Why does health care reform emphasize that hospitals need to reform performance?

Why does health care reform emphasize that hospitals need to reform performance? Yufang Medical Management Founder and Consultant: Qin Yongfang On March 5, 2020, the State Council of the CPC Central Committee issued the Opinions on Deepening the Reform of the Medical Security System (hereinafter referred to as the Opinions), which clearly called for reforming the current departments and personal accounting methods, improving the personnel compensation system that is compatible, flexible and efficient, and conforming to the characteristics of the medical industry, and improving the performance appraisal and distribution system.
1, the current mainstream hospital performance accounting method advantages and disadvantages Of the current mainstream hospital performance accounting, to the balance of income and expenditure or project point value-based two major accounting methods, these two accounting methods and medical insurance after-payment, the advantages and disadvantages are very obvious.
(1) Income and expenditure balance deduction performance accounting method advantages and disadvantages Formula: performance pay , medical income - expenditure - balance × % advantages: large receipts and decreases, balance of the performance, accounting method is simple and clear, easy to understand, incentive effect is obvious, driving income increase, high contribution to the hospital economy.
: reflects the over-receiving and over-receiving, because the price of medical charges is unreasonable, can not fully reflect the technical difficulty, the degree of risk and labor intensity and other value of medical care, easy to promote expensive medical care, and the reform of the medical insurance payment system is contrary.
(2) Medical project point value performance accounting method advantages and disadvantages Formula: performance pay - number of medical items× medical project point value - select cost advantages: partially reflects the medical project risk difficulty factor, to guide the improvement of medical service capacity has a certain contribution;
2, the "big five" reform of medical insurance affects hospital performance "Opinion" put forward, gradually put out-patient medical expenses into the scope of the basic medical insurance co-ordination fund to pay, reform the basic medical insurance personal accounts of workers, establish and improve the mechanism of out-patient mutual assistance.
Analysis: With the case of outpatient reimbursement, patients are willing to cooperate with doctors in hospital treatment, reduce the cost of medical care, with the National Health Insurance Administration "on the establishment of a sound basic medical insurance outpatient co-payment guarantee mechanism (draft for comments)" stressed that improve the characteristics of outpatient care payment mechanism.
Primary health care services can be paid per head, actively explore the combination of head-to-head payment and chronic disease management, day surgery and eligible outpatient special diseases, the implementation of pay by disease and disease diagnosis-related groups, and not suitable for packaging and payment of outpatient fees, can be paid by project.
to speed up the development of medical insurance drug payment standards, to guide medical institutions and patients to take the initiative to use the efficacy of accurate and reasonably priced drugs.
individual account reform, the implementation of outpatient co-ordination payments, patients will balance the time cost of outpatient and inpatient, energy costs, emotional costs and monetary costs, many inpatient diseases will be transferred to outpatient treatment.
challenge to the current hospital performance over-reflecting the incentive of hospitalization.
opinion points out that the use of funds for medical security funds and public health services should be coordinated, the proportion of payments to primary medical institutions should be increased, and the effective convergence of public health services and medical services should be achieved.
: With the integration and integration of medical security funds and public health service funds, the "pool" of primary health insurance funds has been expanded, and the role of payment guidance is more obvious.
with the advance of the medical community, increasing the performance pay incentive of primary medical institutions will effectively encourage primary health care institutions to improve their "medical service capacity", and the phenomenon of delaying referral of patients will gradually decrease.
will have a partial impact on the current number of hospital visits, and the decline in the number of patients will affect the total revenue and performance of hospitals.
"Opinions" clearly, the formulation of fixed-point pharmaceutical institutions to fulfill the agreement assessment methods, highlighting the code of conduct, service quality and cost control assessment and evaluation, improve the fixed-point pharmaceutical institutions exit mechanism.
the direct settlement of medical insurance funds and pharmaceutical enterprises, and improve the coordination mechanism between medical insurance payment standards and centralized procurement prices.
Analysis: The 15th meeting of the Central and Deep Reform Commission adopted the Guidance on Further Standardizing Medical Behavior to Promote Rational Medical Examinations, emphasizing that further standardizing medical behavior and promoting rational medical examination should start with regulating the behavior of medical subjects, increase supervision and management of the behavior of medical institutions and medical personnel, strengthen technological innovation, promote resource sharing, promote comprehensive reform of medical management system, operating mechanism, service price and performance distribution, and promote the construction of industry style.
On June 30, the General Office of the State Council issued guidance on promoting the reform of the regulatory system for medical security funds, noting that it actively promotes the development of medical and health industry organizations and guides and supports their better role in formulating regulatory norms and technical standards, regulating practices and management services, and promoting self-discipline in the industry.
strengthen the guidance and examination of clinical diagnosis and treatment behavior in designated medical institutions, and strengthen the supervision in the event and in-process.
deepen the reform of the supply side of medical services.
speed up the comprehensive reform of public hospitals, establish and improve the modern hospital management system, and standardize the behavior of diagnosis and treatment.
the current hospital performance incentive "do more projects, more income" more accounting model presents a greater challenge.
The Opinion emphasizes the implementation of multi-composite medical insurance payment methods based on disease-based payment, the promotion of pay-per-view group payments for disease diagnosis, medical rehabilitation, chronic mental illness and other long-term hospitalization pay-per-bed, outpatient special chronic diseases pay-per-head.
to explore the separation of medical services from medicines.
to adapt to the development and innovation of medical service model, improve the payment method and settlement management mechanism of medical insurance fund.
To explore the implementation of total payments to close-knit medical complexes, strengthen supervision and assessment, balance retention, reasonable overspend sharing, conditional areas may advance part of the medical insurance funds to medical institutions in accordance with the agreement, to ease the pressure on the operation of their funds.
Analysis: Health insurance payment system reform is a sword, DRG or DIP prepaid system reform, the current performance is mainly reflected in the "income-centric", incentive-oriented "do more projects, multi-income" more performance direct challenges, there may be incentives to do more projects more income, health insurance do not pay the performance of the "double-loss era", forcing hospitals to "raise the cost of efficiency", in line with the new era of health insurance payment reform.
opinions, regulate the practice of medical institutions and medical personnel, implement a prescription review system, and promote rational drug use.
strengthen the internal specialization and fine management of medical institutions, improve the scientific and reasonable assessment and evaluation system, and link the assessment results with the payment of medical insurance funds.
reform the current department and personal accounting methods, improve the incentive compatible, flexible and efficient, in line with the characteristics of the medical industry personnel compensation system, improve the performance appraisal and distribution system.
Analysis: Based on the limited nature of the health insurance fund, is the people's life-saving money, is the biggest people's livelihood, that is, the biggest politics, so the CPC Central Committee and the State Council attach great importance to the hospital reform of the current department and personal accounting methods.
hospitals must adjust the current way of performance accounting, and the new era of medical reform to adapt.
3, how to match the hospital performance reform to design the reform of the medical insurance system, the current performance accounting challenges for hospitals are high, hospital performance is facing "five high", hospital performance reform should be matched.
(1) hospital performance is facing "five high" one high, medical reform policy risk pressure is high.
The requirements of the new medical reform policy clearly stipulate that the personal remuneration of medical personnel should not be linked to income, the reality of hospital performance system and income there is a continuous "inextricably linked", the president is facing policy risks everywhere, there is "high policy risk."
second high, with the progress of society and the improvement of people's economic income level, the people's demand for medical services is increasing, in the face of patients' unlimited demand for medical and health care, medical quality and human services, patient demand is improving.
high, health care monitoring pressure is high.
Hospitals in the limited medical insurance limit, the need to complete the task of medical services, coupled with the medical insurance supervision and payment audit efforts, resulting in medical insurance deductions, fines "pressure mountain", in the face of insufficient medical insurance funds, resulting in the hospital health insurance settlement rate reduced pressure.
: High expectations for medical staff.
Because of the long training cycle, high occupational risk, labor intensity, heavy responsibility, pay treatment can not fully reflect the value, and urgently improve pay treatment, in the face of high salary expectations of employees pressure, and thus affect the stability and loss of talent.
high: Hospital cash crisis high.
hospital public welfare return, profit-seeking is limited, coupled with the impact and impact of the epidemic, the hospital cash flow crisis, to face the pressure of cash flow shortage.
(2) How to match the hospital performance reform the general trend of medical reform is unstoppable, the hospital should follow the trend to force, change the pressure as the driving force, change the crisis into the early layout, speed up the performance reform supporting design, mobilize enthusiasm, realize the harmonious interaction between the hospital and the society, is the true meaning of sustainable development.
performance management mode of performance is the establishment of Yufang Medical Management Research, adopts the integral performance management model, adopts the BSI-KPI comprehensive index method, embodies the characteristics of the medical industry, adapts to the value of medical insurance DRG. DIP payment system reform, in line with the new era of medical reform.
Hospital performance personality design "5 big treasure" is a good choice of points indicators, around the job workload, technical difficulty, risk level, cost control, service satisfaction, science and research, MDT, multi-dimensional, multi-parameter selection indicators, second, the main (first consultation) physician performance to support;
Three is to manage the performance design well, manage the benefits, through the section director, the head nurse goal management assessment, the top-level design management performance, correct both when the athlete and the referee performance secondary distribution problem, but also more reflect the management value.
Fourth, KPI assessment indicators should be refined and less, select key KPI assessment indicators, to connect with the national performance test indicators, and health insurance payment policy, not all-encompassing, to be refined and less, select key and important quantitative indicators monthly assessment.
addition and subtract from daily defects and individual assessments, and use balanced points annually for goal management performance.
5 is the incremental quality gradient incentive clever, performance reform to mobilize enthusiasm, stock performance reform is difficult, incremental reform is easy to implement, take incremental quality improvement and cost-effectiveness ladder incentive, resolve the contradiction of performance reform, leading to the "forward" look.
gradient incentive index includes: outpatient-to-discharge ratio, out-patient surgery, minimally invasive number of discharged patients, third- and fourth-level surgery, CMI value, medical income ratio, cost control contribution, etc.
In short, the reform of the medical insurance system detonates the change of hospital performance, the hospital needs to seriously analyze and study, combined with the specific actual situation targeted, in the framework of policy permission, from the incentive extensive increase in income to stimulate the connotation of quality benefits, to improve the ability of medical services to benefit, to cost control to benefit, to higher patient satisfaction to benefit, give full play to the role of performance baton guidance, to achieve high-quality hospital development, is the core theme of eternal performance management, absolutely can not run.
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