four private hospitals in Hyderabad, namely, Medicover-HiTec City, Yashoda-Raj Bhavan, Sunshine-Secunderabad and Care-Banjara Hills, apart from seeking a response from the state government, and the Centre, over lack of transparency in treatment and billing of COVID-19 patients.

A few days earlier, Asra Sultana, an assistant civil surgeon serving at the Government Fever Hospital, had posted a video calming she was detained in a private hospital for not clearing the exorbitant medical bills generated for her COVID-19 treatment. In a police complaint, she had alleged that the Tumbe Hospital charged her Rs 1.19 lakh for a day.

After paying Rs 40,000 and requesting to pay the rest of the amount later, she alleged, the hospital detained her till her brother came with the money. The hospital, on the other hand, had countered that she abused the medical staff.
Also, the widow of a COVID-19 patient had to approach the High Court seeking an order directing Continental Hospital to hand over the body which was detained for non-payment of a balance bill amount of Rs 6.4 lakh.

The hospital, however, did not wait for an order and released the body. A couple of weeks later, the court had to intervene to get the body of retired Army Captain Ram Kumar Sharma released from Sunshine Hospital.

But what caught the attention of the state government was selfie-videos tweeted out by a 20-year-old Radhesh Reddy who lost his parents and cousin to COVID-19 in a week. Sharing the ordeal he underwent, he alleged a lack of medical care and excessive billing at Deccan hospital.

As the tweet went viral, minister KT Rama Rao responded tagging the health minister Eatala Rajender, requesting the strictest action against the hospital. Soon after the state barred two hospitals — Deccan Hospitals and Virinchi Hospitals — from offering treatment to COVID-19 patients.

While reviewing the COVID-19 situation in the state, Health Minister Eatala Rajender recently said the office of DPH has received hundreds of complaints ranging from excessive billing to collection of advance payments and even outright refusal of treatment. Warned of stringent action, he threatened to take over 50 per cent of beds in all private hospitals for COVID-19 treatment.

What are the changes in the new order?

The August 10 order asks all private hospitals to display rates at prominent places. It also said ‘high-end drugs’ and Personal Protection Equipment, which are excluded from the package price have to be charged only at the Maximum Retail Price, which also has to be displayed. Hospitals have also been told to provide itemised bills.

Speaking to indianexpress.com, Dr. Bollineni Bhaskar Rao, MD, and CEO of KIMS Hospitals and also president of the Telangana Super Speciality Hospitals Association (TSSHA), said hospitals are bound to follow every direction from the government. “For ages, hospitals have been issuing transparent bills. There is no doubt about it. Every patient gets a detailed bill where the MRP is mentioned for things used. Whatever is used for whatever purpose is all mentioned in the case sheet,” said Dr Rao, blaming some hospitals for creating the mess. “Some hospitals are charging lakhs of rupees on PPE kits. In such cases, action should be taken against them. Why blame all?”

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He reminded that not only doctors but also the housekeeping person, food and beverage person, security staff, and sanitation staff, etc are all required to wear PPE. “Five or six PPE kits may be required per person every day. And over the period of treatment, the cost involved might come to a huge amount. People should first understand that,” he explained.

As of August 12, as many as 118 private hospitals are offering COVID treatment in Telangana.