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| What have three DRG paid reform pilot cities done over the past three months |
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| Author：中国铭铉 企划部 Release Time：2017-9-18 11:13:28 Number Browse：1050 |
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On June 2, 2017, the national health and family planning commission selected fujian sanming, guangdong province, and karamay, xinjiang uygur autonomous region, to pilot payment reform for DRG. Three months on, how is the DRG payment reform process in the three pilot cities? What milestones have been achieved? What experience have you summarized? On September 15, representatives of the pilot cities gave the answer at the China DRG pay conference.
Sanming city: establish a national unified DRG related standard
Sanming city on health reform, has been walking before many cities. In order to ensure the smooth implementation of the payment reform of DRG, a series of safeguard measures have been formulated in sanming city.
1. Integrate payment system reform into the reform system. On the basis of "three guarantees and three guarantees", we will integrate payment system reform into the health care system, and make decisions and deploy them together with the implementation.
2. Uniform standards. In order to standardize the diagnosis and treatment of hospital and medical staff, sanming city has formulated the glossary of diagnostic criteria for clinical diseases in sanming city, which has unified the diagnostic terminology and coding of diseases.
3. Unified self-payment: 30 percent of the individual employees of the two tertiary hospitals, 30 percent of the individual hospitals in the secondary hospitals of urban and rural residents, and 50 percent of individual hospitals in tertiary hospitals.
4. Refined management of high value consumables. High-value consumables adopted the practice of price management, according to the sanming joint purchasing price as DRG group settlement price, the price of the above part of the purchase price by patients pay, at the same time through the regulatory system to implement the entire regulation of consumables.
5. Standardize medical practice: it is strictly forbidden to decompose the cost of hospitalization through outpatient service, outsourcing prescription, decomposing hospitalization, coding and upgrading, etc., to increase the burden of patients.
6. Integrated system supervision: based on the intelligent auditing and real-time monitoring system based on DRG, the hospital's medical service behaviors are monitored and evaluated to ensure medical services.
7. To carry out the performance evaluation, organizing experts to track and evaluate the medical establishment that decide a dot, a comprehensive assessment of medical service quality and cost control, medical institutions to implement rewards and punishment according to the assessment results, and ensure the quality of medical security.
Even so, sanming still found some problems, such as the quality of the first page of the case to be completed and the weak information system. In order to improve the medical information system, sanming has made loans to the world bank in the process of DRG payment reform, which is used to improve the information level. In addition, the sanming city also proposed to establish a national unified DRG related standard: unified DRG version, unified medical standard, unified clinical path.
Shenzhen: understanding DRG payment reform from a higher level
Shenzhen health and family planning commission public health commissioner lee chong is introduced, at the meeting did not implement the DRG payment reform, shenzhen set up the "1 + 7" leadership architecture (DRG reform leading group 1 and 7 departments coordination working group), and special working group "5 + 3" (five standard docking and three platform construction group). Shenzhen pilot plan to complete all within the hospital reformation, alignment of information coding docking and try to work, according to the grouping, simulation payments, perfect the grouping rules, medicare pay policies and comprehensive regulation. In order to start from January 2018, the pilot hospital will be selected to collect payment by c-drg. In the concrete implementation process, shenzhen has summarized the following five points:
1. Understand the significance of DRG payment reform from a higher pattern. Li pointed out that DRG is a tool to put it in the big pattern of healthcare reform in the process of carrying out reform, and realize its role in the "triple medical linkage".
2. Information and disease management are the basis. Information platform is the key to implement DRG reform, and it can also carry more tools, "like a CPU".
3. Firmly set up the standard butt fight. To this end, shenzhen is equipped with the standard maintenance team, more than 150 people's work team and expert committee.
4. Deepening negative effects and supporting institutional research. To identify common problems, such as hospital discharge in advance, increase emergency services, deliberately apply high payment standard disease group and so on, and develop corresponding measures. The corresponding measures include perfecting the system of comprehensive medical insurance payment, advancing the management of clinical path and perfecting the comprehensive supervision system of health.
5. Lead innovative development with c-drg standard. We will explore the linkage reform of the financial aid system based on c-drg, and evaluate the medical institutions, medical staff capacity and occupational behavioral occupational risk.
Karamay: clear target specific tasks
, according to deputy director of health and family planning commission of karamay Wu Haiyan karamay DRG accept payment reform pilot preparation, simulation test, pilot work is divided into four stages formal operation, evaluation and promotion. In the process of promotion, the city of karamay chose the city center hospital to take the lead hospital for the DRG charge collection pilot, and carried out the work such as payment training for DRG, quality control of the home page and data docking.
So far, on the clinical diagnostic term docking, whole docking progress degree reached 80%, medical system, all departments have been complete surgical system has completed six departments, the remaining 10 departments; Basic docking in 1311 systems has been basically completed; According to the new 93 index data in the annual report of the inpatient case, the information professionals will reform the homepage of the current medical records.
The pilot work was carried out successfully, and wu haiyan attributed to the following three factors:
1. Leadership is the prerequisite for DRG work. In order to ensure the timeliness, validity of C - DRG pilot and rapid advance of karamay government has carried on the adjustment, the duties of the vice mayor in charge of the unified in pharmaceutical, medical and health care jobs to the deputy mayor in charge of the same name. June pilot start after the conference, the deputy mayor will organize relevant departments held a meeting, discuss the implementation plan of pilot work, and completed within a week the karamay DRG accept payment reform pilot scheme ". In addition, the deputy mayor will be briefed on the reform pilot work every week and personally guided to ensure that the pilot work is progressing rapidly.
2. Define goals and refine tasks. Set at the start of the pilot work in the city the detailed work plan, and according to the target, a clear working process, and the time node and division of tasks, ensure that every link node someone tube, someone asked, someone on.
3. Information is the support, business synchronization is the guarantee. According to the unified standards of karamay, a number of comprehensive regional health information platforms, health insurance departments and medical institutions have been planned, and data sharing has been realized by various medical institutions at all levels. At the same time, this provides the basis for the unification and docking of the home page, disease diagnosis terminology, medical service operation project classification and coding.
The DRG fee reform pilot is expected to expand to 50 cities by 2019 and expand to 100 cities by 2020. For a growing number of pilot cities, the three pioneers' experience or license can be used to help them avoid detours.
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