DRG/DIP changes the prescription logic, and the window period bonus opportunity cannot be missed!

After the implementation of the DRG/DIP three-year action plan, within three years, almost all diseases in all public medical institutions in the country will be covered by DRG/DIP payment methods
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The author communicated with many companies and found that some friends still underestimate the impact of DRG/DIP on the industry, and there are some misunderstandings about its development trend
.
Cheap is not the best solution Some companies believe that DRG/DIP payment only affects high-value products and has no impact on low-value drugs and consumables.
This understanding is one-sided
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After the implementation of DRG/DIP payment, it will first affect the hospital business
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Payment is made according to disease diagnosis grouping and score value, and the value of each group of diseases is determined.
The cost of medical insurance is disassembled into each disease type of each hospital, and each disease type is divided into different payment standards according to regional differences and hospital grades.
Also known as "price"
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This price includes not only drugs, equipment consumables, but also diagnostic tests, medical services and other items
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After the disease is priced, the hospital will reposition its business scope, establish the key development of the dominant disease (clinical department), and the disease without advantage (clinical department) will be marginalized
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Advantageous clinical departments, the hospital has strong disciplinary advantages, complete medical staff (forming an echelon), all kinds of facilities are well-equipped, and has a good reputation and popularity, there are a large number of patients in outpatient and inpatient departments, and there are complete diagnosis and treatment.
The treatment effect is guaranteed by means.
The inpatient department has a high bed utilization rate and turnover rate, which can achieve scale and reduce unit costs
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Non-dominant clinical departments have few patients and weak clinical strength
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From a financial point of view, high costs but low efficiency and low patient satisfaction make such a business unsustainable
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The basic principle of DRG/DIP payment is based on the consideration of cost and diagnosis and treatment effect.
The price of each group is relatively fixed.
The advantageous departments can improve efficiency on the basis of reducing costs, and may also have a balance on the basis of price
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According to the policy of retaining the balance of the medical insurance fund, the cost saved is theoretically returned to the hospital, so the hospital has the incentive to reduce costs and improve efficiency
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In addition, when hospitals and doctors choose drugs and consumables, they do not only choose cheap ones, but good curative effects
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Only when the effect is good can the diagnosis and treatment services be completed at a low cost and efficiently
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Poor or ineffective products can only be used sparingly or even discarded
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Scientific evidence-based evidence, comprehensive clinical evaluation, and pharmacoeconomics are the keys to influencing prescriptions
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Can Chinese patent medicine sit back and relax? According to the policy, TCM medical institutions may not implement DRG/DIP for the time being.
Those that have already implemented it should be given the treatment of improving the score in combination with the particularity of TCM
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As a result, many companies feel that Chinese patent medicines are safe, but not necessarily from the perspective of clinical front-line
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First of all, the policy of "do not implement DRG/DIP temporarily" refers to TCM medical institutions
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In fact, most of the prescriptions for proprietary Chinese medicines are produced in western medicine general hospitals, and these medical institutions still have to gradually cover all diseases in accordance with the rhythm of the three-year action plan
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So, what percentage of TCM medical institutions actually use proprietary Chinese medicines? In fact, the proportion of Chinese patent medicines used in some TCM medical institutions is even lower than that of Western medicines
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Therefore, the overall degree of protection of Chinese patent medicines by TCM medical institutions that do not implement DRG/DIP remains to be seen
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Thinking from another angle, the hospital does not implement DRG/DIP for the time being.
Is it really good for proprietary Chinese medicine? Not necessarily, on the contrary, it is easy to marginalize Chinese patent medicine because Western medicine has a clear basis for diagnosis and treatment and payment
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There are provisions for basic medicines, the varieties selected in the centralized procurement should be committed to complete the purchase volume, and the drugs should be fully allocated and preferentially purchased.
What about Chinese patent medicines? It seems that how to equip and use it has not been separately delineated
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Of course, there are also Chinese patent medicines in the basic medicines, centralized procurement, and nationally-discussed varieties
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Increased academic and policy influence DRG/DIP is a reform of payment methods, which is not only reflected in the changes in how medical insurance pays hospitals, but also has an overall impact on the development, positioning, and operation management of hospitals
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The operation mode of hospitals has changed, which will definitely have an impact on pharmaceutical companies
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1.
Principles and methods of hospital selection of drugs and consumables Under the DRG/DIP model, how can hospitals improve efficiency and reduce costs? The hospital pharmacy management and drug treatment committee will determine the hospital's selection principles and possible future structure in conjunction with the policy
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This is the entrance of medicines and consumables.
The top management of the hospital will determine the principles and control the process.
Therefore, the rules of medicine intake will change in the future
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2.
Changes in the structure of medication (consumables) The cost-effectiveness ratio of medication (consumables) will become the core issue of the hospital's attention, combined with other policies such as the "1+X" medication mode of basic drugs, volume-based procurement, and the "dual channel" of national talks In the future, the trend of medicines (consumables) in hospitals is clear, and the order of priority allocation and use is as follows: basic medicines - selected varieties in centralized procurement - national talks - medical insurance varieties - non-medical insurance varieties
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After the comprehensive management and medical insurance reform in recent years, the order of use of consumables is similar
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3.
Collective purchase report volume Since the centralized purchase policy has rigid constraints on the completion of purchase volume and payment collection, taking into account the refined control of DRG/DIP payment methods and the uncertainty of assessment, the hospital report volume will be more conservative and cautious
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4.
Diagnosis and treatment methods Under the refined management and control of DRG/DIP, doctors' diagnosis and treatment are more inclined to clinical paths, evidence-based evidence, etc.
, and take into account the characteristics of hospital departments, salary assessment and other internal environments
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The influence of academics and policies on doctor's prescriptions will exceed the non-compliant methods such as customer affection and "bringing money"
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5.
Prescription circulation The hospital will comprehensively consider which drug prescriptions will be circulated outside the hospital
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Analyzing the national and local "dual-channel" policies, the drugs that can be transferred out of the hospital are basically locked into the national and chronic disease varieties, at least these two types of drugs are currently compliant
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Under the DRG/DIP model, the hospital will also refine the categories.
Therefore, it is hasty to draw the conclusion of "prescription outflow outbreak" based on a certain policy
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How do pharmaceutical companies respond? First, synchronize with hospitals and adjust target hospitals, target departments and target customers
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Based on the changes in hospitals, pharmaceutical companies should consider the relationship between their products and disease types, disease types and groupings and scores, and then consider which hospitals should focus on developing related departments, and weaken or even eliminate certain departments.

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Only when the goal is synchronized with the hospital can we concentrate limited resources to obtain marketing performance
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Secondly, take into account the changes between drugs (including competing products and related drugs), equipment consumables, diagnostic tests, and diagnosis and treatment methods, especially the relationship between products and services of the same disease in the same group
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The so-called "one piece affects the whole body", under the DRG/DIP payment model, the products and services in the same group are in a competitive relationship with fixed payment standards for the same disease
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The doctor prescribes one product or treatment, and reduces the use of another product accordingly
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The products mentioned here include medicines, equipment consumables and diagnostic tests, as well as corresponding treatment methods
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One and the other
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Enterprises should soberly judge doctors' prescription behavior, have a global view, and not just focus on their own products
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Thirdly, study the multi-product combination and conform to the basic form of the DRG/DIP payment model
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Within the same disease group, various products have both competition and cooperation possibilities
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Enterprises should accurately measure the value of disease components and key indicators such as the number of patients in a certain hospital (inpatient department and outpatient department are separated), operation volume, and turnover days, and research and formulate disease diagnosis and treatment plans that meet the interests of the hospital
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The plan should combine the basic situation of its own products to find "allies" that can implement this solution, such as drugs + drugs, drugs + consumables, drugs + consumables + diagnosis and treatment methods
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If in the same patient group, A drug, B consumables, and C service constitute a paid package, and A, B, and C each have multiple different products, the enterprise can formulate a combination of A1+B2+C1 to achieve the optimal cost, The most efficient, the hospital is willing to accept, and the medical insurance will pay the bill
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Finally, rationally select channels and terminals, and lay out inside and outside the hospital
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The hospital will comprehensively evaluate which drugs are reasonably used in the hospital under the influence of various policies? Which drug prescriptions from which departments will be transferred out of the hospital? With the implementation of the outpatient mutual aid system, patients can also make overall reimbursement in the outpatient clinic, and the DRG/DIP will also be extended to the outpatient coordination department accordingly.
Therefore, it is not excluded that some varieties that originally sold in the outpatient clinic will enter the hospital
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Pharmaceutical companies should seize the window period and accurately grasp the opportunities for drugs in different scenarios inside and outside the hospital
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