Experiences at Indraprastha Apollo Hospitals – I

Indraprastha Apollo Hospitals in New Delhi is our neighbour. Thus, one morning earlier this month, when my brother-in-law called urgently that my father was unwell, extremely lethargic, drowsy and a little disoriented, we decided to call an ambulance from Apollo and rushed him to the hospital.

In the Emergency room, we got prompt attention and we quickly determined that my father had low BP and his leucocytes counts were high indicating an infection. He was admitted in the hospital under Dr. Prasad Rao, who is a specialist in internal medicine. Dr. Rao turned out to be an articulate and soft-spoken man, who explained to me the plan of treatment (basically antibiotics) and said that he was hopeful of getting my father back home in the next 2-3 days. As expected my father made a swift recovery over the next couple of days and Dr. Rao discharged him from the hospital, the entire experience being on the whole quite satisfactory. Now this is what happened at the time of finalising the discharge.

As I went through the detailed itemised billing sheet, I noticed that we had been charged two nights of hospital stay, which was correct. However, under another head something called ‘Other Services’ we have been charged for a laryngoscopy, (which was actually done) and strangely another day’s bed charges. Since Laryngoscopy is a OPD procedure, I was baffled to see the additional bed charged buried under ‘Other Services’ and thought that it must have been a mistake. Enquiries with the billing clerk however revealed another story.

Indraprastha Apollo Hospitals I was informed now has a check-out time of 9 AM, which means that anybody being discharged after 9 AM in the morning has to pay the room rent for that day as well. Strangely everyone knows that in a hospital most discharges are planned after the admitting physicians take their morning rounds, which usually begin around 10 AM in the morning. Thus, it is just not possible for a patient to be discharged from the hospital before 9AM, and hence virtually everyone has to pay the additional charges. The Billing Manager, informed me that at least 130 out of the 150 discharges that happen everyday at the hospital, lead to irate patient attendants venting their anger on him. Clearly, this is a dodgy practice as the hospital knowing fully well that discharges can not be finalised before 9 AM, charges patients for an extra day.

In most hospitals the check-out time is 11-12 noon and the hospital management usually does not charge for a delay of an extra couple of hours as they clear the discharge formalities. The intent clearly is not to bill the patient and all efforts are made to finalize the discharges before the appointed hour. At Apollo, this is clearly not the case as the 9 AM check out rule is designed to bill the patient for an extra day, even when they know that their doctors will not be able to finalize the discharge summaries before 9 AM.

Complaint Redress Mechanism

When I asked the Billing Manager, about the process for lodging a complaint, I was told that I should speak with the GM for Resources Utilization, who refused to meet me saying that if I had a problem, I could write an email to him. When I insisted that I wish to lodge a formal complaint, I was directed to speak with Dr. Priyank, who turned out to be someone who worked in the office of the Managing Director of the hospital. Dr. Priyank too was far too busy to meet me and when I questioned him on this particular practice, he explained that this was all for the benefit of the patients, as it enhanced hospital efficiency!!!

As the word got around about my complaint, I received a message that Rajeev Bahl, GM Resource Utilization has now agreed to meet me. When I sought clarifications on this, he said that this was a new practice and that the hospital felt that this will encourage their doctors to finalize discharges faster. Basically, what he was saying was that since the hospital management is chary of asking its doctors to begin discharging their patients earlier, it would like the patients to put pressure on their doctors to do so. Strange to say the least.

Peculiarly, while the hospital authorities insisted that charging for the additional day was the right practice, they agreed to not charge the same to me now that I had protested. Thus, it seems if you protest and protest hard, the hospital moves quickly to placate you by waiving off the additional charges.

Indraprastha Apollo Hospital is a JCI accredited hospital and yet it seems that there is no formal complaints mechanism. In spite of my best efforts to lodge a formal, written complaint, there appeared no process for the same. Since no complaints gets lodged, the hospital would appear to be running faultless operations and the JCI accreditation can continue unabated.

Thus, in spite of having a reasonably satisfactory medical experience the hospital goofed up at the last leg. It spoilt my overall hospital experience and I came away wondering about the greed of the hospital (150 discharges per day at an average bed charges of Rs. 7500 makes a very tidy sum indeed), its ethics and its philosophy of ‘caring with a human touch’.

My experiences at the Indraprastha Apollo Hospitals

Apollo HospitalThe other day I landed at the Indraprastha Apollo Hospitals, a stone’s throw away from my residence in New Delhi.  My wife needed a test and our doctor at Max Healthcare asked us to get it done at Apollo as the equipment at Max was out of order. The moment I walked in I felt as if I was on a railway platform.  The hospital was full of patients as everybody appeared to be in a mad rush. In the OPD area, the ladies at the reception were busy, chatting amongst themselves, while patients and their caregivers waited for their attention. They wore no uniforms and for some strange reason, they were also collecting cash from the patients (apparently for the doctor’s consulting charges) and handing out receipts scribbled on small chits, which did not even have the hospital’s name on it.

Strangely, I was than directed to a cash counter to pay for the tests.   Continue reading

The Dilemma of Single Speciality Hospitals

DoctorA recent cover story in Business World highlights the growing influence of Single Speciality Hospitals (SSH) in India. I read the story carefully. First and foremost, I was delighted to see a cover on healthcare in Business World. It is not often that the business of healthcare gets prominence in a widely circulated and highly respected business weekly. That, BW decided to do this story is a testimony to the growing importance of the private healthcare sector, which is something to cheer about.

SSH’s make good business sense at least in some specialities. The investment required is low compared to a large Multi Speciality Hospital (MSH), funds can be accessed through PE firms and financial institutions, the hospital can be set up quickly and if one ropes in a well known medical luminary of that particular field, it is not too difficult to fill up the beds. Once the operations stabilise, one can consider franchising or expanding by setting up super specialised centres in large multi speciality hospitals. Specialities like Ophthalmology, Dentistry, Obs and Gynaecology (remember the neighbourhood mother and child centre) have always had Single Speciality Hospitals and clinics.  The trend is now towards large SSH for Oncology, Urology and even Day Care Surgeries.   Continue reading