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The Medical Insurance Bureau issued a document: The use of a large number of consumables in hospital

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On October 23, the National Medical Insurance Bureau issued the Notice on the Technical Specifications and Grouping Scheme for the Printing of Disease-Related Groups (DRG) Payment Countries (hereinafter referred to as the “Notice”).

 

In order to do a good job in DRG basic data quality control, the "Notice" requires each pilot city to use five information service coding standards such as unified use, medical consumables, medicines, and medical insurance settlement lists in accordance with relevant documents.

At the same time, the pilot city medical insurance agency should establish an information service coding standard maintenance team, carry out the dynamic maintenance of medical insurance information system database, coding mapping and related interface transformation, etc., promote the application of information service coding standards, and use "universal language" throughout the country.

Collect data about medical institutions through the medical insurance settlement list. All pilot cities should speed up the information system transformation work related to DRG paying country pilots, improve the implementation and supervision of key links such as program design, bidding, procurement, and deployment, and improve data management capabilities.

It is understood that on June 27, the State Medical Insurance Bureau issued the "Notice on the Guidance and Opinions of the National Medical and Health Protection Bureau on Printing and Distributing Medical Standardization Work", and published four information service coding rules and methods for medical insurance medical consumables.

The code rules for medical insurance medical consumables information business are as follows:

 

Part 1: The consumable identification code is indicated by a 1 capital letter "C".

Part 2: Classification code, according to the medical consumables discipline, use, location, function division, represented by 6 Arabic numerals.

Part 3: Common name code, create a national unified medical insurance medical supplies common name code, represented by 3 Arabic numerals.

Part 4: Product feature code, code given by characteristics such as consumable material, specifications, etc., expressed in 5 digits.

Part 5: The production enterprise code, which is a unique code given to the consumable manufacturing enterprise based on the medical device registration certificate or the filing voucher, is represented by 5 Arabic numerals.

In addition, on October 8th, the National Medical Insurance Bureau also issued the “Regulations and Methods for Encoding 10 Information Services for Medical Insurance-designated Medical Institutions”, and announced the establishment of designated medical institutions, medical insurance, disease-disaggregated diseases, and medical insurance day-to-day surgical diseases. Item information service coding rules and methods.

Consumables are used or restricted

In addition to the above notice, the National Medical Insurance Bureau also issued the National Medical Security DRG Grouping and Payment Technical Specifications (hereinafter referred to as the "Technical Specifications") and the National Medical Security DRG (CHS-DRG) Grouping Scheme (hereinafter referred to as the "Grouping Plan"). .

The "Notice" requires each pilot city to follow the basic principles, scope of application, definition of nouns, and data requirements, data quality control, standardized uploading specifications, grouping strategies and principles, weights and rate determination as determined by the Technical Specifications. Related work.

At the same time, the Grouping Plan should be strictly implemented to ensure that 26 major diagnostic categories (MDCs) and 376 core DRGs (ADRGs) are consistent across the country, and local subdivision DRGs are developed according to the unified grouping operation guidelines and local conditions. (DRGs). The pilot cities must not arbitrarily change the MDC and ADRG groups.

According to the "Technical Specifications", payment by disease diagnosis related group (DRG) is one of the more advanced and scientific payment methods recognized by the world. It is an effective way to control the unreasonable growth of medical expenses, establish a new mechanism for public hospital operation compensation, and realize medical insurance for three parties. Win-win and promote the important means of grading diagnosis and treatment to promote the transformation of service models.

Medicare DRG payment method reform includes DRG grouping and payment. The specification and scientific grouping are important prerequisites for DRG implementation, and accurate payment is an important guarantee for DRG implementation.

National and local implementation of the reform of medical insurance DRG payment methods requires certain basic conditions such as medical record quality, unified coding and supervision capabilities. At the same time, it is necessary to carry out preliminary work such as standard data collection process and audit.

Insiders analyzed that after applying the DRG payment method, the drugs, consumables, and inspections in the hospital will be changed from the source of income to the cost. The hospital and doctors will also actively regulate the diagnosis and treatment behavior, and reasonably control the prescription and drug expenses, which will be for the drug consumables. And medical device manufacturers have a significant impact.

After the implementation of DRG payment, the use of low-value inspections and consumables will be greatly reduced, because in the case of cost control, hospitals will pay more attention to the necessity and actual efficacy when using medical equipment and consumables.

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