The new era of "four-wheel drive" medical reform forced the "five transformations" of hospital performance to upgrade.

The new era of "four-wheel drive" medical reform forces the "five transformations" in hospital performance to upgrade

Chief Consultant of Yufang Medical Management: Qin Yongfang

I. The new era of "four-wheel drive" medical reform

1. One-wheel drive: establishing a modern hospital management system

Guo Ban Fa [217] No.67 "Building a modern hospital" We will basically form a new mechanism for maintaining public welfare, mobilizing enthusiasm and ensuring sustainable operation of public hospitals and a governance mechanism that coordinates decision-making, execution and supervision, checks and balances each other and promotes each other, promotes the healthy development of social medical services, promotes standardized, refined and scientific management of hospitals at all levels, and basically establishes a modern hospital management system with clear rights and responsibilities, scientific management, perfect governance, efficient operation and strong supervision.

2. One-round drive: Strengthening Party Building in Public Hospitals

The Opinions on Strengthening Party Building in Public Hospitals issued by the CPC Central Committee clearly put forward that the Party's leadership over public hospitals should be effectively strengthened, and public hospitals should implement the president responsibility system under the leadership of the Party Committee. Party committees and other college-level party organizations play a leading role in guiding the direction, managing the overall situation, making decisions, promoting reform and ensuring implementation. Implement the party's basic theory, line and strategy, implement the party's health and health work policy, implement policies and measures to deepen the reform of medical and health system, adhere to the public welfare of public hospitals, and ensure the correct direction of hospital reform and development;

3. One-round drive: Strengthening the performance appraisal of public hospitals

The Opinions on Strengthening the Performance Appraisal of Third-level Public Hospitals issued by Guo Ban Fa [219] No.4 takes the performance appraisal results as an important basis for the development planning of public hospitals, the establishment of major projects, financial input, appropriation of funds, the verification of the total performance salary, and the adjustment of medical insurance policies, together with hospital appraisal, the construction of national medical centers and regional medical centers, and various evaluations. Strengthen the orientation of performance appraisal, promote hospitals to implement public welfare, realize the integration of budget and performance management, and improve medical service capacity and operational efficiency.

4. The first round of drive: the strategic purchase of medical insurance

With the establishment of the National Medical Insurance Bureau, whether it is the expansion of anticancer drugs and the national price reduction, or the 4+7 unified procurement bidding, or the DRG payment system reform pilot, the strategic purchase of medical insurance has made great efforts to realize the "cage change", making room for raising the price of medical services and leading public hospitals to transform from extensive management mode to refined connotation quality improvement.

Second, the performance characteristics of the new era of medical reform

1. Traditional performance incentive characteristics

The traditional medical insurance fee system is based on the post-paid payment mode according to the project, and the medical insurance department controls the total amount of medical insurance for the hospital, as well as the average cost assessment. Due to the low price of medical technology services, hospitals save money and medical insurance does not reward them. In line with the medical insurance payment system, hospitals stimulate hospitals to get reasonable compensation by drug price difference (now all of which are zero-added) and medical technology examination. The performance of hospitals also focuses on stimulating extensive scale income growth. Only by doing more projects and earning more can they get more performance. Generally, performance management models such as "single commission, commission for balance of payments (or cost accounting) and project points" are adopted. In addition, due to the extensive medical insurance and hospital management, the value of doctors can not be fully reflected. The social compensation mechanism of "kickback" of drugs and consumables plays a compensatory role, which promotes the high cost of medical treatment and causes a great increase in the risk of the medical insurance fund wearing out.

2. What are the characteristics of the new era of medical reform?

As an important measure of the new medical reform, DRG medical insurance payment is a prepaid method based on value medical care, which is completely different from the traditional payment after the project, and has a great impact on hospital performance management. It is urgent to study and pay attention to DRG medical insurance payment policy. The characteristics of DRG medical insurance payment system affect the performance decision-making of hospitals and even the sustainable development of hospitals.

(1) Drugs become the cost of hospitals

At present, the assessment of drug proportion is a temporary measure of macro-control, and the centralized procurement of strategic drugs by the National Medical Insurance Bureau makes room for rational drug use and price adjustment of medical services, paving the way for the reform of DRG medical insurance payment system. With the reform of DRG medical insurance payment system, drugs have become the cost of hospitals, which has forced the enthusiasm of hospitals to manage drugs and prompted the performance appraisal to need supporting banks.

(2) Consumables become hospital costs

Health materials are partially added. Under the post-project payment and settlement system, most of the expenses of health materials are paid by medical insurance, and it is profitable for hospitals to use more health materials. With the zero price difference of health materials, DRG medical insurance payment and medical service price adjustment, health consumables become hospital costs.

(3) Medical examination has become the prepaid mode of DRG diseases, which has brought a great impact on the hospital to make up for the income from medical examination. The more medical examinations hospitals do, the greater the cost of medical examination, the less disposable funds in the hospital balance, and the income from medical examination has changed from income to cost. Therefore, hospital performance needs to pay more attention to the change of medical insurance payment from encouraging medical examination income.

(4) Paying for value medical care

In the traditional system mode of total medical insurance budget control plus average cost control, it is not cost-effective to control the hospital according to the average cost for serious illness or serious illness, but it is cost-effective to treat minor illness or minor illness, which is easy to lead to "choosy" and shirk referring patients. DRG is mainly based on value medical care, and it is paid according to the total number of DRG, RW\CMI, time efficiency index, cost efficiency index, low-risk mortality rate, etc., which requires high service ability and service efficiency, so performance incentives need to adapt to the changes of medical insurance payment mode.

(5) affecting the source of hospital income

under the traditional medical insurance total budget control mode, hospitals have a relatively fixed share of medical insurance income. Different from the DRG disease payment mode, medical insurance payment according to DRG poses a higher challenge to medical service performance and service efficiency, and plays the role of "insider" competitive control. The higher the efficiency, the higher the income, and the lower the income. Therefore, the change of payment mode affects the hospital's income. Especially in the face of the limitation of medical insurance fund, improving the efficiency of medical insurance fund and ensuring the safety and controllability of medical insurance fund will become more and more strict in the management and control of hospital income drive. Therefore, it puts forward a higher challenge to performance incentive.

Third, the "five transformations" of hospital performance incentive are forced

The reform of the traditional medical insurance payment DRG medical insurance payment system is just around the corner. With the external performance evaluation of public hospitals, the hospital management is forced to achieve "five transformations", and the traditional hospital performance management model is facing "iterative upgrade". Establishing a salary system that conforms to the characteristics of the medical industry is the last mile of medical reform. How to design a better hospital salary performance system, Driving back to the natural attribute of value medical care has become a topic of common concern for health managers and medical staff, and it is also an unavoidable hurdle for medical reform, forcing hospital performance incentives to achieve "five major transformations."

1. Transformation 1: The development mode has changed from scale expansion to quality and efficiency

At present, China's economic development has changed from high-speed to medium-high speed, and the economic development mode is changing from scale speed to quality and efficiency. Facing the acceleration of population aging and the change of chronic disease spectrum, both the national economy, financial investment and medical insurance fund need to adapt to the big environment, and the development mode of hospitals must adapt. The performance incentive of hospitals should shift from guiding the expansion of hospital scale to driving the development mode, to the development mode with connotation, quality and efficiency, and to the fine management.

2. Transformation 2: The management mode is changed from extensive administrative management to all-round performance management

Performance incentive guides the hospital management mode, from extensive administrative management to all-round refined performance management, and speaks with data. By strengthening information construction and replacing experience management with modern management, the management level of fine, accurate and lean is improved.

3. Transformation III: From stimulating development and construction to expanding distribution to increasing medical staff's income

In order to achieve siphon in a happy race, traditional hospitals mainly use funds for hospital construction and equipment purchase, and performance incentives are matched with them. Facing the peak of hospital construction, performance incentives should use more funds to improve the treatment of medical staff and fully mobilize their enthusiasm.

4. transformation 4: the orientation of service function changes from the quantitative type of medical service to the functional orientation of hospital

according to the functional orientation of hospital, the performance incentive changes from the current quantitative type of medical service to the functional orientation.

5. Transformation 5: The service concept is changed from "disease-centered" to "patient health-centered"

Performance incentives should make hospitals "disease-centered" to adapt to the national strategic transformation of healthy China and transform "patient health-centered".

in a word, with the external performance appraisal exerting a great influence on the performance appraisal of public hospitals, the internal performance appraisal of hospitals is forced to be transformed and upgraded, and the function of "workload efficiency score performance management model based on value-driven medical care" of Yufang Medical Management will be greatly expanded and upgraded, which will surely become the "main theme" of hospital performance management in the new era of medical reform.