Payment reform, the case has been transformed from a mere record of medical behavior into a basis for performance management, a basis for disease competence, a basis for ranking the competence of doctors, and a basis for the settlement of funds with health insurance.
To fully utilize the value of medical records and to elevate the importance of case quality control to a new level, it is important to ensure that the ICD codes, the core of the case, are true and accurate.
The use of intelligent coding can improve coding accuracy and efficiency and help case quality control.
2. At the level of hospital cost management
The root of lean management is cost management, and the core of market-based competition is cost competition. Therefore, reasonable cost control has become the key to the survival and development of hospitals in the new era.
DRG, as a medical standardized management tool, can promote the medical parties to collaborate in controlling the rational use of medical costs and effectively control the excessive growth of costs. The core idea of lean cost management is to "calculate clearly, set standards, control well and rationalize" to achieve the development of specialty operations, optimization of disease structure, payment reform and other value creation.
The core idea of lean cost management is to "calculate, standardize, control and rationalize"
"Calculate" means to calculate the DRG cost and to figure out the real resource consumption of DRG groups; Setting standards" means that cost reduction requires reasonable standards, i.e., both quantitative and quantitative standards; "controlling" means controlling the implementation process through systems, communication, training, approval, assessment and other management tools; "rationalization" means that cost reduction is the core idea of Lean Cost Management. Rationalization" that is, to reduce costs to ensure the quality of medical services at the same time, and improve efficiency is an effective means of reducing costs.
3. At the level of specialized lean management
Under the payment method reform, the specialized lean management is to match the medical effect and rate demand of patients in different situations, and to achieve the goal of optimizing resource consumption and improving clinical efficiency.
First of all, it realizes the whole life cycle operation management of cases with pre-diagnosis assessment, process medical resource optimization, and post-diagnosis evaluation;
Secondly, it combines the clinical management and operation management with the dimension of DRG groups or diseases, which is able to achieve the balance of medical quality and cost-effectiveness.
Finally, data-driven optimization of clinical pathways.
Clinical paths were originally developed by experts, but now DRG uses data to drive the formation of clinical paths, and is able to manage medical behaviors, which also means that data-driven optimization of clinical paths is also an important means of safeguarding medical safety and quality of care.