Two ministries and commissions: Organize the centralized procurement of high-value medical consumables (artificial joints)

On March 31, the National Medical Insurance Administration and the National Health Commission jointly issued opinions on the centralized procurement and use of supporting measures for high-value medical consumables (artificial joints) organized by the state
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The opinion proposes that the selected products in the centralized procurement of artificial joints shall be paid with the selected price including accompanying service fees as the payment standard, which shall be included in the scope of medical insurance payment, and the medical insurance fund shall pay according to the prescribed proportion
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If the non-selected artificial joints are covered by the medical insurance fund, all localities should take measures to gradually adjust the payment standard within two years to not exceed the highest selected price of the selected products in the same group of centralized procurement
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Insured patients use products whose price exceeds the payment standard of medical insurance, and the part exceeding the payment standard shall be paid by the patient
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All localities should consider the setting of online price, patient self-payment ratio and medical insurance payment standard in an overall manner to avoid increasing the burden on patients
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The original text is as follows: Opinions of the General Office of the National Health and Health Commission of the Office of the National Medical Insurance Bureau on the Centralized Procurement and Use of Supporting Measures for High-value Medical Consumables (Artificial Joints) organized by the State Medical Insurance Office [2022] No.
4 Production in provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Construction Corps Medical Insurance Bureau and Health and Health Commission: In order to implement the decision and deployment of the Party Central Committee and the State Council on the full implementation of centralized procurement of high-value medical consumables, the state-organized centralized procurement of artificial joints (hereinafter referred to as "artificial joint centralized procurement") will be implemented smoothly.
) selected results, ensure the timely supply of the selected products, promote the standardized use of centralized collection varieties by medical institutions, and standardized provision of relevant medical services, and formulate these opinions
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1.
The overall requirements should be closely combined with the characteristics of artificial joint procurement, distribution, use and accompanying services, give play to the role of medical insurance funds in the strategic purchase, strengthen policy coordination, and make full use of centralized procurement platforms, prepayment of medical insurance funds, medical insurance payment policies, and medical service price adjustments.
, incentives and restraints for medical institutions, etc.
, to promote the stable implementation of the results of the centralized procurement of artificial joints, to achieve the goals of benefiting the people, incentives for medical institutions and medical personnel, and high-quality development of the pharmaceutical industry
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2.
Standardize the work and price of product listing on the Internet.
The selected products (hereinafter referred to as "selected products") are listed on the provincial centralized pharmaceutical procurement platforms at the selected prices of "including accompanying service fees" and "excluding accompanying service fees".
Internet, delivery, surgical tools and other related costs are included in the selected price
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Accompanying services include providing compliant "follow-up" services, assisting in assembling tools, necessary tool usage guidance, surgical operation training, etc.
Non-surgical personnel should be strictly restricted from entering the operating room
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The medical institution chooses whether it needs the company to provide accompanying services according to the actual situation, and pays the corresponding price
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Public medical institutions (including military medical institutions, the same below) will be charged according to the selected price including accompanying service fees.

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Medical institutions and third-party institutions are not allowed to charge additional fees to selected enterprises during hospital admission, inventory and other links
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If the non-selected artificial joint products include the selected product components, they will be listed at the selected price of the component, and other components can be reasonably set based on the actual transaction price.
Restrictions, and guide relevant enterprises to gradually adjust the price to a reasonable level
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If each part of the non-selected artificial joint product is composed of different parts of the selected product, the total price shall not be higher than the price of the selected product of the same category of the enterprise
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For hemi-hip prosthesis and unicondylar prosthesis products, you can refer to the selected price of the full set of hip joint and knee joint products, and hang the net according to the principle of matching performance and price
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3.
Implementing the policy of prepayment of medical insurance funds Local medical insurance departments should organize medical institutions to sign purchase agreements with selected enterprises in a timely manner
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All coordinating regions shall calculate the agreed purchase amount in a timely manner according to the selected prices of the selected products, the purchased products and quantities agreed upon in the agreement between each medical institution and the enterprise
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On the basis of the total budget management of the medical insurance fund, a prepayment mechanism is established.
After the medical institution signs a purchase agreement with the selected enterprise, the medical insurance fund shall be prepaid to the medical institution at a rate of not less than 30% of the annual agreement purchase amount.

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Medical institutions should settle the payment with the enterprise in a timely manner, and the settlement time should not exceed the end of the next month when the consumables are used
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The medical insurance agency shall settle the settlement with the medical institution in a timely manner and allocate the medical insurance fund in a timely manner
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On the premise of implementing the main responsibility of medical institutions for payment for goods, encourage medical insurance funds to settle directly with pharmaceutical companies
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4.
Do a good job in the connection of medical insurance payment policies The selected products for the centralized procurement of artificial joints shall be paid according to the selected price including accompanying service fees, which are included in the scope of medical insurance payment, and the medical insurance fund shall pay according to the prescribed proportion
.
If the non-selected artificial joints are covered by the medical insurance fund, all localities should take measures to gradually adjust the payment standard within two years to not exceed the highest selected price of the selected products in the same group of centralized procurement
.
Insured patients use products whose price exceeds the payment standard of medical insurance, and the part exceeding the payment standard shall be paid by the patient
.
All localities should consider the setting of online price, patient self-payment ratio and medical insurance payment standard in an overall manner to avoid increasing the burden on patients
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5.
Implement the policy of surplus retention and coordinate the adjustment of medical service prices.
Provincial medical insurance departments should follow the requirements of the "Guiding Opinions on Carrying out the Centralized Procurement and Use of High-value Medical Consumables Organized by the State" (Medical Insurance [2021] No.
31), refer to The state organizes the practices related to the retention of medical insurance fund balances in centralized drug procurement, and guides coordinating regions to improve the rules for the retention of medical insurance fund balances
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In areas where DRG/DIP payment method reform is carried out, the weight score of the corresponding DRG/DIP group will not be adjusted in the first year.
Subsequent adjustments should take into account changes in labor costs and consumables costs, and increase or decrease it scientifically and reasonably
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All incentives should be well connected to avoid duplication.
All localities should guide medical institutions to improve the implementation of internal assessment methods for surplus retention, transmit incentive policies to medical staff, and encourage rational, standardized, and prioritized use of selected products
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According to the dynamic adjustment mechanism of medical service prices, in 2022, the total price adjustment can be tilted towards the surgical items related to artificial joint replacement in areas that are eligible to trigger price adjustment after assessment in 2022
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In areas with a large proportion of inter-provincial patients with joint replacement, and the price of core items such as "artificial joint replacement" is significantly lower than the national median price and the price of surrounding provinces, the price of related items can be adjusted specially
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Public medical institutions that use intelligent systems such as "surgical robots" to assist surgical operations, adhere to the principle of balancing labor value and equipment contribution, and matching charges with functions, and use the "artificial joint replacement" project according to the actual function of the intelligent system.
The price is based on a certain percentage of increase, and no separate charging items are set up
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6.
To ensure the stable supply of the selected products.
All localities should consolidate the supply and distribution responsibilities of the selected enterprises and distribution enterprises, strengthen the connection between supply and demand, strictly implement the independent selection of the selected product distribution enterprises by the selected enterprises to carry out distribution, and coordinate the establishment of the selected enterprises, distribution enterprises and medical institutions.
delivery relationship
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The selected enterprises and distribution enterprises should timely distribute the selected products according to the needs of medical institutions, provide special surgical tools and accompanying services, and ensure clinical use
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7.
Standardize the procurement and use behaviors of medical institutions Medical institutions should unblock the channels for the selected products to enter the hospital, and complete the agreed procurement volume on time.
After the agreed procurement volume is completed, they should give priority to the procurement of selected products of high quality and reasonable price from the perspective of clinical rational use
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Medical institutions should adapt to the new post-purchase distribution mechanism, strengthen the capacity building of procurement and inventory management, improve the efficiency of information transmission and procurement operation, and realize the refined management of the preparation, use, inventory, replenishment and other links of medical consumables in the hospital.
good service
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The National Medical Center and the national and provincial regional medical centers should strengthen the guidance on the standardized operation of joint replacement surgery in the covered areas, improve the medical capacity of joint replacement surgery in medical institutions at all levels, increase retraining efforts, and provide high-quality services to patients
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All localities should focus on the clinical use of centralized procurement of consumables, incorporate them into the medical service management system to strengthen supervision, and strengthen medical institutions to strictly implement relevant diagnosis and treatment guidelines, technical operation standards, etc.
, adhere to the principles of safety, effectiveness, economy and appropriateness, and rationally choose treatment methods.
Reasonably determine the variety and quantity of consumables
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8.
Supervision and implementation All localities should closely monitor the performance of the selected companies, including product supply, distribution, special tools and accompanying services, and include selected companies that fail to perform well and are punished for illegal acts such as commercial bribery into the price of medicine and the credit of recruitment Evaluate records and impose appropriate sanction according to the severity
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In accordance with the requirements of "monthly monitoring and annual assessment", monitoring and supervision shall be carried out on the timeliness of medical insurance fund allocation, the progress of medical institutions' implementation of agreed procurement volume and the situation of payment collection
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The implementation of procurement agreements by medical institutions shall be included in the assessment of public medical institutions and the performance assessment of designated medical institutions for medical insurance
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All localities should deeply understand the importance of the state's organization of the centralized procurement and use of artificial joints, enhance the sense of responsibility and mission, effectively strengthen organizational leadership, implement relevant supporting measures, and steadily promote the implementation of centralized procurement results
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It is necessary to strengthen the interconnection and real-time sharing of procurement and use data
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If major problems are encountered in the implementation of local regulations, they should be reported to the National Medical Insurance Bureau and the National Health and Health Commission in a timely manner
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