ECHS Points for Meeting with AG 14 Feb 2012
1. Cashless Facility CGHS irrespective of card city registration at any City
Ref- circular of CGHS Sl:NOs 6 and 12 (Abridged E Mail received by IESM ECHS Division).
Yesterday at Gangenahalli CMO-In-Charge, I got the following clarification:
Now CGHS has got Rs. 70 crores revolving fund with UTI bank. ITSL processes the bills and get the claim from UTI within 15 days. Recoupment process is continuous. So any CGHS card holder can avail CGHS OPD, IP and Diagnostic tests from any CGHS dispensary, irrespective of where the card is registered. On visit to another city, it is always better to know the referral hospitals of that CGHS city either from Website or from that local dispensary. On emergency, any referral hospital will provide cashless facility in any city in referral hospitals or if not emergency from local nearest dispensary you can get referred. If admitted in non-referral hospitals on emergency, you can, intimate the nearest CGHS
2. NA Medicines.
a. CGHS processes allow for patients purchasing medicines and being reimbursed the bill amount. The same is allowed in ECHS for Cancer drugs but not for other NA medicine.
b. Process for collecting NA medicine once they are available needs IT upgrades so the patient does not need to go through the entire wait register wait prescribe wait cycle.
3. IT Refinement for Quicker dispensation of Medicine.
Software may be refined to indicate a separate series for up to 5 medicines so affected patients line up separately and don’t need to wait.
4. On Discharge from Hospital, Medicines Prescribed should be given to Patient by Hospital. Frequently the medicines prescribed by doctors on discharge summary are not available at ECHS polyclinic. These should be handed over to patient for required duration not exceeding one month, to cater for provisioning processes, without the patient needing to switch or buy. In case the suggestion at para 2 above is implemented, then this problem would be partially overcome.
5. Repair and availability of Equipment. The X’ray machine at Noida polyclinic is unserviceable for quite some time. It is informally understood that repairs have not progressed expeditiously due to funds not being available/ sanctioned. May please be expedited.
6. Staff Salary. The ECHS staff being paid through AG Welfare funds has not received any increment consequent to the 6 CPC enhancements to other staff.
Points from Veterans
7. List of empaneled Hospitals should be updated on a continual basis and be easily accessible to all, even if on payment, if in a printed form. It must feature on the ECHS website also.
8. Polyclinic Organization and Accounting System.
a. OIC ECHS should be a MO ex AMC, preferably someone who has held the portfolio of registrar of a MH. A MO as OIC could also help the MO ECHS in case of overload of patients.
b. Demand of drugs by their generic names should be prepared and forwarded by the MO ECHS and should be countersigned by a MO from the MH who is nominated to do the same by the OC MH.
c. Besides ECHS pharmacy, medicines should also be issued through reputed chemists empanelled from various parts of a city to obviate the need to make long trips and stand in queue for long time when a single nursing person issues long list of medicines, and most importantly some medicines are not available and repeat trip is necessitated.
d. Speedy procurement is possible if the procedure is implemented in spirit, not in letter. In AHMEDABAD, the city's most reputed chain Chemist Store ...PLANET HEALTH, gives 13-15 % discount to regular customers. Similar purchase is being done in 45-days lead time, at a discount of 8.8 % by ECHS.
e. All bills of affiliated hospitals should be scrutinized by the MO/ senior MO of the Clinic and countersigned by the OC MH. If there is any doubt on excessive billing, the same should be forwarded to the concerned specialist of MH for his opinion and action taken on his recommendations. I have come across cases where the OIC just felt that a bill was excessive and cancelled charges for the same without knowing whether the procedures were actually necessary procedures.
f. All outstanding bills of affiliated hospitals should be cleared expeditiously under a limited time frame. Delay of payments should be investigated if beyond the prescribed time limit.
9. Reimbursement Claims.
a. When a veteran receives treatment at an ECHS approved hospital on cash reimbursement basis, and the amount of reimbursement received is much less that the amount claimed (sometimes as much as only 50-55%), he should be provided some outline reasons for the amount dis-allowed, even if in outline form.
b. Non acceptance of the entire claim or inordinate delay in its passage, causes tremendous strain on the family especially when the patient has died in spite of the urgent and emergency treatment afforded in the hospital. Interim, reply regarding the cause of delay in the passage of the claim. In case there are technical aspects regarding the treatment carried out by the hospital and its efficacy, the family of the dead patient is not in a position to answer the query and if the claim is kept pending due to perception of sanctioning authority and that of the treating doctor, the patient/ the family should not be made to suffer. The defaulter hospital could even be removed from our empanelment in case of grave errors. Part payment of the claim and balance settled after resolving the issue could be considered in the interest of the patient/ family. (Case in Point- Hospitalization Claim by widow of Late Col. KMV Gopalan Arty dated10 Nov 2010 who died in Malar Hospital Chennai(Non Empaneled)on30 Oct 2010. Claim documents not yet sanctioned. No reply received from ECHS).
10. Issue of drugs by ECHS polyclinics should be on a three monthly basis for those Veterans who have to take specific drugs throughout their lives. For such users, some long term-use medicines, the brand that has stabilised the condition must not be interfered with. The ECHS is buying different brands at different times and even of different dosage and issuing the same. The local ECHS gives 150Mg , COATED ASPIRIN TABLET , and advises to use half at a time ,to patients who need 75 Mg. THIS IS UNDESIRBLE and Logistically difficult to handle.
11. Veterans on specific brands of medicines on long term basis to stabilise a medical condition should be provided the same. If need be charge them the difference or better still pay cash in-lieu of the value of procurement price of approved medicine. It will save procurement, storage, issue and record keeping costs to the govt.
12. Under the LOWEST TENDER Scheme, substandard medicines are being procured , saying that DRUG CONTROLLER OF INDIA HAS APPROVED SUCH MEDICINES. Non-descript, small companies are pushing their medicines, efficacy of which will be tested on veteran-Guinea-pigs after years of use. UNSTABLE MOLECULES ARE OFTEN PURCHASED.
13. ECHS Polyclinic Ahmedabad
a. Located near the Airport- over 20 Kilometers from City Centre, it is not linked with any public transport system - making it extremely in-convenient to use. Trip to ECHS >> MH >>> EMPANELLED DOCTOR in city>> back to ECHS-WAIT FOR 45 DAYS FOR MEDICINE PROCUREMENT >>>Back to ECHS TO FIND SUPPLY WILL COME AFTER SEVEN DAYS >>BACK HOME ...>>.BACK TO ECHS ............can get frustrating. Location of the ECHS should be changed to within the main city. This will help even out-station veterans from nearby villages. Alternatively, a sub-ECHS be located in the city for referral and issue of medicines, on part-time basis. Space can be got from the Soldier Sailor Board, which has been given a big piece of land by the State Govt.
b. Recruitment of AMA's (AUTHORISED MEDICAL ATTENDANTS ) , as is resorted to by CGHS, to recruit Doctors in different city areas to attend to the needs of civilians, should be resorted to by us also.
c. The ECHS Doctor is retired old man who has no zest and initiative left in him. He looks to obeying Soldier i/c to keep his job intact. The ECHS is so deserted that you can catch the Doctor doing CROSS WORD in his chamber! Effective Doctors must be recruited.
d. There are NO good Hospitals willing to get empanelled due the procedures and low rates offered by comparing them with sub-standard doctors / hospitals on LOWEST TENDER basis. Clearance of their bills is delayed, for reasons best known to ECHS.
e. OIC ECHS from non-medical profession is the cause of many problems. In his need to make a mark for his existence, his adherence to rules is ...IMPLICIT OBEDIENCE OF THE LETTER AND NOT FOR GUIDANCE OF THE WISE, as one would like it to be.
f. Transport support is totally absent. Outside ECHS Ahmedabad, you can see veterans seeking lift for Cantt /MH. This must be improved.
g. INVOLVEMENT AND REFERRAL TO MH SHOULD BE DONE AWAY WITH. I have seen weeping patients waiting in queues at ECHS and then for hours at the MH, and thereafter lugging themselves to empanelled Doctor in the city 20 Kms away or to APOLLO HOSPITAL, the favourite recommended hospital of the ECHS , which is 25- Kms away from city ! !
a. All medicines are not available at polyclinic, Chandimandir. Normally two prescriptions are made for monthly medicines, one for issue of medicines at polyclinic and the other for those medicines which are not available at polyclinic and prescription has to be taken to the command hospital ECHS dispensary. It is common that a veteran has to visit four to five persons to get monthly medicines. This chain needs to be shortened when one see very old persons almost walking at a snail pace from one counter to another.
b. CT medicines should be given for three months for chronic ailments as against monthly as at present.
15. Preparation of referral form is also cumbersome. A specialist writes for an investigation through ECHS. Patient comes to echs, goes to oic for his initials before the counter will accept specialist direction for making of a referral. Third, you go to a counter where then the referral will be made. Fourth, you get it recorded at the other counter. Fifthly, you take that to the doctor who will write the "brief clinic note" and sign. Sixthly, take the referral to OIC Polyclinic again who will complete column referred to, sign, stamp and give you the original. Lastly, go to the counter to take the visiting card of the centre/hosp. Some steps could be cut down. I did speak to the OIC Polyclinic but there is no dearth of red tapism in the army. A SOP on the subject should be issued by MD, ECHS for all polyclinics. It must be appreciated at each step, one has to wait for ones turn, as i am told that more than 70 referral papers are made on each day.
16. Lodhi Road Polyclinic
a. Insists on providing CT medications for a max of 30 days at a time. I believe this is against the declared policy of 60 days; and causes avoidable logistics problems.
b. Once medicines are prescribed by the MO who sees the availability on his computer I go to the pharmacy to collect it against a computer printout at the dispensing window. The compounder tells me so and so medicine (tho' on his printed list) is not available and makes an ink notation. How do I know he is telling me the truth? If a medicine is NA the printout should state NOT AVAILABLE. Alternately I should get a supplementary computer printout slip stating: Following medicines not issued being out of stock. And on that basis I should be able to collect it from AFC or AH or RR or anywhere else.
c. Pharmacy staff at Lodhi Road Polyclinic needs to be augmented. Despite their best efforts, the two dispensing windows are woefully inadequate. The waiting time for collecting medicines is twice the waiting time to see the doctor!!!
d. The common car park on LHS as you enter the gate needs to be made into a hard well before the rains set in. Perhaps this is the station commander’s parish.
e. A good word too: The reception staff at Lodhi Road is good - polite and helpful. Talked to Col Manchanda when we were both taking in the sun during the lunch break. came across as a helpful and positive individual.
f. During winters the polyclinic opens at 0830. Patients, some of them serious and from far distances, arrive as early as 0700hrs. Since the lounge remains locked and patients allowed at only 0830hrs they have to wait outside in the shivering cold. So is the case during summer heat. It is suggested that some staff must arrive early so that the lounge is ready and opened at least one hour before the registration time both during winters and summers.
17. Base Hospital Delhi Cantt
a. Polyclinic has dependency overload. Patients have to wait for up to five hours! Since there are only two dental chairs, only 35 + 35 patients are registered for any one day and others have to revisit the following day. One more dental chair needs to be added.
b. Poor sitting arrangements considering the load factor.
c. Chaotic situation in the reception area. A better system needs to be evolved.
d. Unhygienic toilets. Basically we need a system where people should not be made to feel that a favor is being done to them. Dignity is a must.
18. HINDON Veterans dependent on satellite locations like this polyclinic are required to go to polyclinic at Base Hosp Delhi Cantt a distance of 35 kms, It takes 3 hrs due traffic. Infact it takes 3 days( 1day at Hindon,1 day at Base,3rd day to see a doc in NCR.)!! .Hindon polyclinic should be authorized to give referral to all hospitals in NCR as in case of polyclinics in NOIDA,GURGAON.( Lt Gen Jain’s Point- Senior disabled veteran 9717337056)
19. For the last two years plus the ESM Community at Bangalore had been requesting for an ASSISTED HOME, located adjacent to the Command Hospital, be set up as a welfare measure linked with the ECHS. A detailed project with a request for authorization of land use, was submitted to the RM as well the services' HQs, copied to the MD, ECHS quite some months ago. Progress?? Establishing this facility, the only one in southern region, would be of immense help to the otherwise helpless veterans within the community. Needless to say this should not be compared to, or linked in any way, to any of the experiments being carried out at Delhi, or near about, as the environmental / infrastructural / societal dispositions are totally different.
20. Nerul, Navi Mumbai Polyclinc
a. Has chronic shortage of medicines, particularly costlier ones like anti-hypertension, statins for cholesterol treatment, Osteophos, Calcidroletc etc. NA for months together. Local authorities from ECHS Clinic complain that they are helpless as their demand for supply of additional quantity are rejected. They advise us to go to INHS Ashvini- 40 kms from Nerul, to get NA medicines.
b. The general attitude is of typical Government clinic where the staff (except doctors) thinks that they are doing big favor. The waiting area is on the varandah adjoining footpath, in full view of the public walking on the road.
a. We should try to em-panel the CHETINADU HEALTH CITY HOSPITALS & THE Global Hospital. It is all the more important as the AWHO is coming up in OMR.
b. Facilities with regard to the Dental health are poor. Denture replacement and capping should be introduced due to the age of the veterans, and their kith and kin.
c. Proper medicines (mild) tablets should be given. eg mild medicines like ASTHALIN TABLETS 2Mg instead of DERIPHYLLIN. Similarly ASTHALLIN INHALLER is preferable , to AEROVENT which are not available at present in ECHS.
d. Ambulance services to be introduced for emergency cases/ re-imbursement to be made.
a. Facility of ECHS is good provided the MI room is near (in and around 10-15 KMs). For long treatments ECHS provides medicine for 10 or 15 days etc. Care taken is appreciable. ESM residing above 15 KMs face difficulties - just for fever, cough & cold to go there and to spend one day. Kindly think about the issue and consider extending medical services from nearby Defence MI rooms. The medicine issued to the ESM by service MI Rooms may be collected from ECHS. I am just writing this only for minor dressings for injuries, fever, cough and cold.
b. Coimbatore ECHS has been functioning very efficiently and I had no problem till last August, 2011. Whenever we needed referral to KG hospital, Coimbatore was given. This had a good satisfaction level with the ESM. In September 2011, we were told that KG hospital, Coimbatore is no longer empanelled and I was referred to Kongunadu hospital for myself and wife for HBA1c. The hospital is very dirty and no proper seating arrangements exist. Their systems were not proper. The final result was my HBA1c was found to be 8.3 and my wife's 9.0. I was shocked to see the result as we had good control over diabetes and our HBA1c were always under 6.9 on all the previous occasions. I rushed to KG hospital with in two days and got the HBA1c done for both of us in KG Hospital by paying their full amount. The result was my HBA1c was found to be 6.4 and my wife's 6.5. I complained this to OC, ECHS and I believe he did take up the matter. Outcome not known. I feel in the general interest of ECHS patients, I KG hospital may please be empanelled once again which will help for correct diagnosis and proper treatment of patients. This will in the long run reduce the expenditure incurred by ECHS on treatment of patients.
23. Pune Cantt.
a. Polyclinic has been relocated to present location a few years back. Since then a connected new building has been built and inaugurated about six months back. However, the services have not been shifted there, perhaps due to a lack of computer connections. The existing "Reception area" is extremely crowded with undulating ground (very difficult to walk through for the elderly patients). There is no separate waiting room for officers. The "Reception area" should be shifted to the new building and preferably one wing of the "Reception area" in the new building should be earmarked for officers
b. Although uniformed personnel are highly courteous to patients, the other staff is not courteous to the patients. They should be trained to be courteous
c. A number of specialists' services, where ECHS refers outpatients, actually do not have any services. Those agencies in turn send patients to other locations (sometimes two or three different locations) to obtain the indented services. It is suggested that ECHS should inspect and ensure that the "approved agency" actually has the capability and acceptable standard to provide the indented services, before approving them.
d. Present policy of ECHS is to issue medicines for only 30 days at a time. I understand that some members may have misused the facility of issuing medicines for longer durations, hence this policy. However, please understand that it is hard for elderly patients to travel often. Hence, their visits to relatives last for two to three months. The ECHS facilities may not be available at the places where they visit. I am sure a way could be found out to check the misuse as well as alleviate the difficulty. It is Suggested that the policy be revised to issue medicines up to 90 days for the above patients, with provisions of appropriate safeguards for checking the misuse. Incidentally this long term issue of CT medicine would not only avoid periodic visits by Veterans but also cut crowds at the ECHS Pharmacy counter. This practice is already being followed by CGHS.
24. Jammu & Kashmir (And Likely to be true of most remote areas)
a. In remote areas there is no doctor, medical specialist or Nursing Assitant coming inspite of repeated advertisements. To be specific, Poonch, Doda and Nagrota Gujroo are facing this problem.
b. Also, the new ECHS Polyclinics Type E authorized at Poonch and Khanabal still have not received their ambulance. Med equipment authorized for new Polyclinics has not yet been released. Lack of Additional staff required to be authorized like radiographer, data entry operator and pharmacist is impacting efficiency.
a. Once a referral is made to a civil hospital for anything by our doctor, thereafter for any tests needed by that hospitals, patient has to come back again and again to polyclinic (ECHS) to get additional referrals . This results not only in waste of time but lots of inconvenience to the patient also. It is understandable that financial implications are involved and free rope cannot be given to hospitals but some methodology needs to be worked out to reduce harassment of a patient.
b. No Suggestion/Complaints register is kept at OIC Office. There is drop box in which one can drop these but the keys are with station HQ and OIC states that he does not know anything, since these are not shared with him. Many problems can be resolved at his level only if he knew them.
c. No register is maintained for NA Medicines even though these are available with Base/RR Hospital. OCs standard answer is that if required one can go to Base hospital. If NA medicines are requisitioned these will automatically come to ECHS in next lot of medicine. NA Medicines are local purchased only for 10 Days and OIC states that one should purchase the balance from the market as his powers are Limited. I understand that ECHS Clinics in NCR have a Common budget which is changed as per a particular Clinic.
d. There is no register kept for person who cannot be seen by specialist. Registration is closed after 50 patients. Hence Load on ECHS Gurgaon is never known.
e. OIC Polyclinic should be dynamic person and his office Door should be always kept open. He should go out of his way to help Patients. He has been given telephone which he should use liberally to help resolve the problems of patients.
a. Most medicines are not available. The o i/c says he is helpless because of the changeover of administration of the clinic from Army Station HQ Trivandrum to INS Kattabomman, at Tirunelveli Dist.The medical officer of the clinic announces to the ECHS members that medicines are limited. Members have to purchase outside.This is a non-military station. There are only two empanelled hospital. Our ECHS members are suffering without medicine.
b. There is no specialist medical officer at the clinic for more than 2 years. The empanelled hospitals are exploiting this situation.
c. The empanelled hospitals are not interested to admit ECHS members because of abnormal delay in paying their bills.
d. The quality of treatment in the empanelled hospitals is very poor. These hospitals charge sometimes from the ECHS members according to the situation.
e. Even though our report dt.Jan 8, 2012 on ECHS polyclinic Tirunelveli is satisfactory, but now it is not so. Something wrong somewhere. Kindly take up the complaint with MD ECHS and set right the things.
27. Some ESM are bed- ridden & cannot go to ECHS. Can a system of House Calls by MOs of ECHS and/ or affiliated hospitals be worked out?. Sometimes, relatives take them directly to Hospitals as EMERGENCY cases even if not really needed. The Hospital admits them for few days .Eventually may prove economical!! Direct cash payment by ESM to visiting MO/ ECHS could be laid down to prevent gross misuse.
28. During Polyclinic off hours Veterans don’t have access to medical facilities of ECHS. A system of Off hours OPD needs to be evolved to cater to non-emergency medical conditions. Else patients may go to hospital who would admit JUST to cater to the financial considerations. As against what could have JUST been an OPD payment.
29. Local purchase procedure should be simplified. In Metros, the local purchased medicines should be available within a few days. Elderly patients get used to a particular brand of medicine. They should be provided the same, even if local purchase is required to be done and equivalent should not be forced on them.
30. All ECHS Polyclinics / Region Hq must have a WELL ADVERTISED e-mail ID where queries about availability of medicine/ specialist/ list of empanelled hospitals/ other difficulties can be conveyed. Routine, periodic referral of predetermined schedule of specialist procedure should be completed on Internet. After visit to specialist, Ahmedabad polyclinic wants veteran to report back to echs to hand over copy of specialist’s examination report. This should be acceptable to be done on internet
31. ECHS Website must be constantly updated for status of empaneled hospitals; Recent Orders etc, and provide hyperlinks to associated forms and telephone numbers.
32. Corruption needs to be checked. A sting op was planned at a leading Heart Hospital in Delhi to show how affiliated hospital bill clearance needs a bribe; the prime reason why most good hospitals have got themselves de-panelled with ECHS.
33. Also, one needs three teeth with RTC to qualify for three crown. In case one has only one RTC at a time (which is always the case), the officer needs to fend for himself. Unfair.