Kolkata: The Association of Hospitals of Eastern India (AHEI) has asked CM Suvendu Adhikari to allow Tier 1 rates for Ayushman Bharat in Bengal. The state has been allotted Tier 3 rates that are significantly lower than the two higher tiers and may not be sustainable for hospitals, the latter feared. Hospitals had raised objections about Swasthya Sathi rates with the former state govt and many had started refusing to admit patients under the scheme. It now has very limited acceptance at hospitals.According to health department sources, the state govt is considering Tier 2 rates for Bengal. The Ayushman Bharat classification for cities lists Kolkata under Tier 1, but the rates sanctioned for the city are those of Tier 3.“Unless the rates are viable, the same could happen with Ayushman Bharat and MMSBY. We don’t want that to happen. So, we have approached the CM and asked him to allot Tier 1 rates for Bengal and Kolkata. Delhi has Tier 1 rates, so Kolkata should have it, too,” said Rupak Barua, CEO of Woodlands Hospital and president of the AHEI.Bengal has been placed in Tier 3 which includes smaller towns/rural/district-level areas. These areas receive the standard base package rates, often baseline or up to 75%–80% of Tier 1 rates. The latter are supposed to have lower overhead and facility operational costs.The base rate for any surgical procedure or medical treatment under PM-JAY (Ayushman Bharat) is defined by the standard package. However, hospitals receive a percentage adjustment (incentive or adjustment multiplier) on top of or relative to these base rates based on their tier:Hospitals in Tier 1 cities receive the highest reimbursement rates (typically 100% of the base rate, plus additional city-based top-ups or incentives ranging from 10% to 15% for high-cost metro living). High real estate, staffing and administrative overheads in major metropolitan hubs are the reasons behind this.Package rates in Tier 2 cities are typically adjusted to around 85%–90% of Tier 1 rates. The reason for the relatively lower rates is moderate operational and real estate costs, serving as regional medical hubs.On top of tier rates, hospitals can earn additional percentage add-ons (5% to 15%) for being NABH-accredited, acting as teaching/medical colleges or being located in aspirational districts. “The CM has assured us that he would look into this after the schemes are flagged off,” said Barua.Ayushman Bharat packages for Tier 3 cities are low and payments are irregular, said a hospital head. “To make these schemes widely accepted and beneficial to patients, Tier 1 rates are essential. Without it, the scheme will fizzle out along with Mukhyamantri Swasthya Bima Yojana, if the latter replicates the Swasthya Sathi rates,” he said.“We expect a gradual promotion to Tier 2 as the scheme takes off. But the city deserves to be in the highest category. The difference in rates is significant and could turn out to be crucial in deciding the sustainability of Ayushman,” said Peerless Hospital CEO Sudipta Mitra.
