The great transformation of hospital medication under "4 + 7" purchasing with quantity

As we all know, the establishment of the national health insurance bureau is to fulfill the role of purchaser of medical services, with highly unified purchasing power, pricing power and payment power DRG payment is to solve the problem of pricing and payment, while centralized procurement with volume is to solve the problem of procurement, and the two are complementary ▍ relationship between DRG payment and volume purchase With the expansion of "4 + 7" to the joint mining of 25 provinces, on October 23, 2019, the National Health Insurance Bureau officially announced DRG technical specifications and grouping scheme, chs-drg came out, and centralized volume purchase will become the active consensus of all DRG paying medical institutions, rather than the compulsory implementation required by the health insurance bureau Under the promotion of DRG in the future, medical institutions will reach more volume with the health insurance bureau of the overall planning area According to the consensus of the procurement method, the volume procurement will be from the centralized procurement of some single products to the centralized procurement of a specific DRG disease group This centralized procurement of the disease group will pack all related drugs, consumables, and even inspection and inspection items, and strive to promote the reduction of the cost of some key disease groups In the past, most of the cost of inpatient services in our medical institutions was "three fees" (drugs, consumables, devices), while the labor value of professionals was relatively low from the cost account, while the total DRGs was fixed, and the uncontrolled "three fees" soon accounted for the total, and when the total amount was full, the medical insurance "owed money" With the implementation of DRG, the hospital's medical services will return to normal value, and the profit mainly depends on the addition of drugs, consumables and devices will be greatly changed From "buying medicine" to "buying people", at the same time, medical insurance, as a strategic buyer, will help the hospital realize the cost structure adjustment through some strategies The centralized and volume procurement of 4 + 7 to 25 provinces has become a consensus strategy The overall strategy of the medical insurance bureau is to "release cages and replace birds" On the one hand, "three fees" cost must be reduced, on the other hand, "labor cost" should be increased, and the two goals need to be completed at the same time DRG implements fixed payment, for example, the payment rate for a specific coding disease is 30000 yuan If the cost of purchasing drugs and materials is very high, the profits will be taken away by drug companies and consumables manufacturers If there is no balance in the hospital, there is no wage, bonus or sustainable development The implementation of DRG has changed the revenue of drugs and consumables into the cost, and every hospital has the power to reduce the price of procurement In the past, the cost was passed on to patients and payers, and became the main source of hospital profits With the implementation of DRG, the interests of medical institutions, medical insurance bureau and patients have changed from game to consensus This will release the autonomy of the hospital's centralized procurement, and the medical institutions will have the initiative to jointly purchase With the change of hospital management environment from passive control to active cost control, each medical institution has the ability of centralized purchase with higher quality and more reasonable price, which will also be one of the core competitiveness of medical institutions as a modern hospital management system At the same time, with the implementation of DRG, it will also solve a very prominent problem of centralized volume purchase at present In the process of participating in the national drug centralized volume purchase pilot, some public hospitals report that the purchase volume tends to be conservative Some 4 + 7 varieties also have other sales channels besides public hospitals In general, there is still a considerable surplus market! Of course, the regulation of "surplus market share" in the national policy of volume purchase also considers the diversity and imbalance of market demand, and gives hospitals, doctors and patients appropriate free choice, but how to use the free choice is the key After the implementation of DRG, the hospital will also take the initiative to select products with high cost performance in the residual market, avoid the gray space in the sales process, and effectively reduce the burden of medical insurance funds ▍ how does DRG payment affect volume purchase? What kind of drugs will hospitals select through centralized volume purchase under the implementation of DRGs payment? Through interviews with nearly 100 directors, their answers are: our hospital's objectives are: Improve efficiency and control cost (after zero addition of drugs, the cost of drugs needs to be reduced as much as possible); select the product with the best cost performance (pharmacoeconomic research of drugs, therapeutic drugs are the first choice, cheap and good quality); select the product that helps to improve efficiency (quick effect, faster patient recovery, and reduce time efficiency index); select the product that helps to control cost (the cost is relatively low, which is conducive to reducing the cost efficiency index At the same time, from the perspective of long-term treatment, it can reduce the return rate of patients and reduce the readmission); select brand enterprise cooperation (through consistency evaluation, it has academic support, and large brand enterprise is our first choice); select the cooperative enterprise that can ensure the long-term benefit improvement of the hospital (it is conducive to the development of our discipline , enterprises with long-term development of the hospital); select enterprises that can realize the public welfare of the hospital (enterprises that use this product or cooperate can reflect the public welfare of our hospital) "DRGs are tools, and the ultimate goal is to make the medical value truly and reasonably reflected." Zuo Hua, executive director of the management and research center of sepiland hospital, made an image metaphor of DRGs: This is a ruler, which measures the real and reasonable value of medical treatment Pharmaceutical enterprises should take advantage of the situation, rearrange their products and markets, actively participate in the centralized procurement promoted by the medical insurance bureau and medical institutions, and work together to achieve the real value return of medical care We know that there are 376 groups in chs-drgs core, 167 in surgical group, 22 in non-surgical group and 187 in internal medicine group Then all medical insurance plans are subdivided, and the contribution of complications and complications to resource consumption of disease group should be fully considered in the whole process to generate MCC table and CC Table, the final breakdown into DRGs group is usually about 900-1000 groups, and we used to say that there may be tens of thousands of single diseases If we still need to consider patients, treatment, complications and complications, there may be tens of thousands or even hundreds of thousands of different situations, so it is easy to lead to senior management costs, because too much is too complex, and it is not feasible Therefore, the cost control of medical institutions is not for a single disease, but for a disease group of DRG Single disease charge only covers limited disease classification, and the hospital under implementation It's very easy to eliminate the single disease charge from the single disease compensation system for the cases with high medical data consumption under various excuses Although some provinces in China have started to implement the single disease charge reform, so far, no country in the world has implemented a comprehensive medical insurance payment scheme based on the single disease DRG payment is to determine the purchase payment price for the medical insurance Department of the disease group, which directly affects the cost compensation level of the hospital, the income of the hospital, and the medical expense burden level of the patients, so the hospital needs to pay more attention to "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 to supplement medicine, equipment to supplement medicine, inspection to supplement medicine", leading to serious untrue disease cost, resulting in significant deviation of disease cost accounting results Based on the irrationality of the actual cost of disease, how much is the cost of disease in the hospital? If there is a clinical pathway, the cost of standard diseases will 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 will be determined according to the expert evaluation of the operation process, and a "consensus" will be reached within the hospital to form the hospital's exclusive DRGs standard treatment procedure, which requires all medical and technical personnel to implement according to the standard treatment procedure of diseases Standard disposal procedures include not only how to use drugs (of course, our pharmaceutical enterprises are most concerned about how to choose drugs), but also inspection and testing items, treatment items, activities and safety, nutrition and diet, excretion, psychology and society, health education, discharge plan, nursing problems, etc., and are detailed to every day of hospitalization Let's look at a real case: how the clinician's medical behavior changes after a hospital implements the DRGs system performance appraisal program Dr Li's hospital introduced DRGs performance appraisal system in April 2019 In the past, when doctors gave doctor's orders, they would not choose drugs from a fixed clinical path, 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, and 10% of drugs are imported from the designed clinical pathway, the medical group will be rewarded with 5000 yuan The average person is about 1000 yuan It's also an incentive for doctors ▍ conclusion: from the above real case, we can see that the DRGs standard treatment procedure covers the content of clinical pathway, which is richer and more specific than the clinical pathway At the same time, due to the different diagnosis and treatment, inspection and drug catalog, the content of standard treatment procedure is also different in each hospital The author predicts that, with the DRG payment going on in an all-round way, in the future, the medical insurance bureaus of each overall planning area will carry out centralized and volume purchasing for some specific DRG groups in combination with all medical institutions in the region   We all know the existence of the two eight principle The same 20% of the disease groups occupy 80% of the medical insurance expenses We can focus on the common disease groups with high proportion of regional total expenses, high amount of refusal to pay for medical insurance, high proportion of drugs, high proportion of consumption, high cost consumption index and time consumption index The common disease groups with RW value less than 1 can package and purchase the treatment schemes of the disease groups, so as to help the medical institutions reduce a certain amount of medical insurance expenses as a whole The cost of some common disease groups to achieve the package purchase of some medical services For some enterprises that can integrate treatment plans for specific disease groups, it is a very good thing.