The big picture is set! How far will Zhejiang promote DRG payment nationwide?

After two important standards of DRG have been published by the National Medical Security Bureau, DRG has made substantial progress nationwide! On November 21, 2019, Zhejiang Medical Insurance Bureau, Department of Finance and Health Committee jointly issued the Interim Measures for DRGs point based payment of hospitalization expenses of Zhejiang basic medical insurance: the district and city medical insurance administrative departments are required to formulate implementation rules before December 15, combined with the local reality, together with the financial and health departments, to ensure the implementation on January 1, 2020 This also means that Zhejiang Province will become the first province to implement DRG point method in a unified way Liu Jun, an expert specially invited by "China's county health" and the county health development research center, commented that this is a day worthy of remembering in the reform process of China's medical insurance payment Previously, Xiong Xianjun, director of the medical service management department, put forward the three-year three-step strategy of "do a good job in top-level design this year, simulate operation next year, and start actual payment next year" when the National Health Insurance Bureau held DRG related meetings Obviously, Zhejiang Province has been at the forefront of the pilot According to the specific rules of DRG, for pharmaceutical companies, whether products can enter the DRG payment group of corresponding diseases has become a key action to determine the fate of products to some extent DRGs, as a payment management tool and standard, its core role is to influence the diagnosis and treatment concept and method of medical institutions from the root through refined medical insurance management, so as to achieve a balance between improving diagnosis and treatment efficiency and quality and ensuring the sustainability of medical insurance As the supply end of the pharmaceutical industry chain, the impact of drugs and medical devices on the use end will also directly affect their development concept, path and mode First of all, DRGs' package payment mode will transform drugs, medical devices, various testing equipment reagents, etc into the cost of pharmaceutical operation, rather than the means of profit Secondly, DRGs changes the assessment mechanism of medical insurance from simple cost control to focusing on medical quality and safety, which makes medical institutions have the motivation and willingness to choose drugs, devices, consumables and reagents more in line with the law of pharmacoeconomics Third, the change of hospital operation concept will directly affect doctors' prescription behavior, and the changes of the two will jointly affect the pharmaceutical industry, and affect the current supply end product structure and marketing mode of drugs and medical devices Next, with the introduction of two important DRG payment standards issued by the state health insurance bureau and the implementation of the documents in Zhejiang Province, the window period for enterprises to change their business ideas and product structure to adapt to the requirements of the new market in the future has been very short! The implementation of DRG in Zhejiang Province will undoubtedly be implemented nationwide in the future, providing important sample reference significance June 20, 2017: the general office of the State Council issued the guiding opinions on further deepening the reform of payment methods of basic medical insurance; May 31, 2018: the State Medical Insurance Bureau was officially listed; December 10, 2018: the State Medical Security Bureau issued the notice on applying for the pilot countries to pay by disease diagnosis; June 5, 2019: the National Health Insurance Bureau released the list of pilot cities in countries that pay by disease diagnosis; July 18, 2019: Zhejiang Medical Insurance Bureau issued the opinions on promoting the reform of basic medical insurance payment mode of county medical communities in Zhejiang Province; October 8, 2019: the State Medical Security Bureau issued the notice on printing and distributing the coding rules and methods of information business of designated medical institutions of medical security; October 11, 2019: Provisional Measures for DRGs points payment of hospitalization expenses of Zhejiang basic medical insurance (Draft for comments); October 24, 2019: the state health insurance bureau issued the notice of DRG payment country pilot technical specifications and grouping scheme; November 21, 2019: Zhejiang Medical Security Bureau, Department of Finance and Health Committee jointly issued the Interim Measures for DRGs point based payment of hospitalization expenses of Zhejiang basic medical insurance: the district and city medical insurance administrative departments are required to formulate implementation rules before December 15, combined with local reality, together with the financial and health departments to ensure the implementation on January 1, 2020 E-drug managers have conducted in-depth analysis on the introduction of DRG core standards before, and share the following: After the pilot implementation of "DRG payment" in 30 cities nationwide in May, another heavy standard of National Medical Security Bureau has been officially released! On October 16, 2019, the National Medical Security Bureau officially issued the notice on printing and distributing the technical specifications and grouping schemes of DRG paid country pilot, which contains two important standards, namely, the national medical security DRG grouping and paying technical specifications and the national medical security DRG (chs-drg) grouping scheme It is worth noting that the importance of these two standards is not common "The technical specifications and grouping plan are authoritative and professional standards formulated under the unified guidance of the state, forming the basic compliance of national medical DRG (chs-drg) Chs-drg is the only standard for DRG payment in the national health insurance department " Xiong Xianjun, director of the medical service management department of the National Medical Security Bureau, described the importance of the two standards at a special policy interpretation meeting organized by the National Medical Security Bureau on the 23rd In short, the introduction of the technical specifications means that the national DRG payment pilot will have unified technical specifications and guidance standards in the future; the introduction of the grouping scheme means that each pilot city must follow the unified grouping operation guidelines given in the grouping scheme in the next practical implementation of the DRG payment group, and then combine with the local actual situation, from the The local subdivision DRG group (DRGs) is established In the meeting, director Xiong Xianjun also clearly described the logic of the current national DRGs pilot work, which can be summarized as "three years and three steps", that is, "do a good job in top-level design this year, simulate operation next year, and start actual payment next year" In an interview with e-medicine manager, director Xiong Xianjun also said that he would also consider pushing DRGs across the country based on the actual situation of the pilot work For pharmaceutical companies, whether the next product can enter the DRG payment group of corresponding diseases has become a key action to determine the fate of the product to some extent But obviously, with the latest two standards issued by the state health insurance bureau, the window period for pharmaceutical enterprises to change their business ideas and product structure to meet the requirements of the new market in the future has been very short! In fact, in recent years, in addition to the 4 + 7 volume procurement, the discussion about DRGs should be the most attractive one in the industry The so-called DRG, English for diagnosis related groups, translates into "disease diagnosis related groups" This idea was born in the United States in the 1960s It is essentially a case mix tool with risk adjustment function Its basic idea is that different disease types, or similar cases with different treatment methods, or similar cases with different individual characteristics should be distinguished It focuses on the two dimensions of "clinical process" and "resource consumption" The grouping results should ensure that the clinical process and resource consumption of cases in the same DRG are similar Because of its outstanding risk adjustment function and convenient for management, it was gradually adopted by other countries In China, DRG has been studied and applied since 1980s In 2017, the guiding opinions of the general office of the State Council on further deepening the reform of payment methods of basic medical insurance formally stated that pilot payment by disease diagnosis related group (DRG) should be carried out nationwide By May 30, 2018, the National Medical Security Bureau had held a video conference to launch the DRG payment pilot project in China, and announced the list of 30 DRG pilot cities, including Beijing, Tianjin, Handan, Hebei, Linfen, Shanxi, etc., which became a landmark event to promote DRG pilot projects in China The "technical specifications" and "grouping plan" released this time are two programmatic standards issued after 62 million case data were collected in 30 pilot cities nationwide for big data statistical analysis and verification, and they are also compiled on the basis of summing up the experience of DRG pilot projects in previous regions Such a job is not easy After more than 20 years of development, there have been several DRG versions in China, among which there are four mainstream authoritative versions, namely bj-drg of Beijing Medical Insurance Association, cn-drg jointly developed by the medical administration and Health Administration Bureau of the national health and Health Commission and the information center of Beijing Municipal Health and Health Commission, cr-drg of the basic health department of the national health and Health Commission, and Research on health development of the national health and Health Commission The c-drg of the center is applied to different scenes and targets respectively The grouping rules and application management of these versions are similar, but there are some differences in covering diseases, operation scope and application targets, so it needs to be integrated and summarized "For example, the common disease of varicose veins of the lower limbs, the patients are treated in hospital, the medication is basically the same, but different versions will be divided into different DRG groups, such as BJ version, peripheral vein disease group, Cr version, lower extremity vein disease group, CN version, other vein disease group." Zheng Jie, deputy director of the medical insurance center of Beijing Medical Insurance Bureau, gave an example at the meeting, saying that it is necessary to integrate different versions The chs-drg released this time is a combination of the above four mainstream versions "At the time of initial integration, all versions of ADRG were grouped into pharmaceutical companies, with a total of 638 There were nearly 100000 combinations of diseases and treatments, but most of them were repetitive." Zheng Jie said that the final chs-drg compressed the ADRG group to 376, with a weight removal rate of 41% The final combination of disease diagnosis and surgical operation was compressed from 95689 to 73550, with a total of more than 20000 removed From a macro point of view, DRGs system is a concrete embodiment of deepening the reform of medical insurance payment mode Its purpose is to promote the fine management of medical insurance, improve the use efficiency of medical insurance fund, give full play to the basic role of medical insurance in medical reform, so as to effectively safeguard the health rights and interests of the insured However, from the micro level, the implementation of DRGs system is likely to be a nearly reconstructed impact on the future market pattern of Chinese pharmaceutical enterprises This needs to start from the basic logic of DRG grouping and the actual running program Taking the grouping scheme as an example, the newly released grouping scheme has identified 26 main diagnostic categories, namely MDC; and 376 core DRG groups, namely ADRG In the actual DRG work, the formal grouping procedure should be divided into three steps: The first step is to divide into 26 MDCs according to disease diagnosis, such as endocrine system, blood system or immune system; The second step is to further subdivide it into 376 ADRG groups according to whether it is operated or not, medical medication, etc It is worth noting that these two steps can't be changed no matter in the next 30 DRG pilot cities or in the DRG trials started by local governments What local governments should do is to develop local sub DRG groups, i.e DRGs, which can also be understood as the actual DRG payment groups according to the actual situation of each region, that is, the third step