CHS⁃DRG分组方案重磅升级,医疗机构该如何应对?

With CHS⁃DRG Grouping Payment Scheme Significantly Upgraded,How Should Medical Institutions Respond?

2024年7月,国家医保局发布《关于印发按病组和病种分值付费2.0版分组方案并深入推进相关工作的通知》,标志着我国疾病诊断相关分组(diagnosis related group,DRG)支付改革正式迈入2.0时代。2.0版分组方案中,DRG增加了6组,核心DRG增加了33组,具有分组更科学合理、更契合临床实际情况的特点。国家医保局同步明确了5个配套管理机制,即特例单议机制、基金预付机制、谈判协商机制、意见收集反馈机制和数据公开机制,旨在优化DRG支付改革管理,确保医疗机构、医保部门和患者实现多方共赢。2.0版的发布,为医疗机构提供了更精细化的管理工具和更合理的支付机制。医疗机构应积极拥抱该项改革,通过优化内部管理和提高服务质量,实现成本控制和效率提升,最终达到患者、医保基金和医疗机构三方共赢。

In July 2024,the National Healthcare Security Administration issued“Notice on Printing and Distributing the 2.0 Edition Grouping Scheme for Diagnosis Related Group(DRG)and Disease⁃based Payment and Further Advancing Related Work,”marking the official entry of Chinas DRG payment reform into the 2.0 era.In the 2.0 edition of the DRG grouping scheme,the number of DRGs has increased by six groups,and that of the adjacent DRGs has increased by 33 groups,featuring more scientific and reasonable grouping that aligns better with clinical practice.The National Healthcare Security Administration has also clarified five supporting management mechanisms,including the special case negotiation mechanism,the fund prepayment mechanism,the negotiation and consultation mechanism,the feedback mechanism for opinion collection,and the data disclosure mechanism.These are aimed at optimizing the management of DRG payment reform to ensure a win⁃win situation for medical institutions,healthcare security departments,and patients.The release of the DRG 2.0 edition provides medical institutions with more refined management tools and a more reasonable payment mechanism.Medical institutions need to actively embrace this reform,optimize internal management,and improve service quality to achieve cost control and efficiency enhancement,ultimately leading to a win⁃win situation for patients,healthcare security funds,and medical institutions.