DRG付费下皮肤病专科医院面临的挑战与对策

Challenges and countermeasures faced by dermatology hospital to DRG payment

DRG(Diagnosis Related Group,DRG)付费是当前国家重点推进的医保支付改革方式,其核心是按照疾病诊断分组权重予以医保费用结算。皮肤科病种繁多,整体病组权重低,导致支付标准较低。如何在DRG支付方式改革背景下,更好运营发展、提供高质量诊疗服务,是当前皮肤病专科医院及皮肤科面临的一个挑战。本文拟基于我院数据,从DRG管理体系建立包括病种运营管理、病种成本控制、调整收入结构、规范路径管理、加强科室运营管理,同时提升病案首页质量和编码的准确性、开展日间病房与日间手术、与医保经办机构加强沟通、优化信息系统建设等方面,为皮肤科DRG付费下的运营模式提供参考。

DRG(Diagnosis Related Group,DRG)payment is a key way of medical insurance payment reform currently promoted by the state,which is to settle medical insurance expenses according to the weight of disease diagnosis grouping.The wide variety of dermatology diseases and the low weight of the overall disease group lead to low payment standards.How to better operate and develop and provide high-quality diagnosis and treatment services under the background of DRG payment reform is a challenge for dermatological hospitals and dermatology departments.Based on the data of our hospital,this paper analyzed the DRG management system of our hospital,including disease operation management,disease cost control,adjustment of income structure,standardization of path management,strengthening of department operation management,while improving the quality of the first page of medical records and the accuracy of coding,carrying out day ward and day surgery,strengthening communication with medical insurance agencies,optimizing information system construction,etc.,to provide reference for the operation mode of DRG payment in dermatology.