Patients Rights and Responsibilities on Hospital Bills

The PhilHealth Benchbook requires all hospitals to have a publicized Patients’ Rights and Responsibilities.

Each hospital can come out with its own version as long as the following are included (based on PhilHealth Benchbook):

1.2b Patients’ rights include rights to: (a) good health (b) to information its confidentiality (c) privacy e.g. visual and auditory (d) participate in care decisions (e) withdraw consent without prejudice to care (f) second opinion.

1.2c Patients’ responsibilities includes: (a) to provide the hospital with truthful and complete information (b) to heed hospital regulations (c) to be an active partner in regaining and maintaining health (d) to ensure that their healthcare is paid for.

Last year, 2017, when I was trying to help a private hospital in the north formulate its Patients’ Rights and Responsibilities, I suggested a balance in the responsibilities and rights on patients’ hospital bills, meaning there must be a counterpart on the patients’ rights.

In the Philippines, all the Patients’ Rights and Responsibilities that I have seen so far include a declared responsibility for the patients and relatives to settle their hospital bills.  There is no corresponding declared rights on hospital bills.  Not stated but just implied, the patients and relatives have the right to examine and receive an explanation of their hospital bills.  What I suggested last year is to put an open statement like this: patients’ right to be billed accurately.

January 13, 2018, I encountered a situation which convinced me all the more all hospitals should bill patients accurately.

This patient underwent a breast mass excision under local anesthesia and on outpatient basis. I told and assured her before the operation her hospital expenses could be covered by the PhilHealth benefits of P5,200.00 (no need for out-of-pocket payment).  Before I left the operating room, I asked the operating room clerk how much was the hospital bill of my patient.  She said P9,000 +.  I was taken aback by her answer.  I investigated.  The laboratory department gave a charge of P7,600 for the histopathology of the 3-cm breast mass.   Before the operation, I computed the histopathology charge to be only around P2,100 to P2,400 for small to medium-sized specimen (based on experience with this hospital).  Image (2)

I called up the laboratory department and inquired further.  I was told by the laboratory department clerk the specimen “looked big.”  Therefore, she gave a charge for a large specimen (P7,600).  “What?  The specimen was just about 3-cm.”  I said.  I then asked her what were the bases for classifying specimens into small, medium and large.  I was expecting she would give an answer in term of numerical values such as more than 4 cm would be considered large; less than 2 cm would be considered small; etc.  She could not give me such kind of an answer.  When I said I would cancel my request for histopathology because the charge was unreasonable, she right away told me to wait and would ask her colleague in the laboratory department. When she came back to me, she openly admitted she made a mistake and would just make a charge of P2,700 (medium-size specimen).  In answer to my query on how the size of the specimen was being classified, she said any specimen that could not fit into the 100-cc plastic container being used in the operating room would be considered large.  I was not contented with the answer but I left it at that for the moment since she had offered to adjust the charge (P2,700 for medium specimen).  The total bill came out to be P4,924.57, still within the benefits of PhilHealth.

If I did not question the hospital bill, the patient would have shelled out around P4,600.00.  Patients usually do not know the bases of the charges.  They usually pay as billed.  Some will question. Majority will not.

This is the very reason for my advocacy to include in the Patients’ Rights to be billed accurately.   

It is correct to declare that patients have the responsibility to settle their hospital bills but it should also be stated that the patients have the rights to be billed accurately.

Side recommendations for physicians:

Physicians should help in the checking of charges of their patients’ hospital bill.

Physicians should be patient-advocates.

 



I took pictures of the specimen plastic container being discussed above:

IMG_0003

IMG_0008


ROJ@18jan15

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Alignment, Integration and Coordination Needed in a Care of a Patient

In a patient confined in a hospital, there are usually a good number of staff (physicians, nurses, medical technologists, radiology technicians, pharmacists, house keepers, etc.) taking care of him, that is, providing health care services.

See picture below:

people_in_one_episode_care

http://docplayer.net/14478453-Patient-experience-is-not-patient-satisfaction.html

There must be alignment, integration and coordination of the health care services to be provided in order to achieve quality and safe patient care and excellent patient experience.

Who should orchestrate this alignment, integration and coordination?

The attending or head physician?

The nurses?

The attending or head physician assisted by the nurses and the hospital-wide alignment, integration and coordination management system in patient care?

I think the best answer is the last one.

This is a challenge to all hospital administrators – how to accomplish the third task and responsibility!


ROJ@17dec9

 

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Governance of a Hospital Clinical Department Framework

Governance of a Clinical Department_roj_17dec6

 


ROJ@17dec6

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Quality vs Safety – Quality and Safety Patient Care – ROJoson’s Notes

Quality vs Safety – Quality and Safety Patient Care – ROJoson’s Notes

Quality vs Safety – Quality and Safety in Patient Care

ROJoson – 15feb12

Circa 1995s, I spelled out the universal goals in the management of a patient which consist of resolution of the patient’s health problem or concern in such a way that the patient does not end up dead, with disability, or with complication and in such a manner that the patient is satisfied and there is no medico-legal suit.  I have been using these formulated goals in the management of my patients.  I have also been telling my medical and surgical students to have these goals in mind whenever they treat patients.  I have not called these goals as quality or safety goals, just simply goals in the management of a patient.  It is only now as I prepare for a lecture on patient safety management to be held on February 12, 2015 that I come to realize that these goals are quality and safety goals.  One can see the quality and safety components if I restate the goals as such: resolution of the patient’s health problem (quality) in such a way that the does not end up dead (safety), with disability (safety), with complication (safety) and in such a manner that the patient is satisfied (quality) and there is no medicolegal suit (quality).

In 1999, when I started my journey in hospital quality management system, my practice had been to have “safety” subsumed by the goal of quality service and patient care without spelling it out.  It was only in 2010 when I was made aware by the assessors from Accreditation Canada International surveying Manila Doctors Hospital of the importance to have the “safety” goal spelled out.

So, what is the difference between quality and safety? Should the quality and safety goals be independent of each other?

Quality vs Safety (Agency for Healthcare Research and Quality)

Below is an excerpt from an article that gives a backgrounder on the evolution of safety from quality and attempts to differentiate the two. (Emmanuel L: What exactly is patient safety?  Ahrq.gov 2008)

“Part of the challenge lies in distinguishing safety from quality, a line that remains important to some, while being dismissed by others as an exercise in semantics. In 1998, the IOM convened the National Roundtable on Health Care Quality, which adopted the following definition of quality that was widely accepted: “Quality of care is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” (Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 1998; 280: 1000-1005.)  

Health care quality problems were classified into three categories: underuse, overuse, and misuse, all of which the evidence shows are common. Misuse was further defined as the preventable complications of treatment. Although the IOM Roundtable was careful to distinguish misuse from error (the latter may or may not cause complications), the misuse category became a common reference point for conceptualizing patient safety as a component of quality.

In 2006, Leape and Berwick observed that, as attention to patient safety has deepened, the lines between the overuse, underuse, and misuse categories have blurred. “It seems logical,” they wrote, “that patients who fail to receive needed treatments, or who are subjected to the risks of unneeded care, are also placed at risk for injury every bit as objectionable as direct harm from a surgical mishap.” (Leape LL, Berwick DM. Five years after “To Err Is Human.” What have we learned? JAMA 2005; 293: 2384-2390.)   

The National Patient Safety Foundation identified the key property of safety as emerging from the proper interaction of components of the health care system, thereby leading the way to a defined focus for patient safety, namely systems. (Cooper JB, Gaba DM, Liang B, et al. The National Patient Safety Foundation agenda for research and development in patient safety. Med Gen Med 2000; 2: E38.)  

Its goal has been defined as: “[t]he avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the process of care.” (Vincent C. Patient safety. London: Elsevier; 2006.)

Quality vs Safety; Quality and Safety (Accreditation Canada International)

Quality is “the degree of excellence; the extent to which an organization meets clients needs and exceeds their expectations”. Key attributes of high quality healthcare systems, as defined by the Institute of Medicine (U.S.) include safety, timeliness, effectiveness, efficiency, equity and patient centeredness.

Patient safety is often considered a component of quality, thus, practices to improve patient safety improve the overall quality of care.

Quality vs Safety; Quality and Safety (Joint Commission International)

Quality and safety are inextricably linked. Quality in health care is the degree to which its processes and results meet or exceed the needs and desires of the people it serves.  Those needs and desires include safety.

The Institute of Medicine defines quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Patient safety emerges as a central aim of quality. Patient safety, as defined by the World Health Organization, is the prevention of errors and adverse effects to patients that are associated with health care.  Safety is what patients, families, staff and the public expect. While patient safety events may not be completely eliminated, harm to patients can be reduced, and the goal is always zero harm.

The ultimate goals are quality of care and patient safety.

ROJoson’s Summary Statements: There is a difference between quality and safe patient care.  Safety is within the quality dimension.  It is recommended for the safety goals to be extracted from the quality goals for emphasis reason.  However, the ultimate goals should still be an alignment and integration of quality and safety in patient care.

ROJ-TPOR@15feb12


A Repost.


ROJ@17nov30

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Quality health care services revisited – ROJoson – 17nov30

Quality in health care services where quality is defined with the following parameters: accessible, timely, rational, cost-effective, cost-efficient, and safe medical care, whether in the hospital, clinic or any health care institution.  Ultimate parameter: excellent patient experience.

ROJoson – November 30, 2017



Quality vs Safety

It is said that there is a difference between quality and safe patient care.  Safety is within the quality dimension.  It is recommended for the safety goals to be extracted from the quality goals for emphasis reason.  However, the ultimate goals should still be an alignment and integration of quality and safety in patient care.

Quality vs Safety; Quality and Safety (Accreditation Canada International)

Quality is “the degree of excellence; the extent to which an organization meets clients needs and exceeds their expectations”. Key attributes of high quality healthcare systems, as defined by the Institute of Medicine (U.S.) include safety, timeliness, effectiveness, efficiency, equity and patient centeredness.

Patient safety is often considered a component of quality, thus, practices to improve patient safety improve the overall quality of care.

Quality vs Safety; Quality and Safety (Joint Commission International)

Quality and safety are inextricably linked. Quality in health care is the degree to which its processes and results meet or exceed the needs and desires of the people it serves.  Those needs and desires include safety.

The Institute of Medicine defines quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Patient safety emerges as a central aim of quality. Patient safety, as defined by the World Health Organization, is the prevention of errors and adverse effects to patients that are associated with health care.  Safety is what patients, families, staff and the public expect. While patient safety events may not be completely eliminated, harm to patients can be reduced, and the goal is always zero harm.

The ultimate goals are quality of care and patient safety.

 


ROJ@17nov30

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ROJoson Medical Clinic Booked Appointment Performance Report – November 2017

Booked Appointment Performance – November 2017

Target: No patient will have a waiting time for more than 60 minutes from booked appointment time.

Only two (2) patients waited for more than 60 minutes from booked appointment time (62 and 68 minutes). This was due to long consultation time and late arrival of booked patients of some patients that destroyed the flow.   [Year-to-date figures: 12 waited for more than 60 minutes from booked appointment from January to November 2017]

The range was 0-68 minutes with a mean of 12 minutes.

There was totally zero waiting time in one out of the 11 clinic sessions.

NO late in coming to clinic by ROJoson.  

Have to keep on reminding patients on lates and no-shows.

November 2017 Late No-show Range and Mean Waiting Time (From Booked Appt Time) Mean Waiting Time
2 0 0 0-5 3
4 0 0 0-32 11
7 0 0 0-62 28
9 2 2 0-6 2
11 5 1 0 0
16 3 1 0-33 12
18 3 0 0-26 5
21 5 0 0-68 47
23 2 3 0-25 4
25 4 0 0-25 6
28 5 3 0-43 8
  29 10 0-68 12

ROJ@17nov28

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Differences between patient satisfaction and patient experience

 

patient_experience_satisfaction_comparison

 

The trend is towards patient experience survey.

 

23795772_10154874286555800_5454281257854405985_n

 

patient_satisfaction_pitfall



ROJ@17nov26

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