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    Home > Active Ingredient News > Drugs Articles > Can national key monitoring catalogue varieties enter into DRGs standard disposal procedures?

    Can national key monitoring catalogue varieties enter into DRGs standard disposal procedures?

    • Last Update: 2019-07-09
    • Source: Internet
    • Author: User
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    On July 9, medical network reported that the first batch of national rational drug use catalogue (the first batch) was finally released on July 1 The document clearly stated that this catalogue is also to implement the assessment of the proportion of auxiliary drugs in the "opinions on strengthening the performance assessment of three-level public hospitals" issued by the general office of the State Council, and at the same time, the key monitoring catalogue was clarified Clinical application rules of internal medicine "Is it possible for our products to enter the DRGs standard disposal procedure?" asked the author from the person in charge of the enterprise involved in the national version of the key monitoring products To answer this question, we need to explain what DRGs standard disposal procedure is Cost control is the king On June 5, the state health insurance bureau jointly released the notice on printing and distributing the list of pilot cities in countries paying by disease diagnosis, which proposed that each pilot city and its province should follow the three-step general idea of "top-level design, simulation test and actual payment" to ensure the completion of the task, and stipulated that "2020 is the simulation operation period, and 2021 is the actual payment period" Leather time DRGs is not mysterious, that is to say, the transformation from the current pay as you go project to the pre paid package according to the disease group, so as to improve the use efficiency of medical insurance funds, will have a significant impact on the current operation and management mechanism and system of the hospital, which indicates the arrival of the era of "cost control as the king", forcing the hospital to strengthen the refined disease cost accounting For the disease group, the medical insurance department determines the purchase price, which directly affects the cost compensation level of the hospital, the hospital income and the patient's medical expense burden level, so the hospital needs to pay more attention to the disease cost accounting In the past, due to the unreasonable pricing of medical service charges, the labor value could not be reflected, mainly relying on medicine, equipment and inspection, leading to serious untrue disease cost and significant deviation of disease cost accounting results Based on the irrationality of the actual cost of diseases, hospitals need to evaluate themselves What is the cost of diseases?   If there is a clinical pathway, the cost of standard diseases shall be calculated according to the clinical pathway specification and with the help of the actual cost accounting data of diseases; if there is no clinical pathway, it shall be determined according to the expert evaluation of the operation process, and a "consensus" shall be reached within the hospital to form the exclusive DRGs standard treatment procedure of the hospital, which requires all medical and technical personnel to implement according to the standard treatment procedure of diseases The content of standard disposal procedure not only includes how to use medicine, but also includes inspection and test items, treatment items, activities and safety, nutrition and diet, excretion, psychology and society, health education, discharge plan, nursing problems, etc., and is detailed to every day of hospitalization Evaluation of hospital performance DRGs is not only a payment method of medical insurance, but also a very good tool for medical management and hospital performance evaluation, which provides a new dimension and standard for hospitals to consider Hospitals will evaluate and rank from the following five levels: the first level: regional ranking of hospitals Small can be in the region, middle can be in the province, big can be in the country According to this standard, the clinical status of hospitals in this area is ranked The second level: every employee in the hospital should have a sense of achievement If the hospital develops well and treats a large number of difficult and miscellaneous diseases for the masses, at the same time, everyone's quality of life and economic level have also been improved, and they will feel proud How can hospitals improve the service quality through the reform? The way is to improve the ability to solve difficult diseases The third level: the hospital is two-level management, strong discipline, strong hospital For example, there are 10 companies in a unit, 8 of which are sharp knife companies This company will surely win the battle Our ranking is second level discipline If the second level discipline of the hospital is strong, the hospital will be strong and its influence will be improved The fourth level: the Department is not strong The basic unit of the hospital is the treatment group If the treatment group is strong, the Department will be strong The assessment, evaluation, year-on-year and month on month comparison can be carried out at these levels The fifth level: implement peer evaluation On the premise of safety, we should use examination, treatment, drugs and consumables reasonably and scientifically, evaluate in different specialties and different treatment groups, and find the best treatment way From another point of view, a corresponding clinical estimate can be made, and performance evaluation and knowledge assessment can be carried out at the same time In addition to writing articles, doctors in charge, deputy directors and chief doctors are optimistic about diseases The assessment indicators of the hospital can be used to measure the comprehensive ability of clinicians from multiple levels, such as the number of DRG groups (types of diseases), CMI (difficulty), RW (service volume), cost efficiency index and service efficiency index (work efficiency), low-risk mortality rate (medical quality), etc Based on the performance evaluation and ranking of DRGs, from the first level to the fifth level, the hospital urgently needs a complete DRGs standard treatment procedure as the general guiding principle To change the clinical medical behavior, the hospital will change the medical behavior of the clinicians by implementing the performance evaluation program under the DRGs system The performance management of Dr Li's hospital has been criticized by many hospital presidents and experts The performance reform mode, which mainly includes registration fee and operation fee commission, is considered to lead to excessive medical treatment Relevant departments of the state have also issued a regulation that "doctors' income should not be linked to their workload", but this regulation is even more questioned because of the result of guiding the "big pot" In June this year, when more than 3700 hospitals in Beijing participated in the linkage of medical consumption and the cancellation of medical consumables markup, the prices of 6621 medical service items were increased at one time The general direction of reform was clear: cutting off the consumables markup and presenting the doctor's labor value to improve the service items In April this year, Li Li's hospital introduced DRGs performance appraisal system In the past, doctors did not choose drugs from the fixed clinical path when they gave medical orders, and their drug use decisions were sometimes affected by the promotion methods of pharmaceutical companies However, in the process of DRGs diagnosis and treatment, the hospital has provided standard treatment procedures for each DRGs disease, and what kinds of tests and drugs are required in the treatment stage of each disease have been packaged If doctors choose drugs from DRGs standard disposal procedures, 10% of the drugs are imported from the designed clinical pathway, and the medical group will have 5000 yuan reward, with an average of about 1000 yuan per person It's also an incentive for doctors It can be seen that DRGs standard treatment procedure covers the content of clinical pathway, but it is richer and more specific than clinical pathway At the same time, each hospital has different contents of standard treatment procedure due to different diagnosis and treatment, inspection and drug catalog Big data accelerated the landing of DRGs On June 27, the state health insurance bureau issued the notice of Guiding Opinions on medical security standardization, which will accelerate the landing of DRGs nationwide and provide information and big data support for the real landing of key monitoring catalog product policies According to the document, by 2020, on the basis of the construction of the national unified medical security information system, 15 information business coding standards, such as disease diagnosis and operation, will be gradually put into use Among the four standardized information, the standardization of drug coding rules is included to realize the traceability of medical insurance drug use from the national level (20 key monitoring products are medical insurance products), so as to ensure the accuracy of data of key monitoring products From the coding rules, it can be seen that the medical insurance department can achieve multiple purposes through drug big data analysis: 1 Understand the structure of drug use 2 Facilitate the implementation of "two ticket system" for drugs and realize the traceability management of drug enterprises 3 Realize drug price analysis 4 Docking with disease diagnosis to evaluate the rationality of medication 5 Through big data collection, analyze and determine the cost of diseases, calculate the "proportion of drugs" in the reasonable cost of diseases, and provide reference for medical insurance to pay for drugs 6 It is convenient for accurate analysis of the rationality of hospital medication The premise of big data technology is standardization, medical insurance drug coding and rules are unified, big data analysis can let the medical insurance bureau grasp more initiative, which has a significant impact on hospital medication habits and behaviors As we all know, more than 70% of the hospital's income comes from medical insurance, and the payer has the absolute right to speak The key monitoring of the national health and Health Commission is whether it can be effectively implemented at present, whether the hospital has a continuous internal source of power to carry out, but also depends on the change of the payment method of medical insurance The establishment of standard disposal procedures under DRGs has even greater impact on the products of pharmaceutical enterprises, because this is hospital health The source of development Then, can the national key monitoring catalogue varieties enter the DRGs standard disposal procedure? The author's prediction is that from the perspective of the level of about 10000 hospitals above the second level (each hospital has different DRGs standard disposal procedures), from the perspective of the ultimate goal of DRGs standard disposal procedures (to achieve the optimal cost performance, to achieve the overall disease revenue), from the perspective of the role positioning and authority scope of the health care Commission and the medical insurance bureau (the final decision is the payer), of course, it is organic Yes, but it needs to be promoted and operated more systematically It needs to think like the president and do more non clinical services.
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