Judging from the latest policies related to the medical insurance payment reform of the state and Sichuan province, the reform of medical insurance diagnosis-related group (DRG)/diagnosis-intervention packet (DIP) payment methods is imperative. The impact of DRG/DIP payment method reform on public hospitals is mainly analyzed from the aspects of hospital cost accounting and control, quality of filling in the first page of medical cases, coding accuracy, standard of medical practice, development of diagnosis and treatment technology innovation business, multi-departmental linkage mechanism, competition between hospitals, performance appraisal mechanism, and negotiation and communication mechanism. We should put forward hospital improvement strategies from the top-level design of the whole hospital and from the aspects of improving the quality of the first page of the cases and the quality of the coding, strengthening the cost accounting and control of the disease, carrying out in-hospital and out-of-hospital training, establishing a liaison model, finding gaps with benchmark hospitals, enhancing the core competitiveness of innovative technologies, and improving internal performance appraisal, etc., to promote the high-quality development of hospitals.
Objective To explore the impact of diagnosis-related group (DRG) payment method reform under total amount control on neurology and neurosurgery departments. Methods The DRG grouping data of the Department of Neurology and the Department of Neurosurgery of Panzhihua Central Hospital from January 2018 to December 2020 were collected, and the mature DRG evaluation indexes in China were selected. Using the interrupt time series analysis method, the DRG-related indexes of the two departments before and after the introduction of the performance appraisal plan in July 2019 were compared, to evaluate the intervention effects on the two departments. Results Both neurology and neurosurgery departments showed a slow downward trend in the overall medical service capacity under the DRG payment. The efficiency of medical services showed a slow upward trend and the consumption of medical expenses showed a slow downward trend in the Department of Neurology, while the efficiency of medical services showed a slow downward trend and the consumption of medical expenses showed a slow upward trend in the Department of Neurosurgery. According to the results of interrupt time series analysis, in the Department of Neurosurgery, the total weight showed a significant downward trend before intervention (β1=−5.526, P=0.003), and the downward trend became sluggish after intervention, with a statistically significant slope difference before and after intervention (β3=4.546, P=0.047); the case-mix index showed a downward trend before intervention (β1=−0.050, P<0.001), and no obvious trend after intervention, with a statistically significant slope difference before and after intervention (β3=0.052, P=0.001); the cost consumption index showed no obvious downward trend before intervention (β1=−0.006, P=0.258), and an upward trend after intervention, with a statistically significant slope difference before and after intervention (β3=0.027, P=0.032). The impact of this assessment plan on the Department of Neurology was not statistically significant (P>0.05), needing further observation. Conclusions The reform of DRG payment method under total amount control has different effects on the evaluation indicators of clinical departments of different natures. It is recommended to implement classified management and assessment for clinical departments of different natures.
Taking the Breast Surgery Department of the Second Affiliated Hospital Zhejiang University School of Medicine as an example, this paper introduces the quality management experience of day surgery case settlement checklist. Through the establishment of diagnosis-related groups (DRGs) settlement checklist quality control review mechanism, the introduction of DRGs information system to monitor the quality of settlement checklist in real time, and strengthening the supervision of low-rate cases and other measures, the quality of medical insurance fund settlement checklist and the accuracy of case enrollment have been effectively improved, and the occurrence of low-rate cases has been reduced. On the whole, day surgery and DRGs payment jointly promote the effective improvement of medical service efficiency and the reasonable allocation of medical resources, and reduce the average cost per patient and the average length of hospital stay.