The influence, misunderstanding and countermeasures of DRG/DIP

After the DRG/DIP three-year action plan is issued, almost all diseases in all public medical institutions nationwide will be covered by the DRG/DIP payment method within three years
.
We have communicated extensively with enterprises and found that some friends still underestimate the impact of DRG/DIP on the industry and future development trends, and there are some obvious misunderstandings.
This article attempts to clarify these misunderstandings and provide some countermeasures for reference.
Criticisms and corrections are welcome
.
Misunderstandings about DRG/DIP payment by pharmaceutical companies There are three misunderstandings about DRG/DIP by pharmaceutical companies.
One is that they only focus on their own varieties and do not consider the use of all products in the hospital; the other is that DRG/DIP payment only affects high value.
The product has no effect on low-value pharmaceuticals and consumables
.
Drug companies only look at the impact of DRG/DIP on drugs, and do not consider the impact on device consumables, medical services, and diagnosis and treatment methods.
The same is true for device consumables companies
.
The third is that TCM medical institutions can temporarily refrain from implementing DRG/DIP, and Chinese patent medicines are temporarily "safe" and become a special safe haven
.
After the implementation of DRG/DIP payment, the first is to affect the hospital business
.
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", in this "price", it includes not only medicines, equipment consumables, but also diagnostic tests, medical services and other items
.
In addition, some companies believe that DRG/DIP only affects high-value drugs and will not affect the centralized procurement of generic drugs, basic drugs and other varieties that have been reduced in price.
Such understanding is also one-sided
.
DRG/DIP payment will affect the hospital's business positioning and department business So, how does the hospital treat these priced diseases? In a word: the hospital will reposition its business scope, establish the key development of dominant diseases (clinical departments), and the diseases without advantages (clinical departments) will be marginalized
.
What are the dominant clinical departments? It must be that the hospital has strong academic advantages, complete medical staff (forming an echelon) and various facilities, and has a good reputation and popularity
.
Such a department has a large number of patients in both outpatient and inpatient departments, and has perfect diagnosis and treatment methods to ensure the treatment effect.
The utilization rate and turnover rate of beds in the inpatient department are very high
.
Therefore, such a department can be scaled up, thereby reducing unit costs and improving efficiency.
The development of such a department will enable the hospital to develop sustainably, and the medical insurance department is also happy to see such a situation
.
In contrast to the clinical departments with advantages, there are few patients and weak clinical strength.
From a financial point of view, the cost is high, the efficiency is low, and the satisfaction of patients is not high.
Such a business is unsustainable
.
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".
According to the policy of retaining the balance of the medical insurance fund, the cost saved will theoretically be returned to the hospital, so the hospital is motivated to find ways to reduce costs and improve efficiency.
To achieve this goal, only the development of superior departments, non-advantaged departments will gradually be marginalized
change .
Medicines and consumables are not only cheap, but the most cost-effective ones.
In addition, when hospitals and doctors choose medicines and consumables, they do not only choose cheap ones as some people think, but choose good therapeutic effects.
, because only the effect is good, the diagnosis and treatment service can be completed at a low cost and efficiently
.
Products with poor effect or no effect at all have high cost, poor effect and low efficiency, and can only be used less or even abandoned in DRG/DIP mode
.
Under this payment model, the price of medicines and consumables does not determine whether they are prescribed or not
.
Scientific evidence-based evidence, comprehensive clinical evaluation, and pharmacoeconomics are the keys to deciding whether to use it
.
Therefore, considering the characteristics of DRG/DIP payment methods, the hospital will adjust its business positioning and concentrate resources to develop advantageous departments
.
At the clinical use level, drugs and consumables will be selected and used according to the actual effect of drugs and consumables and related technical evaluations, and the drug structure will be optimized, and hospitals will become more rational and prudent in the selection of drugs
.
TCM medical institutions can temporarily refrain from implementing DRG/DIP, and can Chinese patent medicines sit back and relax? According to the latest 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
.
As a result, many companies feel that Chinese patent medicine is "safe", at least not as abused as Western medicine
.
However, thinking about this policy from the perspective of the clinical frontline may not be beneficial to Chinese patent medicines
.
First of all, the policy of "do not implement DRG/DIP temporarily" refers to TCM medical institutions.
In fact, most of the prescriptions of Chinese patent medicines are generated by western medicine general hospitals (more than 70% according to previous media reports).
This part It is still necessary to gradually cover all diseases according to the rhythm of the three-year action plan
.
And what percentage of TCM medical institutions actually use proprietary Chinese medicines? In fact, the proportion of Chinese patent medicines used in many TCM medical institutions is even lower than that of Western medicines
.
Therefore, the degree of "protection" of proprietary Chinese medicines by TCM medical institutions that "do not implement" is generally limited
.
Secondly, think about it from another angle.
If the hospital does not implement DRG/DIP for the time being, is it really good for proprietary Chinese medicines? not necessarily! On the contrary, it will completely marginalize Chinese patent medicine because Western medicine has a clear diagnosis and treatment and payment basis for entering the group.
Hospitals have more "reasons" not to use Chinese patent medicine
.
There are provisions for basic medicines, the varieties selected in the centralized procurement must be committed to complete the procurement volume, and the drugs under the national consultation should be fully prepared and selected for optimal procurement, but what about Chinese patent medicines? It seems that there is no separate regulation on how to prepare and use it (of course, there are also Chinese patent medicines in the basic medicines, centralized procurement, and nationally-discussed varieties)
.
Impact on Enterprises DRG/DIP is a reform of payment methods, which is not only reflected in the changes in how medical insurance pays for hospitals, but also has an overall impact on the development, positioning, and operation management of hospitals
.
The operation mode of hospitals has changed, which will definitely have an impact on pharmaceutical companies
.
It is reflected in several aspects such as drug selection, centralized collection and reporting, diagnosis and treatment methods, and drug (consumption) structure
.
How can hospitals improve efficiency and reduce costs under the DRG/DIP model? The hospital pharmacy management and drug treatment committee will definitely determine the hospital's selection principles and possible future structure based on the policy
.
This is the entrance of medicines and consumables, and the top management of the hospital will determine the principles and procedures to check, so it will become more and more difficult to get medicines in the future
.
Changes in the structure of medication (consumption) The cost-effectiveness ratio of medication (consumption) will become the core issue of concern for hospitals.
Combined with other policies such as the 1+X medication model of basic drugs, volume-based procurement, and dual-channel national talks, the future hospital medication ( The trend of consumption) has become 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.
.
.
Consumables have also passed comprehensive management and medical insurance reform in recent years.
The general order is similar
.
Due to the rigid constraints of the centralized procurement policy on the completion of purchases and payment collection, and considering the fine-grained control of DRG/DIP payment methods and the uncertainty of assessment, the hospital’s reported volume will become more conservative and cautious.
In turn, it affects the formation of centralized procurement
.
Diagnosis and treatment methods Under the refined management and control of DRG/DIP, doctors' diagnosis and treatment will be more inclined to clinical paths, evidence-based evidence, etc.
, and consider the characteristics of hospital departments, salary assessment and other internal small environments
.
The influence of academics and policies on the formation of doctor's prescriptions will exceed the gray non-compliance methods such as customer affection and gold
.
Prescription circulation The hospital will comprehensively consider which drug prescriptions will be circulated outside the hospital
.
From the analysis of the national and local "dual-channel" policies, the drugs that can be transferred outside the hospital are basically locked in the drugs of the country and the varieties of chronic diseases, at least these two types of drugs are currently "legalized" compliant categories
.
Under the DRG/DIP model, the hospital will also refine its categories, and we will continue to pay attention
.
Therefore, it is hasty to draw the conclusion that "prescription outflow outbreak" is easy from a certain policy
.
How do pharmaceutical companies respond? First of all, pharmaceutical companies should synchronize with the adjustment of the hospital, and adjust their target hospitals, target departments and target customers
.
Based on changes in hospitals, pharmaceutical companies need to consider the relationship between their products and disease types, disease types, groups and scores, and then consider which hospitals will focus on developing related departments and weaken or even eliminate certain departments.
some departments
.
Only when the goal is synchronized with the hospital can it concentrate limited resources to obtain marketing performance.
If the enterprise does not make any adjustments regardless of the changes in the hospital, it can only choose the wrong market and customers, and invest resources in the wrong direction, which will eventually lead to wrong results
.
Secondly, pharmaceutical companies should also 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 within the same disease and within the same group.

.
The so-called influence affects the whole body.
Under the DRG/DIP payment, under the fixed payment standard for the same disease, the products and services in the same group are in a competitive relationship
.
Doctors are actually "dancers in shackles"
.
After a doctor's judgment, a prescription is issued to choose one of the products or treatments, and the use of the other product will be reduced accordingly
.
The products mentioned here include medicines, equipment consumables, diagnostic testing methods, and corresponding treatment methods
.
This long and the other disappears
.
Enterprises should have a clear understanding, judge the prescription behavior of doctors, and have a global view instead of just staring at their own products
.
Thirdly, enterprises should study multi-product portfolios and conform to the basic form of DRG/DIP payment model
.
Within the same patient group, various products have both competition and cooperation
.
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.

.
The solution should be based on the basic situation of its own products, to find "allies" that can implement this solution, the combination of drugs and drugs, drugs and consumables, combination of drugs + consumables + diagnosis and treatment, rather than fighting alone, in order to achieve the future of DRG Find your footing in the /DIP payment model
.
If in the unified disease group, A drug, B consumables, and C service constitute a paid package, and there are multiple different products in A/B/C, then the enterprise should formulate A1+B2+C1 based on the above situation.
Combination mode, in order to achieve the goal of optimal cost and highest efficiency, so as to make hospitals willing to accept and medical insurance to be assured
.
Finally, in the selection of channels and terminals, rationally arrange the inside and outside of the hospital
.
The hospital will comprehensively evaluate which drugs are reasonably used in the hospital under the influence of various policies, and which departments? Which drug prescriptions are circulated outside 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 overall planning part of the outpatient clinic.
Therefore, it is not excluded that some varieties that originally sold in the outpatient clinic will enter the hospital
.
Pharmaceutical companies should seize this window period and accurately grasp the opportunities for drugs in different scenarios inside and outside the hospital
.