Four major impacts of payment reform on hospitals
1. The biggest impact is hospital revenue
After the reform of the hospital's payment method, the compensation method of the medical insurance to the hospital has changed. The main influencing factors are:
1) The first page of the doctor's medical record is incorrectly filled or not standardized, the RW value of the wrong type of DRG entry is reduced or some cases cannot be enrolled, resulting in reduced payment or refusal to pay for medical insurance;
2) Second, the actual medical expenses incurred by some disease groups are higher than the medical insurance DRG group payment. After the implementation of DRG group payment, the hospitalization income of this part of the disease group has decreased.
2. Increased requirements for hospital cost accounting and management and control capabilities
The reform of payment methods has become a focus of medical reform. A series of medical reform policies and measures, including hospital performance appraisal and tertiary hospital evaluation standards, have clearly stated that the number of disease types charged by disease types should be expanded, based on the reasonable cost of medical services. Gradually establish a dynamic adjustment mechanism for charging standards.
In terms of cost accounting and management and control capabilities, disease cost accounting has also begun to move towards the "stage" due to its scientific and reasonable operability and strong promotion. Strengthening the refined management of disease cost accounting is an important measure to realize the good development of the hospital in the future, which is conducive to the high-quality development of the hospital.
3. Bringing challenges to hospital medical record quality and information management
The implementation of the payment reform, the existing hospital's weak medical record management information application system, cannot meet the needs of the reform, and cannot support the number of disease groups, disease codes, medical order terms, discharge diagnosis codes, operation codes, medical record homepages, and cost costs Information and other big data technologies. If the hospital provides medical insurance-related medical records with inaccurate information, incorrect coding, incorrect diagnosis, and operation information after the reform, it will lead to the risk of not being compensated for the medical services provided.
4. Put forward higher requirements for hospital management
In order to cope with the impact and huge challenges brought by the payment reform to the hospital, the hospital needs to establish a complete management system through top-level design, and each management department must carry out corresponding functional transformations, including reforming the original incentive mechanism under the condition of project-based payment , Quality assessment indicators, etc., to promote more standardized hospital operation and management, and further promote the development of hospital medical technology and the further improvement of the diagnosis and treatment capabilities.
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