These 5 tertiary hospitals will implement DRG collection and payment on July 20, and the pilot will be expanded

Medical Network, July 16th, Fujian has made it clear that it will expand the scope of the reform of collecting and paying according to the diagnosis-related group (DRG) to achieve full coverage of tertiary public general hospitals, and gradually expand to other hospitals with conditions.
July 13, Fujian Medical Insurance The Bureau and the Fujian Provincial Health and Health Commission issued the "Notice on Expanding the Pilot Reform of DRG Collections and Fees", clarifying the orderly operation of the actual DRG collection and fees reform in 3 pilot hospitals including Fujian Medical University Affiliated Union Hospital , To further expand the scope of the pilot reform of DRG collection and payment
.
Among them, five pilot hospitals including Fujian Provincial Hospital, the First Affiliated Hospital of Fujian Medical University, Fujian Cancer Hospital, Zhongshan Hospital Affiliated to Xiamen University, and Xiamen Second Hospital are scheduled to implement DRG collection and payment on July 20, 2021
.
The collection and payment policies of the 5 pilot hospitals are in accordance with the " Notice of the Fujian Provincial Health and Health Commission on the Pilot Reform of the Collection and Payment of Groups Related to Disease Diagnosis" (Minyibao [2019] No.
117), "Fujian Medical Security Bureau The Notice on Issues Concerning the Adjustment of the Collection and Payment Standards for Disease Diagnosis Related Groups (Min Medical Insurance [2020] No.
91) and other documents shall be implemented
.
At the same time, seven tertiary general public hospitals in the province, Fuzhou, Xiamen, Quanzhou, and the military were determined to be included in the third batch of DRG collection and payment reform pilots
.
The notice will be implemented from July 20, 2021
.

Strengthen medical record management, establish medical record expert database.

Pilot hospitals should further strengthen medical record quality management, and implement the three-level control system of medical record quality in hospitals by medical groups, departments, and hospitals
.
Carry out the quality inspection of hospital medical records seriously, and improve the accuracy rate of the main diagnosis and main operation filling and coding on the first page of the medical record
.
The medical insurance department and the health department use national and provincial expert resources to establish a medical record expert database, adopt a mode of combining remote spot checks and on-site inspections, review and evaluate the medical records of DRG collection and payment problems, and provide timely feedback on problems found to further improve the quality of hospital medical records , To effectively improve the accuracy of DRG collection and payment entry and settlement
.
Carry out monitoring and evaluation, and establish an internal hospital performance evaluation system that is compatible with the DRG collection and payment policy.
The "Notice" requires the medical insurance department to carry out monitoring and evaluation and strengthen the management of designated agreements, make full use of information technology to implement intelligent supervision, and strengthen the DRG collection of medical institutions.
In the supervision of the payment process, the difference between the actual resource consumption caused by the diagnosis upgrade and the DRG fee standard is not paid by the medical insurance fund after the organization's expert argumentation
.
The health and health department should guide hospitals to strengthen clinical path management, refine the clinical path form and incorporate it into information management, promote standardization of diagnosis and treatment behavior and improve medical quality, establish a hospital internal performance evaluation system that is compatible with the DRG collection and payment policy, and deepen public hospitals The reform of the internal remuneration system further mobilized the enthusiasm of medical staff, and incorporated the implementation of DRG collection and payment into the performance appraisal of the deans of public hospitals
.


　　Encourage Appropriate Technology The
"Notice" clearly supports the use of appropriate technology in DRG pilot hospitals to improve medical quality and improve patient experience.
New technologies and new projects provided within the standard fees of the DRG group include appropriate technologies for which project fees have not yet been specified.
Pilot medical institutions can According to relevant medical management regulations, you can choose to use it independently, and upload the diagnosis and treatment items (item code XJS000001) or medical consumables (item code XJS000002) and other information according to the regulations
.
The appropriate technology independently selected by the Dian Hospital is only used as the cost of the DRG group, and the pilot hospitals shall not charge the patients separately
.
Promote the orderly advancement of DRG collection and payment reforms, explore the formation of multiple payment methods for medical insurance, develop regional total budgets and point-based payment (DIP) pilot areas for DRG collection and payment pilot hospitals, and medical insurance departments should implement separate DRG collection and payment medical insurance totals The budget requirements have promoted the orderly advancement of the DRG collection and payment reform, explored the formation of multiple payment methods for medical insurance, and improved the efficiency of the use of medical insurance funds
.
All coordinating districts should carefully sort out and calculate the supporting payment policies for DRG collection and payment medical insurance, and do a good job in the balance and connection of employee medical insurance and urban and rural residents’ medical insurance with previous benefits.
In principle, the proportion of DRG collection and payment coordinating fund payment should not be lower than the original payment method for insurance.
The actual reimbursement ratio of personnel protects the rights and interests of the insured
.
Fujian: Gradually expand the scope of reforms, and DRG collections and payments will cover tertiary public general hospitals.
On May 18, 2021, the Fujian Provincial People’s Government issued the "Opinions on Further Deepening the Reform of the Medical and Health System", clarifying that it will expand the groupings related to disease diagnosis (DRG).
) The scope of the reform of collection and payment, to achieve full coverage of tertiary public general hospitals , and gradually expand to other hospitals where conditions permit
.
While Xiamen and other four districts and cities are implementing disease-based or DRG-based fees, they will also carry out pilot projects for total regional point-based budgeting and disease-based value-based payment (DIP); promote the national pilot program for DRG fees in Nanping City
.
Improve the packaged payment for medical insurance of the county medical community, and clarify the specific methods for retaining the balance and sharing the reasonable over-expenditure
.
On February 15, 2020, three public hospitals including Union Hospital Affiliated to Fujian Medical University, Fuzhou First Hospital, and Xiamen University First Affiliated Hospital implemented the reform of collecting and paying fees according to the diagnosis-related group (DRG)
.
In addition, according to the work deployment of the Fujian Provincial Medical Insurance Bureau, it is expected that in the future, the scope of reform will be expanded to five tertiary public hospitals, including the Fujian Provincial Hospital, the First Affiliated Hospital of Fujian Medical University, and the Fujian Provincial Tumor Hospital
.