Performance management in public hospital based on the benchmark of disease group cost under diagnosis related groups payment reform
10.3760/cma.j.cn111325-20231221-00430
- VernacularTitle:DRG支付方式改革下基于病组成本标杆的公立医院绩效管理实践
- Author:
Lina ZHANG
1
;
Yinfen JIANG
;
Liang SUN
;
Lixiang ZHANG
;
Juanying HUANG
;
Bo XU
;
Qinhai WEI
;
Qian ZHOU
;
Yu WANG
Author Information
1. 苏州大学附属第二医院运营绩效处/医保物价处，苏州 215004
- Keywords:
Hospitals, public;
Diagnosis related groups;
Performance management;
Benchmarking;
Disease group cost
- From:
Chinese Journal of Hospital Administration
2024;40(8):594-598
- CountryChina
- Language:Chinese
-
Abstract:
Taking the reform of payment methods based on diagnosis related groups as an opportunity, implementing performance management based on disease groups is an important lever to promote the improvement of hospital diagnosis and treatment level and high-quality development. In 2023, a tertiary comprehensive hospital introduced benchmarking management into performance management, using the average days of stay, drug costs, and consumables costs of the disease group as cost benchmark indicators. The cost benchmark values for each disease group was determined based on the big data of the disease group of the tertiary comprehensive hospital in the region and the clinical pathway management goals of the hospital. Through multidimensional and multi-level comparative analysis of the hospital′s historical values and regional big data distribution values of the benchmark indicators for each disease group, the cost benchmark values for each disease group was determined. The hospital has established a performance reward and punishment mechanism based on the benchmark value of disease group costs, and at the same time, established a performance management communication mechanism to promote relevant departments and medical groups to improve their management against the benchmark. In addition, with changes in the external environment and internal practices, the cost benchmark value of the disease group was dynamically optimized, forming a closed-loop management system that included establishing benchmarks, comparing benchmarks, achieving benchmarks, and optimizing benchmarks. Since the implementation of performance management based on disease group cost benchmarking in March 2023, the hospital′s case mix index has increased from 1.52 in March to 1.54 in September; The average days of stay decreased from 6.22 days to 5.90 days; The monthly payment weight has increased from 18 103 to 18 558; The average hospitalization cost has decreased from 16 724 yuan/person to 15 278 yuan/person, mainly due to the decrease in drug and consumables costs. The proportion of drug costs has decreased from 27.45% to 26.32%, the proportion of consumables costs has decreased from 28.75% to 26.85%, and the proportion of medical service revenue has increased from 24.64% to 26.08%; The proportion of low magnification cases decreased from 9.09% to 8.24%; The medical insurance payment rate has increased from 99.3% to 107.0%; The job satisfaction of physicians has increased from 70.00% in 2022 to 76.77% in 2023, which can provide reference for performance management practices in other hospitals.
