Comunicados de Prensa

Buscan salidas a “gravísima situación” frente a la prestación de servicios de salud en Norte de Santander

Encuentro EPS y ESES 2

Ante Gerentes de EPS, ESES e IPS de la red privada, el Gobernador de Norte de Santander, el Director del Instituto Departamental de Salud y la Red de Controladores presentaron el balance de acciones adelantadas para llamar la atención ante el nivel nacional y garantizar calidad y oportunidad en la atención en salud de la población en régimen contributivo y subsidiado.

 En lo corrido del año, el Instituto Departamental de Salud ha realizado seguimiento a las 269 IPS habilitadas en el departamento, 24 de objeto social diferente, 773 profesionales independientes y 9 de transporte especial de la mano de la Superintendencia Nacional de Salud en cumplimiento de la Resolución 2003 de 2014.

 También se adelantó un ciclo de encuentros con las 11 EPS y su red prestadora para identificar deuda y establecer estrategias que garanticen la prestación de los servicios de salud a 411.137 personas en régimen contributivo, 908.562 en régimen subsidiado y 26.857 en régimen de excepción, en una región que ha alcanzado un aseguramiento del 98.45%, mientras la Población Pobre No Asegurada es atendida por el nivel departamental.

 Esta situación ha sido analizada con la Red de Controladores que agrupa entidades, organismos y agentes responsables de la vigilancia, inspección y control de los actores del Sistema General de Seguridad Social en Salud, lideradas por la Contraloría General del Departamento y la Procuraduría Regional, estableciendo mecanismos de coordinación, cooperación, concertación, con una participación activa de la comunidad.

Una radiografía de la región.

 A 30 de junio, la deuda reportada por las IPS de la red pública y privada al Sistema General de Información a la Protección Social SISPRO asciende a 1.3 billones de pesos, mientras la admitida por las EPS llega a 492 millones, haciendo necesaria la depuración y conciliación a partir del cruce de facturación y glosas, situación que fue analizada en tres mesas de conciliación de cartera.  En la III Mesa realizada en agosto participaron 73 entidades (Entre IPS privadas y ESES, EPS contributivas y subsidiadas), logrando 190 compromisos para depuración de cartera y 41 compromisos de pago por 4.620 millones.

Adicionalmente se han realizado ejercicios de revisión al cumplimiento en la prestación de servicios de salud en régimen subsidiado con la participación de las EPS Ecoopsos, Nueva EPS, Cafesalud, Saludvida, Coosalud, Comfanortee y Comparta y las IPS que conforman su red prestadora recordando que la referencia y contrareferencia es obligación de las EPS, quienes deberán disponer de red suficiente en todos los niveles de complejidad, garantizando recursos humanos, físicos o tecnológicos, insumos y medicamentos requeridos para la atención de los pacientes, como lo establece el Decreto 4747 de 2007. Actividades en la que la Defensoría del Pueblo regional Norte de Santander, Secretaría de Salud de Cúcuta, ESE Imsalud y Centro Regulador de Urgencias y Emergencias CRUE analizaron la situación evidenciada en cada caso.

157 visitas de inspección, vigilancia y control de las cuales 115 fueron certificadas y 45 corresponden a investigaciones administrativas sin que se hayan presentado cierres, con un recaudo por sanciones derivadas de incumplimiento en condiciones de habilitación 530 millones de los cuales 234 millones corresponden a 2014, 247 a 2015 y 48 millones a 2016.

Este año, 15 Prestadores de servicios de salud cuentan con medida preventiva que conlleva a clausura temporal de la institución y suspensión de servicios de salud total o parcial y 27 Prestadores en investigación administrativa por Queja.

La situación evidenciada llevó a la Superintendencia Nacional de Salud a instalar dos oficinas para seguimiento, una Cúcuta y una en Ocaña y durante el fin de semana emitió la Circular externa 013 de 2016, entregando instrucciones a los prestadores de servicios de salud para frenar el cese de servicio a afiliados a EPS con cartera superior a 360 días, según la cuál “Las entidades vigiladas NO podrán implementar estrategias de cierre de servicios de las IPS como mecanismo para exigir el pago de las obligaciones a cargo de sus aseguradores ni utilizar otras medidas administrativas que limiten el acceso de los usuarios al servicio”.

El cierre y posterior apertura de frontera llevó las IPS a asumir la atención de población proveniente de Venezuela sin que existan recursos adicionales.  La ESE HUEM reporta la atención de 1.324 personas con 1.110 millones facturados en los últimos meses, en IMSALUD 1.025 personas fueron atendidas con 24 millones facturados, 71 en Medical Duarte, 18 en IPS Unipamplona y 13 en Clínica Norte con 3 millones facturados.

Los gerentes han propuesto al nivel nacional la asignación de recursos nacionales y autorizaciones para traslados a entidades de otros departamentos para evitar el colapso de la red de atención.  Las medidas especiales previstas incluyen la expedición de un decreto que retome el listado censal facilitando la atención de colombianos procedentes de Venezuela como población pobre no asegurada PPNA a cargo del IDS como réplica del ejercicio realizado en 2015 y mecanismos de afiliación oficiosa para garantizar el ingreso al Sistema General de Seguridad Social en Salud.

JUAN ALBERTO BITAR MEJIA

Director

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