The new era of "four-wheel drive" healthcare reform is forcing hospitals to perform "five major transformations" and upgrades
Chief consultant of Yufang Medical Management: Mr. Qin Yongfang
A... Four-wheel drive" new era of medical reform
1. One-wheel drive: the establishment of a modern hospital management system
The State Council issued [2017] No. 67 The establishment of a modern hospital management system of the guiding opinions is clearly put forward. By 2020, the basic formation of a new mechanism for maintaining public welfare, mobilizing enthusiasm, guaranteeing the sustainable operation of public hospitals and a governance mechanism for decision-making, implementation, and supervision of mutual coordination, mutual checks and balances and mutual promotion, promoting the healthy development of social medical care, promoting the standardization of hospital management at all levels and all types of hospitals, refinement and scientification, and basically establishing a clear rights and responsibilities, scientific management, perfect governance, efficient operation and supervision of the powerful modern hospital management system.
2. A round of drive: to strengthen the construction of the party in public hospitals
The Central Office issued the "Opinions on Strengthening the Construction of the Party in Public Hospitals", which explicitly puts forward the effective strengthening of the party's leadership of public hospitals, and the implementation of public hospitals to carry out the presidential system of responsibility under the leadership of the party committee. The party committee and other hospital-level party organizations to play a leading role in the direction, management of the overall situation, decision-making, promoting reform and implementation. Implement the Party's basic theory, basic line, basic strategy, implement the Party's health and health work policy, implement the policy measures to deepen the reform of the medical and health system, adhere to the public welfare of public hospitals, and ensure that hospital reform and development in the right direction;
3. Wheel-driven: strengthening the performance assessment of public hospitals
State Office of the Government of the People's Republic of China (SOCOP) issued [2019] No. 4, "Opinions on Strengthening the Performance Assessment Work of Tertiary Public Hospitals". Opinions on Performance Assessment of Public Hospitals" was released, taking the results of performance assessment as an important basis for the development planning of public hospitals, the establishment of major projects, financial inputs, funding allocation, the approval of the total amount of performance pay, and the adjustment of medical insurance policies, closely integrating it with the evaluation of hospital accreditation, the construction of national medical centers and regional medical centers, and the work of various excellence assessment, and as an important reference for selecting and appointing the secretary of the party organization of public hospitals, the president, and the As an important reference for the selection and appointment of party organization secretaries, deans and members of the leadership team of public hospitals. Strengthen the performance appraisal orientation, promote the implementation of public welfare in hospitals, realize the integration of budget and performance management, and improve medical service capacity and operational efficiency.
4. A round of drive: health insurance strategic purchasing power
With the establishment of the National Health Insurance Bureau, whether it is the expansion of anti-cancer drugs and the price reduction of the State negotiation, or the 4 + 7 unified procurement bidding, or the DRG payment system reform pilot, the health insurance strategic purchasing power to realize the "cage for birds", to make room for improving the price of medical services, leading the health care system to improve the quality of health care services. The first step in the process is to make sure that you are able to get the most out of your time and money, and that you are able to get the most out of your time and money.
Second, the performance characteristics of the new era of health care reform
1. Traditional performance incentive characteristics
The traditional health insurance premium system, is based on the project according to the post-paid payment model, the health insurance department of the hospital has a total control of the health insurance, as well as the average cost of the assessment. Due to the low price of medical technology services, hospitals save money health insurance is not rewarded, with the health insurance payment system, hospitals to stimulate hospitals to rely on the drug price difference (now all zero percent), medical inspection to obtain reasonable compensation, hospital performance is also around the stimulation of the crude scale of income growth incentives, more projects, more income in order to get more performance, generally take the "single item commission", revenue and expenditure balances (or cost assessment). Generally adopt the "individual commission, income and expenditure balance (or costing) commission, project points" and other performance management model. In addition, due to the health insurance and hospital management is relatively loose, the value of the doctor can not be fully realized, drugs, consumables, "rebate" social compensation mechanism plays a compensatory role in promoting the price of medical care, triggered by the health insurance fund through the bottom of the risk of a large increase.
2. What are the characteristics of the new era of health care reform
DRG health insurance payment as an important initiative of the new health care reform, is based on the value of health care pre-payment method, and the traditional payment according to the project is very different from the hospital performance management to produce a greater impact and impact, research and attention to the DRG health care payment policy, has been urgent. DRG health insurance payment system features impact on hospital performance decisions, and even affect the performance of hospitals. The characteristics of the DRG health insurance payment system affect the hospital's performance decision-making, and even affect the hospital's sustainable development.
(1) Drugs become hospital costs
Now the drug ratio assessment is a temporary initiative of macro-control, the National Health Insurance Bureau of the strategic centralized purchasing of medicines, for the rational use of medicines, medical services price adjustment to make room for the DRG health insurance payment system reform to make a good pavement. Along with the reform of the DRG health insurance payment system, drugs become the cost of hospitals, forcing hospitals to manage drugs to enhance the enthusiasm, prompting the need for performance appraisal supporting line.
(2) Consumables become hospital costs
Sanitary materials have a part of the markup, in the health insurance in accordance with the project postpaid settlement system, the cost of sanitary materials, health insurance most of the bill, the hospital more use of sanitary materials is also profitable, with the zero price difference in sanitary materials, DRG health insurance payment, medical service price adjustment, sanitary consumables become the cost of hospitals,
(3) Medical examination becomes the cost of hospitals
DRG disease prepayment model, for hospitals to rely on medical examination income to make up for the major impact, hospitals do more medical examination, hospitals invested in medical examination costs the greater the hospital balance of the less disposable funds, medical examination income from the revenue into the cost of hospital performance from incentives for medical income, the more need to pay attention to the changes in the health insurance payment.
(4) pay for value-based healthcare
The traditional health insurance total budget control plus average cost control system model, to see a large number of diseases or major diseases in accordance with the average cost control hospitals economically uneconomical, to see a small number of diseases or light disease instead of economically cost-effective, easy to lead to "picking and choosing the thin," shirking referrals of patients. DRG is mainly based on value-based healthcare, with reference to the DRG, which is the most important and most effective way to improve healthcare. Based on the value of medical care, with reference to the total number of DRG, RW \ CMI, time efficiency index, cost efficiency index, low-risk mortality rate, etc., the implementation of the payment, for the ability to provide services and service efficiency requirements are high, so the performance incentives need to adapt to changes in the health insurance payment model.
(5) affect the hospital revenue source
The traditional health insurance total budget control model, hospitals have a relatively fixed share of the health insurance revenue, and the DRG payment model is different, in accordance with the DRG payment of health care services and service efficiency put forward a higher challenge to play the "insiders". Competitive control, the higher the efficiency, the higher the income, and the lower the efficiency, the lower the income, therefore, the change of the payment model affects the income of the hospital. Especially in the face of the limited nature of the health insurance fund, to improve the efficiency of the health insurance fund, to ensure that the health insurance fund is safe and controllable, the hospital revenue-driven control will become more and more stringent. So the performance incentives put forward a higher challenge.
Third, forcing the hospital performance incentives "five major transformations"
The traditional health insurance to pay the DRG health insurance payment system reform is imminent, with the public hospitals external performance appraisal, forcing the hospital management to realize the "five major transformations", the traditional hospitals to pay the DRG health insurance payment system reform, with the public hospitals external performance appraisal, forcing the hospital management to realize the "five major transformations". Transformation", the traditional hospital performance management model is facing "iterative upgrading", the establishment of a pay system in line with the characteristics of the medical industry, is the last kilometer of health care reform can not be bypassed, how to design a better hospital pay performance system, driven by the return of the value of the natural attributes of health care, become health managers and Medical personnel *** with the topic of concern, but also health care reform can not be bypassed, forcing the hospital performance incentives to realize the "five major transformations".
1. Transition 1: development mode from scale expansion to quality and efficiency
Currently, China's economic development from high-speed to medium-high speed of the new normal stage, the mode of economic development from the scale of the speed type of quality and efficiency type of transformation. In the face of accelerated population aging and changes in the spectrum of chronic diseases, both the national economy, financial inputs, health insurance funds need to adapt to the general environment, the hospital development mode must be adapted to the hospital performance incentives from the guidance of the hospital scale expansion-driven development model, shifting to the connotation of the quality and efficiency of the development model to the refinement of the management of the benefits.
2. Transformation II: management mode from the rough administrative management to the full range of performance management
Performance incentives to guide the hospital management mode, from the rough administrative management, to the full range of refined performance management, with data to speak, through the enhancement of information technology, modern management to replace the experience of management, to improve the level of management of fine, precise, lean.
3. Transformation three: from stimulating the development and construction to expand the distribution of medical staff to improve income
Traditional hospitals in order to run the siphon, the main funds for hospital construction and equipment purchases, performance incentives with the matching, in the face of the peak of the hospital construction in the past, performance incentives to the funds to be used to improve the treatment of medical staff more, to fully mobilize the enthusiasm to come up.
4. Transformation four: service function orientation from the number of medical services to the functional orientation of the hospital
In accordance with the functional orientation of the hospital, performance incentives from the current number of medical services, guide to the functional orientation of the transformation.
5. Transformation 5: service concept from "disease-centered" to "patient health-centered"
Performance incentives to prompt the current hospital "disease-centered", to adapt to the national health of China.
In short, with the external performance appraisal of public hospitals performance appraisal force, forcing hospitals to internal performance appraisal transformation and upgrading, goodwill medical management "based on the value of medical driven workload performance points performance management model" function to expand the big upgrade, will become the new era of health care reform, hospital performance management of the "main theme". "The main theme of the new era of health care reform is hospital performance management.