What are Diagnosis Related Groups (DRGs)

DRGs (DiagnosisRelatedGroups) is recognized as one of the more advanced payment methods in the world today, known as Diagnosis-Related Groups (DRGs), which is a patient classification scheme and a classification and coding standard specifically used in the Medicare Advance Payment System. It classifies patients into 500-600 Diagnostic Related Groups (DRGs) based on the patient's age, gender, number of days of hospitalization, clinical diagnosis, disease, surgery, severity of disease, comorbidities and complications, and regression, etc., and makes scientific measurements on the grading to grant a fixed amount of prepayment. In other words, DRGs is a payment system in which the medical insurance organization reaches an agreement with the hospital on the payment standard of the disease, and when the hospital admits and treats the patients who are enrolled in the medical insurance, the medical insurance organization pays the hospital the prepayment standard of the disease, and the hospital bears the exceeding part of the payment system. This payment method takes into account the interests of patients, hospitals, health insurance and other parties. Its effects are: controlling costs, ensuring quality and improving management. Such as incentives for hospitals to strengthen the quality of medical management, forcing hospitals to take the initiative to reduce costs in order to obtain profits, shorten the number of days of hospitalization, reduce the payment of induced medical expenses, which is conducive to cost control. This also brings a change to hospital management, promoting the development of hospital quality management, economic management, information management and other disciplines, emerging like clinical path, strategic cost management, digital hospital and other advanced management methods. Second, the advantages of DRGs DRGs is a kind of payment method which is considered to have more advantages and fewer disadvantages in the international arena, and DRGs not only provides an important database for health insurance reform, but also provides practical measures for further comprehensively grasping the real situation of hospital inpatient medical consumption, and also lays the foundation for researching and formulating the method of controlling over-servicing of medical care, which can determine the amount of different medical outputs according to the different types of patients' illnesses, different conditions, different medical needs, and different treatments. It can determine different medical outputs according to patients' different diseases, conditions, medical needs, treatments, etc., and it can reflect the diagnosis and conditions of diseases as well as the medical resources and medical technologies invested in medical services. In the reform of the medical insurance system, the DRGs price standard is used as the basis of prepayment to hospitals by insurance agencies, which enables hospitals to know the maximum limit of resource consumption before providing medical services, and thus hospitals must control the level of consumption within the payment standard of the DRGs to have a surplus, or else they will have a loss. the payment standard of the DRGs has become the threshold of the project's profit and loss, which will mobilize hospitals to provide services, explore potentials and save money. The DRGs payment standard becomes the threshold of profit and loss of the program, thus mobilizing hospitals to be active in providing services, cutting potentials and saving money, improving diagnosis rate and shortening hospitalization days, so as to improve efficiency and ensure quality. At the same time, the high or low payment standard of DRGs is also an important basis for the demand side to choose the designated hospitals, thus it is also conducive to the introduction of the competition mechanism, forcing hospitals to seek survival and development in the competition. According to the experience at home and abroad, it is feasible to study DRGs suitable for China's national conditions or regional realities as a prepayment system for medical expenses.?　As can be seen from the above, DRGs payment method can prompt hospitals to strengthen preventive health care, reduce morbidity; more comprehensive and effective control of disease diagnosis and treatment costs, and effective control of medical costs. the implementation of DRGs has far-reaching significance in improving the basic quality management of hospitals: it is conducive to the conservation of limited health resources; it is conducive to the improvement of the quality of medical care; it is conducive to the consolidation and improvement of China's urban and rural is tending to be a sound medical insurance system; it is conducive to curbing the unreasonable medical insurance costs. The application of DRGs payment method also has certain significance to improve the management level of China's hospitals: single-patient management can ensure the quality of medical care by strictly controlling the average number of days of hospitalization and medical safety indexes; it can summarize the types of illnesses and charges, and control the rate of hospitals in arrears; the use of single-patient payment during the period of hospitalization can control the cost of medical care, and make the cost of medical care tend to be higher than that of other hospitals, so that the cost of medical care can be reduced to a certain level. At the same time, by strengthening the cost accounting, strengthening the management of doctors, reducing the proportion of drug costs to control the cost of single disease, thereby improving the competitiveness of the hospital itself. Third, the shortcomings of DRGs DRGs in the process of implementation also appeared some negative impacts: First, hospitals in order to reduce the actual length of stay of patients, increase outpatient services, which leads to outpatient costs rise, so that the total cost of health services has not been well controlled; Second, the hospital in the diagnostic process, there is a tendency to charge a high diagnosis of the disease climbing; Third, it may be induced to health care providers to choose a low-risk, low-cost, and low-paying hospitals, which is not the case. Thirdly, it may induce medical service providers to select low-risk groups to be insured and shirk patients with difficult and serious illnesses; fourthly, some hospitals are forced to cancel certain clinical service programs that are of high investment and really needed by the society due to the reduction of income; fifthly, there are problems such as the quality of hospital services decreasing, the motivation of medical service providers decreasing, and the impediment of technological advancement, and so on. In addition, there are controversies about the categorization of DRGs. Diagnosis Related Groups (DRGs) Q&A1 What is DRGs? A: DRGs is Diagnosis Related Group System, which is a classification scheme based on patient's diagnosis; it links the hospital's treatment of the patient with the costs incurred, thus providing a basis for the development of payment standards, especially the implementation of prepayment.2 What is DRGs? A: DRGs-PPS is the Prospective Payment System based on DRGs, which is a method of making payment standards for each group on the basis of DRGs through scientific calculations and making prepayment to healthcare organizations based on these standards. A: To control unreasonable payment in medical services. A: To control unreasonable consumption of medical services and limit excessive medical treatment; to guide hospitals and medical staff to rationally utilize medical and healthcare resources, and to achieve the goal of prompting hospitals to tap their potential, improve the quality of their medical care, increase medical efficiency and effectiveness, and reduce the waste of healthcare resources by controlling the average hospitalization days and hospitalization costs.5 What is ICD-10 and what is ICD-9-CM-3? What is the relationship between ICD-10 and ICD-9-CM-3 and DRGs? A: ICD-10 is the abbreviation of the 10th revision of the International Classification of Diseases (ICD), which is a coding method, based on certain characteristics of diseases, in accordance with certain rules for the classification of diseases, in order to achieve the purpose of statistical analysis of diseases in hospitals, scientific research, retrieval, comprehensive utilization, medical management. ICD-9-CM-3 is the third volume of the Clinical Modification of the International Classification of Diseases. In the 1980s, China's Ministry of Health decided to use the American International Classification of Diseases, Clinical Modification, Volume 3, which is the classification of surgical operations, in China. A: Single-disease payment and DRGs belong to the same category of payment by disease, both are patient classification programs based on disease diagnosis. A: DRGs mainly take into account a number of factors reflecting the characteristics of the case, such as the patient's primary diagnosis; secondary diagnosis; major operation; important concomitant diseases and comorbidities; age; neonatal weight; duration of coma; and whether or not the patient is dead. And according to the severity of the disease and the intensity of medical services for each DRGs respectively designated price, the patient in the whole process of diagnosis and treatment of a one-time payment to the hospital for that designated price. Excerpted from: Peking University People's Hospital website