Evaluation of discharge process of insurance versus paying category of patients in a hospital

Back ground: The discharge of patients in the hospital starts from the clearance given by the treating doctors during their rounds and the final step is the patient leaving the hospital. The discharge of Dr NTR VSP patients, being under the Insurance scheme of the government, should follow guidelines of documentation, information and approvals in the system which leads to delays when compared to payment category of patients. This leads not only to dissatisfaction among patients and attendees but also has impact on costs of stay, treatment costs and other overheads. There is a need to identify the factors responsible for bottlenecks and suggest measures for improvised patient care and patient satisfaction and at the same time reduce costs to the hospital and patient.
Methods: A pilot study is conducted to identify the sequence of activities in the VSP and paying patients’ discharges. Focussed group discussions are done with VSP staff & Nurses and opinion surveys taken to analyse the reasons responsible for delays by ranking the reasons in order. Retrospective study of statistics for number of discharges and prospective study to confirm and compare steps between VSP and paying procedures and identify bottle necks and measures to reduce delays.
Results: The VSP discharge process has more steps in discharge process when compared to paying discharge process due to the need to follow insurance guidelines as per the MOUs. The documentation and evidences need to be recorded in the case sheet as well as in the Aarogyasri trust online as compared to the simple and direct steps for paying type of discharges.Opinion of staff nurses on paying mode of discharge. Ranking in order top three reasons are 1. Finalisation of discharge summary by the doctor. 2. Patient and their attendees waiting or making arrangements for transport to leave the hospital 3. Finalisation of the bill by billing section
The opinion of staff nurses on insurance process revealed and Ranking order top three reasons are 1. Finalisation of Discharge by the doctor 2. Verification of case sheet By VSP staff 3. Indenting and procurement of medicines The opinion of insurance staff on insurance discharge: Ranking in order top three reasons are 1. Handing over of the case sheet from ward to insurance office 2. Case sheet received by ins top three reasons are ce office and Finalisation of discharge summary by the doctor 3. Shifting of patient from ward for mithra photo.
Conclusions: The discharges should be planned in advance and should utilise the data available in the system since admission starting from demographic data, investigations, progress notes, treatment advised, operation notes etc, which are tracked and documented in the case sheet at every service level during the stay in the hospital. Coordinator and floor in charges along with cooperation of Nursing and Billing can reduce delays and for patient satisfaction