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    Home > Medical News > Medical World News > How will the NATIONAL Health Insurance Administration's DRG be rolled out? Interview with DRG Paid National Technical Guidance Group Leader.

    How will the NATIONAL Health Insurance Administration's DRG be rolled out? Interview with DRG Paid National Technical Guidance Group Leader.

    • Last Update: 2020-08-03
    • Source: Internet
    • Author: User
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    Text . . . On June 18, the State Administration of Health Security released the "ChS-DRG) Sub-group Program (VERSION 1.0) of the Medical Security Diagnosis Group (HEREinafter referred to as the "CHS-DRG Subdivision Group"), which means that the GROUP plan of CHS-DRG with Chinese characteristics is ready to be announced before it lands.

    CHS-DRG, known collectively as the National HealthCare By Disease Diagnosis Related Group, is intended to reflect the authority of the national health care system and the typical characteristics of paid management.
    further in-depth DRG pilot, is one of the priorities of the National Health Insurance Administration in 2020. It is also one of the key contents of the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical Security System, which is also the highest-level program of medical insurance.
    the introduction of CHS-DRG with a clear timeline: the top-level design will be completed by the Health Care Administration in 2019, the pilot city will be simulated in 2020 and the actual payment will be launched in 2021.
    previously, there are several versions of DRG in the Chinese market, including four major versions: BJ-DRG, CN-DRG, CR-DRG, and C-DRG. These DRG grouping versions have limited impact due to the lack of agreement at the top level.
    CHS-DRG sub-group programme was due to be introduced earlier this year, affected by the new coronapneumonia outbreak, delayed for a full six months. However, it also gave THE DRG Paid National Pilot Technical Guidance Group more time to refine the CHS-DRG subdivision programme.
    the guidance group was set up by the State Health Insurance Bureau, set up in the Beijing Municipal Health Insurance Bureau, the Beijing Municipal Health Insurance Bureau, deputy director of the Medical Insurance Center Zheng Jie as the group leader, to participate in the CHS-DRG sub-programme out of the whole process. can the CHS-DRG pilot be completed on schedule
    ? Is it universal? What impact will it have on China's healthcare market landscape?
    recently, Zheng Jie received an exclusive interview with eight jianwens, on the CHS-DRG sub-group to develop the process, landing problems, the characteristics and significance of the version and so on.
    Zheng Jie has been studying DRG for many years, has been involved in the development of one of the mainstream versions of BJ-DRG, this time CHS-DRG is about to land, he is very excited, and the implementation of the version in the country is full of confidence.this sub-group to develop a plan from the country's 30 pilot areas, 8 areas, from the health care policy formulation, hospital health insurance department, case room, statistical analysis and other fields of experts, how do you choose experts and how to conduct group discussions?at the beginning of the DRG payment pilot, we attached great importance to working with experts, and the National Health Care Administration established a group of 99 experts, which played a key role in the development of the DRG technical specifications and sub-programmes. After the release of the core DRG group, in order to strengthen the guidance of the pilot cities, we grouped the experts, 2-4 experts from each pilot city, divided into eight regions, and implemented step-by-step guidance.
    December 2019, the State Medical Security Administration, in conjunction with the Chinese Society, organized a one-week on-site discussion with the relevant professional chapters. In accordance with the needs of the DRG sub-group, the discussion was divided into 30 groups, each led by the Vice Chairman of the Professional Branch of the Chinese Medical Association and above, and including experts in health insurance coding, for full communication and discussion.
    each discussion group has built a WeChat group, before the meeting in the group of some key issues, task arrangements have been arranged, after the meeting to determine the matter for further discussion. Through this demonstration we also and the Chinese Medical Association to establish a cooperative mechanism, we this time released CHS-DRG sub-group, in the pilot process to absorb the views of the Chinese Medical Association, and constantly adjust, improve the grouping, to achieve clinical, medical insurance and other multi-party consensus.
    so the CHS-DRG formulation process follows the scientific law, integrates the views of all parties, has a certain authority. Few other DRGs have been deployed by the National Medical And Medical Administration, as chS-DRG, using 30 clinical societies of the Chinese Medical Association to make clinical arguments. So in terms of clinical recognition, it is currently relatively authoritative.the process of on-the-spot discussion, where are the differences concentrated?mainly not differences, is a gradual process of standardization, at the beginning of some clinical experts on the classification and coding of surgical operations is not very understanding and recognition. Mainly because DRG development is based on ICD coding, ICD coding comes from WHO disease statistics, clinical for ICD coding is not very concerned. Because of the implementation of the DRG pay reform, especially in this two-year period, more research and attention to ICD coding will be achieved in the application process.
    . Next, CHS-DRG's subdivision will run simulations in 30 pilot cities, and what is the other way around with their own health-care payment model? What version of DRG?most of the 30 pilot cities have not yet applied DRG payment, only a few cities have explored the field of DRG, the version used is basically the CHS-DRG fusion version, so CHS-DRG has a strong compatibility. And 30 pilot cities and the provincial health insurance departments attach great importance to the pilot work, all set up to ensure the smooth work of the pilot work guarantee mechanism, after careful screening to determine the list of their respective pilot cities, at the same time to complete the pilot work has the determination and confidence.can these 30 cities represent the situation of different cities across the country?in accordance with the unified arrangementof the State Health Insurance Administration for the pilot work of the DRG paid country, each province and city selected a pilot city, are after careful consideration by the Party committee government decided to recommend, in line with the basic conditions of the pilot, but also have a strong will for reform. Each province chooses to have their own different starting point, some choose to have DRG experience, some choose not related experience, but there is enthusiasm, good hardware conditions, information technology foundation is strong, is also possible.
    finally determine the 30 pilot cities, both have been carried out exploration of the landing, but also a piece of white paper, because this can try out the effect. Including super-large cities, large cities, medium-sized cities, and even some of our remote county-level cities, it is equivalent to saying that the pilot in line with a full range of accumulated experience.
    CHS-DRG grouping once down, for the already explored landing, involving the replacement of the old and new DRG version, so accumulated an experience, is how to go and the national version of the unified experience. Another experience is that I am pure small white, from a piece of white paper cultivation, from do not understand to understand, is a blank filling experience.
    the pilot has gained mature experience, the provinces and municipalities will start from their respective pilot cities, pilot medical institutions, the deployment of cluster program experience to other cities within the jurisdiction.. CHS-DRG was a three-year plan when it was first developed. Is there a delay in the current plan due to the outbreak?the three-year plan is to develop a national grouper in 2019, a simulation in 2020, and a gradual promotion of the fee in 2021 on the basis of simulation. According to the original plan, it should be said that there are no problems and can be completed on schedule.
    but an outbreak did affect the process of work. We had worked out a sub-group plan as early as January this year, but on January 23rd Beijing issued a first-level response to the outbreak. Therefore, the impact of the outbreak has an impact on the pilot work. Fortunately, we in this six months did not waste, has been organizing experts to polish our program, to ensure that the content of the program more perfect. Later, under the leadership of the State Health Insurance Administration, we will accelerate the pilot work, return lost time, and strive to complete the established pilot tasks on schedule.expects these 30 pilot cities to start simulation operations as soon as possible?now the pilot cities are actively preparing their own DRG groupings according to the sub-group plan issued by the National Health Insurance Administration.
    this preparation is sufficient to mean, first, your operating system is sufficient to give force, the system is a key factor to support THE DRG, if the system is not in place, DRG can not run, in fact, some urban systems are still lacking. Second, the pilot city's hospital management relative norms, such as DRG operation of the prerequisite is the disease case, then we group even if the science, if your case code is miswritten, we get the wrong message, the division must be wrong, so the group of science or not, to a large extent depends on your foundation is not solid.
    in accordance with the "three-year, three-step" plan of the State Bureau and the overall requirements of the sub-group, the pilot cities will submit a self-assessment report before the simulation run on August 31 this year, after the technical guidance group to assess its sub-programme and other technical work, in the year to start the simulation operation.also a concern is the old question, is all the DRG groupers and new technology incompatible, how the new technology how to pay for health insurance?first of all, to clarify what is new technology, to have health technology assessment is indeed new technology, but also to make it clear that not all medical institutions have the ability to carry out real new technologies. The second is to see if this new technology changes the existing economic laws of disease treatment. New technologies are not available because there is no data accumulation after they are available.
    some new technologies to treat major diseases, moving up is tens of thousands, hundreds of thousands, such as this new technology must be excluded, let the market fully to verify it, accept it, run its price. By the time the market has accumulated 2-3 years of case data, we feel that the amount of data is huge enough, the new technology to code, we will pack and group again.
    but not all new technologies are excluded, there are some auxiliary technologies that basically do not affect the current cost of disease treatment, such as a dressing, although a new type of dressing, but also in our treatment of a small cost. So to see the cost loss, cost loss of large new technology is not included in the DRG payment, you can first use the project payment model, and so the market to verify its law, and then included. CHS-DRG is also a dynamic adjustment process when it lands in various locations, and annually, the application of new technologies is analyzed and studied.. Is there a limit to the application of the CHS-DRG subdivision scheme? . The CHS-DRG grouping is fully covered for all cases, covering all ICD diagnostic and surgical operation codes, reflecting the integrity of management, but internationally universally paid for acute hospitalizations within 60 days.
    CHS-DRG has a more important feature: accuracy. Where is this accuracy reflected? 65 million data validations. These data are the most realistic data, we have two teams of experts to organize and analyze this data, data processing team by research institutions, universities, medical institutions and other personnel, statistical analysis team composed of statistical experts, they put 65 million copies of the data for statistical analysis, looking for law. CHS-DRG's 618 subdivisions are the patterns found in big data, which are repeatedly measured and corroborated by clinical experts, so this is a unique feature of CHS-DRG.
    this version is currently the only one that can be paid nationwide, the pilots in accordance with the requirements of national unity, in line with the national version of the basis of dynamic refinement.What do you think is the biggest advantage of CHS-DRG? . THE CHS-DRG IS A DETERMINATION TO REFORM THE WAY THE NHS HAS BEEN ESTABLISHED. We should use the most unified advanced technology to pay management, through the implementation of the national unified CHS-DRG to achieve three efficacy: first, to promote group standardization, the second is to make medical services transparent, and third, the medical expenses have reasonable expectations. Among them, it is the core meaning of changing the basic unit of payment and improving the efficiency of the use of the health insurance fund to implement THE drG payment.
    clinical behavior is not you can enforce it can be regulated, it is very technical, it is difficult to give it a standard and guidelines, so to make it standard, only let it produce its own internal motivation, not from the outside to intervene.
    how to make it produce internal power, is to break the technical closure, Zhang expert is Zhang expert, Li expert is Li expert, each do each, this is a closed, closed, opaque, to make clinical information become transparent, in order to promote it towards uniform standards.
    the role of DRG is precisely to establish a comparable platform for the original uncontrastable clinical behavior. On this platform, the difference in the level of diagnosis and treatment in the same group is immediately clear. This constantly prompts clinical experts to improve their own technology, can not say that there are differences must have problems, DRG this platform to promote clinical mutual learning, and ultimately find everyone recognized, relatively unified norms of diagnosis and treatment, or clinical path, this is the endogenous motivation.
    example, for example, the same is lumbar fusion, why a hospital only used two nails and four steel plates, and you a hospital suddenly gave patients six nails and a dozen steel plates? We need analysis, not necessarily much more must be excessive, the possibility of treatment of cases more complex, but with DRG to give everyone a fair platform to find the reason, can promote more standardized clinical behavior. What impact will CHS-DRG have on the healthcare industry after it is piloted and rolled out nationwide? by summing up the experiences of Europe, the United States and Australia, DRG technology has a good effect on supporting hospital development and health care monitoring. Now we say that clinical behavior is excessive, inflated, some are safe and invalid medical behavior, the annual health insurance fund income is limited, but also to pay for this kind of safe and invalid behavior, which is not wanted to see. With so many resources, why can't we put these limited resources into efficient health care?
    through health insurance payments to promote hospitals to strengthen their own fine management, there may be hospitals, even if improved, but because of our limited resources, may not be able to invest in you, we prefer to put resources into the treatment of good results, low cost control and low-cost hospitals, which may prompt hospitals.
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