The first in the country! Anhui introduced a DIP guidance program for 7 cities pilot

Author| Qin Yongfang February 1, 2021, Anhui Provincial Health Security Bureau, Anhui Provincial Health And Health Commission, Anhui Provincial Finance Department issued the "Anhui Province basic medical insurance regional points of the total budget and pay by disease value pilot work guidance program" notice issued, this is the State Health Insurance Bureau on the DIP program issued, the first province in the country to issue DIP documents, instantly caused widespread concern in the industry|
impact of the DIP pilot on hospitals in the province? What are the challenges to hospital management? How will the national DIP trend develop in the future? "Look at the medical profession" for you to interpret as follows.
policy frequently, DIP national pilot promotion October 14, 2020, the Office of the State Health Insurance Administration issued the "regional points law total budget and pay according to the disease sub-value of the pilot work programme notice", the notice clearly, from March 2021, qualified areas for the record can start the actual payment, by the end of 2021, all pilot areas into the actual payment phase.
half a month later, on 3 November 2020, the Office of the National Health Insurance Administration (SSSA) identified 71 pilot cities nationwide with a notice on the issuance of a total budget for the regional points law and a list of pilot cities paying for disease-based points.
less than a week, on November 9, 2020, the Office of the National Health Insurance Administration issued the National Health Insurance Pay-as-You-Go (DIP) Technical Specifications and THE DIP Disease Directory (1.0) Version) of the notice, requiring the "disease library" to distinguish the main directory into nearly 11553 groups of core diseases, 2499 groups of integrated diseases, the pilot cities of the disease catalog of the grouping rules and the "disease library" consistent.
December 9, 2020, the Notice of the Office of the National Health Insurance Administration on the Establishment of a Total Budget for the Regional Points Act and a Pool of Experts payable by Disease Score (DIP) was issued, in accordance with the Total Budget of the Regional Points Act and by Disease A total of 200 experts were selected for the total regional points budget and the DIP Expert Pool (2021) list of pilot work arrangements for value- split payment (DIP) after voluntary declaration and selection according to procedures.
the first in the country! Anhui issued the DIP guidance program On February 1, 2021, Anhui Provincial Medical Security Bureau, Anhui Provincial Health and Health Commission, Anhui Provincial Finance Department issued a notice on the issuance of the "Anhui Province Basic Medical Insurance Regional Points Law Total Budget and Pay by Disease Value Pilot Work Guidance Program" (Medical Insurance Secretary (2) 021 No. 9, hereinafter referred to as the "Guidance Program"), which is the first province in the country issued a DIP document, in the national pilot Wuhu, Huainan, Puyang, Ceju, Xuancheng, Huangshan City and provincial pilot Anqing City 7 cities to carry out DIP pilot.
"Guidance Program" clearly, regulate the payment process by disease score.
First, to reasonably determine the annual regional total budget indicators;
the Guidance Program emphasizes that it is effectively connected with the county medical bodies.
first, select the types of diseases that are accepted at the grass-roots level, and select the list of diseases suitable for treatment in township hospitals (community hospitals) or primary medical institutions, county-level hospitals or secondary medical institutions.
the suitable collection and treatment of primary medical institutions should include suitable day beds (including appropriate chinese medicine technology) for the treatment of diseases, the score of primary medical institutions should remain relatively unchanged in principle, not affected by the grade coefficient of medical institutions.
Second, implement the county medical union "packaging" payment, according to the county area in the current year's estimated total fund-raising after the withdrawal of risk funds, transfer funds, major disease insurance and other funds 95% according to the total amount of "packaging" budget to the county medical union, the implementation of balance retention, reasonable overspend sharing.
Third, improve the assessment mechanism of the county medical union, select the relevant monitoring indicators for the payment of medical insurance of the county medical union, and assess according to the new part of the monitoring index required by the DIP work, and the results of the assessment can be used as a reference basis for the adjustment of the coefficients of medical institutions and the use of transfer money.
performance motivates change! Hospitals will welcome five points to affect the seven pilot cities in Anhui Province to fully implement DIP, the pilot area of the hospital what impact? What are the challenges to hospital management? The author believes that there will be the following impact worthy of hospital management focus.
The first big impact: do more projects to influence the traditional performance incentive, according to the project point value incentive to do more projects more performance, generally take RBRVS or project point value to calculate performance, health insurance DIP payment is based on prepaid, do more project health insurance do not pay, the hospital also has to pay the department performance, resulting in "increased income does not increase efficiency", into the "double loss era."
has a significant impact on the hospital's current performance incentive to do more projects.
the second major impact: multi-income impact on traditional performance incentives, generally take the balance of income or cost accounting method, through income increase to achieve more performance, easy to guide medical personnel over-medical treatment, over-examination to increase income.
, overtreated and over-examined, not only does it not bring benefits to hospitals, but they also cost them more.
has a significant impact on the hospital's current performance incentive multi-income accounting method.
The third major impact: the impact of the average cost control of traditional medical insurance in accordance with the project to pay, combined with the second average cost assessment control, the hospital also took the second average cost assessment to control the medical insurance overspend deduction, resulting in the reverse choice of departments, dare not receive major illnesses or serious illnesses, the treatment of relatively light patients, bringing the lack of medical services capacity.
DIP payment is based on the principle of homogeneity and homogeneity of the same disease and treatment of value medical treatment, the main reference is based on the value of medical services, which has a significant impact on the performance appraisal of the hospital's current average cost.
Four major impact: the impact of lightweight hospitals currently pay too much attention to the number and income indicators, DIP payment, not only need the number, but also need to pay attention to high-score diseases, all directly affect the health insurance payment settlement, the hospital's current lightweight management brings major challenges.
the fifth major impact: extensive cost accounting impact of the current cost accounting generally implement department cost accounting, did not carry out disease and project cost accounting, cost control is relatively extensive.
DIP payment is based on the prepaid disease, directly determines the hospital income, under the condition of relative control of income, the hospital fine disease cost accounting and control presents a great challenge.
hospital management ushered in 5 challenges along with DIP brought about by the performance appraisal incentive changes, the traditional medical management model is also gradually micro, in the face of the new medical insurance payment methods, hospital management will also usher in five major challenges.
First challenge: Medical service capacity challenge Although hospitals at all levels have a patient out-of-payment threshold and out-of-payment ratio, in the face of personal life safety, as well as lack of medical knowledge, patients are most concerned about medical technology and quality, all want to obtain quality medical services, hospitals should pay more attention to improve medical service capacity, improve technical level, ensure the quality of medical safety, is the first element of hospital competitiveness.
is also at the heart of competition between hospitals.
The second biggest challenge: the big challenge of medical efficiency in the face of DIP payment, is based on pre-payment, disease income is relatively stable, which requires hospitals to strive to shorten hospital days, improve bed turnover, reduce the cost of secondary hospitalization and other measures to improve medical efficiency, in order to obtain better benefits.
the DIP payment will inevitably lead to hospitals to pay attention to the great challenge of improving medical efficiency.
the third major challenge: cost accounting control capacity challenges DIP payment hospital revenue meet the ceiling, how can hospitals get better income, how to do a good job of DIP disease cost accounting, calculate which DIP losses? What DIP is profitable? How to ensure the quality of medical care under the premise of controlling and reducing the cost of diseases, the challenges to hospitals greatly increased, cost control is not good may be serious losses.
the challenge of enabling hospital cost accounting and control.
The fourth major challenge: patient satisfaction challenges DIP payment, hospitals to obtain better returns on the premise that a certain number of patients need to ensure support, hospital services convenient and fast, high patient satisfaction, can drive more patients to hospital.
, DIP drives hospitals to strengthen lean operational management, expand word-of-mouth benefits by improving patient satisfaction, enhance hospital brand competitiveness, and empower hospitals to innovate "patient-centric".
The fifth major challenge: Under the post-payment system of the performance design challenge project, the main way of hospital performance incentive is to adopt the way of income and expenditure balance or project point value, to stimulate multi-income, multi-project performance, to face DIP prepaid, to drive the iterative upgrading transformation of performance design, and to challenge the performance transformation of hospitals to comply with DIP.
the first shot in Anhui! DRG and DIP will be "double stag" as the health care payment system reform DRG and DIP two important ways, DRG and DIP "double stag."
province of Anhui started the first shot of DIP health insurance payment, the future trend of the national DIP trend? There are three big prognosmations.
First prejudgment, DIP medical insurance payment faster promotion of "big probability" DIP in the concept and operation method, in line with national conditions, basic objective reflection of clinical reality, not only applicable to health insurance governance, promote health reform, public hospital management and many other areas, compared with DRG, the key is to have open, transparent, easy to understand, simple and cheap, and so on, therefore, pre-judged DIP health insurance payment in the country to promote the rapid promotion of "big probability."
Second Prejudgment, the development of big data accelerates the reform of DIP medical insurance payment with the application of big data technology analysis, China's institutional advantages make medical insurance medical data fully gathered, for the combination of diseases "random" "average" laid the foundation conditions.
changed the simulation, prediction and even actuarial mode of DRG sample calculation population, DIP used real and full data to objectively restore the disease characteristics and medical behavior of the disease, through the discovery of disease common characteristics and personality change law, establish the "measurement and measurement" system of medical services, more objective fitting cost, calculation of points, settlement payment, the application of big data technology to form an important technical support for the reform of medical insurance payment methods, and help the hospital management foundation and information construction is not high.
Third, the medical insurance DRG and the medical DRG "in one" current DRG, there is the medical insurance version DRG and medical DRG, the medical insurance version DRG focus on payment function, the medical version DRG focuses on the medical service capacity evaluation function, an impact on the hospital "ticket", an impact on the hospital "face", so that the hospital "anxiety".
the future trend of DRG is bound to be "one in one", health care authorities are responsible for DRG medical performance and service capacity assessment and evaluation, for medical insurance payments to provide reference data basis.