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(NAR) VOL. 22 NO. 1, JANUARY - MARCH 2011
[ PHIC PHILHEALTH CIRCULAR NO. 33, S. 2010, December 06, 2010 ]
GUIDELINES FOR THE PERFORMANCE MONITORING OF HOSPITALS BASED ON THE PHILHEALTH BENCHBOOK ACCREDITATION STANDARDS
RATIONALE
Pursuant to Republic Act 7875, as amended by Republic Act 9241, Article 1, Section 2, Item p, A Guiding principle of the National Health Insurance Program is Quality of Services wherein the program shall promote the improvement in the quality of health services provided through the institutionalization of programs of quality assurance at all levels of the health delivery system.
In consonance to the foregoing, Philhealth implemented the Benchbook as the new accreditation standards through Board Resolution No. 453, s. 2002, which evolved into the present ‘“Benchbook on Performance Improvement of Health Services”. With the implementation of the Benchbook accreditation standards for hospitals by virtue of PhilHealth Circular No. 50 s. 2009, Guidelines for Accreditation of Hospitals Using the Benchbook Standards, New Application Form, Checklist and Warranties of Accreditation of IHCPS and Hospital Self-Assessment Tool, PhilHealth needs to ascertain that accredited hospitals continue to demonstrate compliance to quality standards.
In line with this, PhilHealth shall conduct monitoring activities on accredited hospitals in accordance with the Benchbook standards to ensure improvement in the hospitals’ level of performance.
GUIDELINES ON PERFORMANCE MONITORING OF HOSPITALS
I. POST-ACCREDITATION/MONITORING SURVEY
a. PhilHealth shall conduct post-accreditation or monitoring survey to determine continued compliance of hospitals to the Benchbook accreditation standards.
b. Monitoring shall focus on compliance to Benchbook indicators in the performance areas that are applicable to their current accreditation award, as defined in PHIC Circular No. 50 s. 2009.
c. The required compliance rate for the core indicators and for the performance areas applicable to the accreditation award shall be the same as those set in PHIC Circular No. 50 s. 2009.
II. CONDUCT OF MONITORING SURVEY
a. Centers of Safety shall be monitored only if deemed necessary by the PhilHealth Regional Office (PhRO) or the Central Office based on but not limited to the following:
b. Centers of Quality and Centers of Excellence during the validity period of accreditation, shall be monitored at least once, beginning on the second year of the validity period, unless there are conditions that warrant additional monitoring visits, such as those mentioned above.
c. The monitoring survey team shall be composed of at least two (2) surveyors with a physician as team leader, and which shall not necessarily be the same team that con- ducted the pre-accreditation survey.
d. The monitoring team shall provide feedback on their findings and recommendations to the hospital leadership through exit conference that shall be conducted at the conclusion of the monitoring survey. The team shall furnish the hospital with a copy of the monitoring findings.
III. UTILIZATION OF MONITORING FINDINGS
a. There shall be no downgrading or upgrading of existing accreditation award as a result of monitoring findings.
b. Monitoring survey results however, shall be used as one of the references during the deliberation of the hospital’s application for renewal of accreditation or re-accreditation.
c. Non-compliance to any of the Benchbook indicators or obtaining a compliance rate or performance area score below that of the pre-accreditation survey score shall not constitute an offense under PHIC Circular 10 s. 2008. Said result shall however render the hospital/facility qualified to apply only for an award lower than their current award upon renewal of accreditation. Centers of Safety shall remain qualified to apply only for the same award for the next renewal period.
All existing policies, orders and other issuances that are inconsistent with this Circular are hereby repealed and/or amended accordingly.
This Circular shall take effect beginning January 2011.
Adopted: 06 December 2010
(SGD.) DR. REY B. AQUINO
President and CEO
Pursuant to Republic Act 7875, as amended by Republic Act 9241, Article 1, Section 2, Item p, A Guiding principle of the National Health Insurance Program is Quality of Services wherein the program shall promote the improvement in the quality of health services provided through the institutionalization of programs of quality assurance at all levels of the health delivery system.
In consonance to the foregoing, Philhealth implemented the Benchbook as the new accreditation standards through Board Resolution No. 453, s. 2002, which evolved into the present ‘“Benchbook on Performance Improvement of Health Services”. With the implementation of the Benchbook accreditation standards for hospitals by virtue of PhilHealth Circular No. 50 s. 2009, Guidelines for Accreditation of Hospitals Using the Benchbook Standards, New Application Form, Checklist and Warranties of Accreditation of IHCPS and Hospital Self-Assessment Tool, PhilHealth needs to ascertain that accredited hospitals continue to demonstrate compliance to quality standards.
In line with this, PhilHealth shall conduct monitoring activities on accredited hospitals in accordance with the Benchbook standards to ensure improvement in the hospitals’ level of performance.
I. POST-ACCREDITATION/MONITORING SURVEY
a. PhilHealth shall conduct post-accreditation or monitoring survey to determine continued compliance of hospitals to the Benchbook accreditation standards.
b. Monitoring shall focus on compliance to Benchbook indicators in the performance areas that are applicable to their current accreditation award, as defined in PHIC Circular No. 50 s. 2009.
c. The required compliance rate for the core indicators and for the performance areas applicable to the accreditation award shall be the same as those set in PHIC Circular No. 50 s. 2009.
a. Centers of Safety shall be monitored only if deemed necessary by the PhilHealth Regional Office (PhRO) or the Central Office based on but not limited to the following:
- Pre-accreditation survey results;
- Member/ patient complaints;
- Any other situation that may have resulted from or may result to poor quality of care.
b. Centers of Quality and Centers of Excellence during the validity period of accreditation, shall be monitored at least once, beginning on the second year of the validity period, unless there are conditions that warrant additional monitoring visits, such as those mentioned above.
c. The monitoring survey team shall be composed of at least two (2) surveyors with a physician as team leader, and which shall not necessarily be the same team that con- ducted the pre-accreditation survey.
d. The monitoring team shall provide feedback on their findings and recommendations to the hospital leadership through exit conference that shall be conducted at the conclusion of the monitoring survey. The team shall furnish the hospital with a copy of the monitoring findings.
a. There shall be no downgrading or upgrading of existing accreditation award as a result of monitoring findings.
b. Monitoring survey results however, shall be used as one of the references during the deliberation of the hospital’s application for renewal of accreditation or re-accreditation.
c. Non-compliance to any of the Benchbook indicators or obtaining a compliance rate or performance area score below that of the pre-accreditation survey score shall not constitute an offense under PHIC Circular 10 s. 2008. Said result shall however render the hospital/facility qualified to apply only for an award lower than their current award upon renewal of accreditation. Centers of Safety shall remain qualified to apply only for the same award for the next renewal period.
All existing policies, orders and other issuances that are inconsistent with this Circular are hereby repealed and/or amended accordingly.
This Circular shall take effect beginning January 2011.
Adopted: 06 December 2010
President and CEO