The two major reasons for the hospital's arrears of loans and serious debts are in this report card!

It's on the list!

The national performance appraisal of public hospitals is a comprehensive physical examination at the national level, allowing many presidents to scratch the top of their heads for it.

The same ruler is aimed at 3,074 secondary public hospitals. On January 6, the National Health Commission announced the "Circular on the National Monitoring and Analysis of the Performance Appraisal of Second-level Public Hospitals in 2019", and the "Physical Examination Report" of Second-level Public Hospitals was announced for the first time.

According to the requirements, the national second-level public hospitals should be gradually included in the scope of performance appraisal within 3 years (2020 to 2022). A total of 3,074 second-level public hospitals (including 908 second-level public hospitals of traditional Chinese medicine) across the country participated in the 2019 annual performance appraisal, accounting for about 53% of the total number of second-level public hospitals in the country.

The "medical examination report" shows that the performance of secondary hospitals in terms of operational efficiency is not optimistic, and the debt is serious. What is the reason for the excessive debt ratio of some secondary hospitals? What other key signals are on this transcript? How do I get a good result? Undoubtedly, it is the most concerned topic of the majority of hospital managers, and the health community has interviewed a number of experts to make judgments and interpretations on this.

Source: Figureworm Creative

Arrears? Borrowing money to operate?

From the data point of view, the operation status of secondary hospitals is uneven. The medical surplus rate of the second-level public hospitals participating in the assessment was 2.07%, but there were still 519 second-level public hospitals with a negative medical surplus rate of 24.59% - compared with 22.65% of the third-level public hospitals with negative balances of income and expenditure.

Compared with tertiary hospitals, secondary hospitals do not have the content of resource efficiency and economic management. However, in the national monitoring indicators, cost control has increased the indicator of medical income growth compared with tertiary hospitals.

Tang Honglei, an expert in medical management consulting in Guangzhou Jingyi, noted that the debt of secondary hospitals is still serious. At present, the asset-liability ratio of secondary hospitals is 49.39%, but among the loss-making hospitals, the asset-liability ratio of 3.22% of secondary public hospitals exceeds 100%, and the asset-liability ratio of 40.60% of secondary public hospitals exceeds 50%. Of the total liabilities, long-term and short-term borrowings accounted for 26.59%.

"The general corporate debt ratio warning line is 50%." Han Binbin, chief accountant of Henan Provincial Cancer Hospital, introduced to the health community that the medical market with insufficient competition is relatively special, "The debt ratio of secondary public hospitals can be slightly more than 50%, but more than 70% must be highly vigilant."

What affects operations more than the debt ratio is the cash flow situation. "Units that lose money can still operate for a period of time, but if there is a cash flow problem, they will immediately face the test of survival." Han Binbin speculated that the capital flow situation of some county-level hospitals will not be too optimistic.

The reason why the debt ratio of some county-level secondary hospitals is too high, Han Binbin believes that there are two main situations: either the payment cycle to the supplier is too long, or the debt operation.

Individual examples may be more illustrative. In March 2021, the Juxian Traditional Chinese Medicine Hospital in Henan Province was exposed to the news of "layoffs of 645 employees", which attracted public attention. The second-class first-class public hospital was disclosed to be in debt of up to 1 billion yuan and had to be rescued by personnel reductions.

In the same month, 89 primary medical and health institutions in 14 counties (cities, districts) in 7 cities in Shandong were notified of non-payment of drug payments to pharmaceutical enterprises;

At the end of 2020, Quzhou County Hospital of Traditional Chinese Medicine in Handan City, Hebei Province, was exposed to be involved in cases involving "loan contract disputes", "lease contract disputes", "private loans" and other cases, with a total amount of more than 300 million yuan ...

In recent years, public hospitals have experienced operational crises abound, and most of them are second-level hospitals and tertiary hospitals in third- and fourth-tier cities and county towns.

"The national examination data is very consistent with the actual situation, which also shows that some secondary hospitals have seriously lost points in the operational efficiency part." Tang Honglei mentioned to the health community that many secondary hospitals are operating in debt and borrowing funds, hoping to become bigger and stronger, which is inconsistent with the positioning of secondary public hospitals by the national health authorities.

Tang Honglei said that the secondary hospital should do a good job in the diagnosis and treatment work and health maintenance of the county masses, rather than competing with the tertiary hospital for patients, and the pursuit of the more difficult fourth-level surgery "should be stopped in moderation."

Medical staff are paid low salaries

There are also two low data, which deserves the attention of the industry: the proportion of personnel expenses in secondary public hospitals is 38.45%, and the income from medical services (excluding drugs, consumables, and inspection and inspection income) accounts for 29.56% of medical revenue.

The new medical reform refers to reducing the inflated prices of drugs and consumables, called "teng cages"; increasing the price of medical fees and the treatment of medical personnel, which is called "changing birds".

With the implementation of measures such as medical insurance control fees, drug and consumables bonus cancellation, the "cage" has been vacated, but the price adjustment of medical services has not been in place, and the income of medical staff has not increased.

"Revenue from medical services is the main source of performance compensation for medical staff." Han Binbin said that at present, the proportion of the two sets of data is generally low, and the price structure of medical services needs to be further adjusted.

Perhaps this is one of the reasons for the low satisfaction of medical staff.

In 2019, the satisfaction of outpatients in secondary public hospitals participating in the assessment was 84.43 points, the satisfaction of inpatients was 89.32 points, and the satisfaction of medical staff was 76.48 points.

Among them, the most dissatisfied with the medical staff is the salary and welfare, work content and environment, which reflects the low salary and heavy workload of the medical staff in the secondary hospital, and the working environment needs to be improved.

The satisfaction of outpatients with the registration experience, environment and logo is relatively low, and the satisfaction of inpatients with the environment and logo, meals, admission and exit information and procedures is relatively low.

Compared with the satisfaction of tertiary public hospitals in the same year, the satisfaction of outpatients, inpatients and medical staff in secondary public hospitals was 0.98 points, 1.69 points and 2.36 points lower, respectively, indicating that there is still a gap between the service quality of secondary hospitals and tertiary hospitals.

Tang Honglei said that the satisfaction evaluation is the easiest "point" for secondary hospitals to achieve.

For example, to improve patient satisfaction, hospitals can work the contact points with patients. Including improving the outpatient inpatient process, rational layout of parking charges, keeping toilets clean and tidy, security personnel service attitudes, and standardized placement of items in the diagnosis and treatment area, etc., are all good ways to improve patient satisfaction.

In terms of improving employee satisfaction, the hospital can first solve the problem of parking and eating for employees, so that employees have fixed parking spaces, and the canteen meals are nutritious and delicious, which is not difficult for hospitals to do.

At the same time, the hospital should conduct a separate special survey to understand the specific needs of employees in work and life, especially for those employees with low satisfaction, do a good job of satisfaction surveys, and carry out PDCA rectification. Tang Honglei said that these are all measures that can be effective in the short term and improve satisfaction.

The rational use of drugs is not optimistic

In terms of the promotion effect of graded diagnosis and treatment, a set of comparative data released a positive signal.

In 2019, the average medical expenses of outpatient and inpatient drugs in secondary public hospitals increased by 6.75% and 6.08%, respectively, and the average cost of outpatient and inpatient drugs increased by 8.36% and 3.31%, respectively.

In contrast, in 2019, the average cost increase of outpatient visits and the average cost of hospitalizations in tertiary hospitals increased by 6.28% and 5.27%, respectively, and the increase in outpatient average drug costs and inpatient drug costs increased by 5.98% and 3.23%, respectively.

The business volume of secondary hospitals has increased faster than that of tertiary hospitals, which is a good thing in Han Binbin's view: "This shows that the service capacity of county medical institutions is improving, and more patients are left at the grassroots level."

Interestingly, compared with the urban second-level public hospitals, the specialty capabilities of the second-level hospitals in Qixian Are relatively excellent, and the completeness of the department settings, the coverage of diagnosis and treatment of diseases, and the types of operations that can be carried out are better than those of the second-level public hospitals in the city. However, some general hospitals also have incomplete department settings, and some hospitals do not have obstetrics and gynecology, pediatrics, or the corresponding departments treat less than 1 patient per week on average.

While more and more patients are left at the grassroots level, the rational use of drugs in secondary hospitals is not optimistic. The intensity of antimicrobial use (DDDs) is the only national monitoring indicator among the five indicators of rational drug use, so whether rational drug use is done well depends on this indicator.

In 2019, the antimicrobial use intensity of secondary public hospitals was 40.96 DDDs, which has not yet met the requirement that the intensity of antibacterial drug use in general hospital inpatients should not exceed 40DDDs, and there are still 967 (44.64%) general hospitals with antibacterial drug use intensity of more than 40DDDs.

Judging from the results of the national examination, the level of rational use of drugs in second-level public hospitals is still not high, which is a more prominent problem in terms of medical quality. Tang Honglei believes that the rational use of antibacterial drugs is not an overnight thing for many secondary hospitals, which stems from the lack of training of many doctors, which is not yet understood enough, so hospitals need to make great efforts to train doctors.

How to improve the assessment score?

Data capture is a difficult problem faced by the "catch-up" hospital.

"Performance appraisal uses data to analyze the operation of the hospital, and the data provided by the hospital must be true and clear." For Rao Rui, secretary of the party branch and president of Yanchi County People's Hospital, it is more difficult to grasp the data in response to the national examination, "there are more manual statistics, resulting in inaccurate data and errors." To this end, they solved the problem of data export by adding a case management system, a quality control system for the home page of the case, and an electronic medical record system to connect with the hospital HIS and other related systems.

Among the second-level public hospitals participating in the assessment, a total of 1843 hospitals participated in the grading evaluation of the functional level of electronic medical record application, with an participation rate of 85.09% and an average grade of 2. Among them, 33.75% of the hospitals have reached the level of level 3 and above, which can achieve the requirements of interdepartmental data exchange; 51.34% of the hospitals are at the level of level 2 and below, and it is not yet possible to achieve interdepartmental data exchange within the hospital.

This set of data shows that the overall level of electronic medical records in secondary hospitals is not high.

Some experts suggest that secondary hospitals can not only think about how to "build a house, buy equipment", but should make more efforts in software investment, the standardized management and use of data is insufficient, personnel training is not kept up in time, and doctors continue to work in the past for a long time, resulting in the inability to close the loop management of patients.

Rao Rui also believes that the construction of hospital informatization urgently needs to be strengthened, and it needs support in terms of funds and the construction of informatization talent teams.

More financial support, more financial investment, is also the appeal of many public hospitals.

According to the 2019 China Health Statistics Yearbook, the revenue of all hospitals in China in 2018 was 3.19 trillion yuan, of which 269.6 billion yuan was financial subsidies, accounting for less than 1%.

"I don't expect many county hospitals to receive more than 5% of their financial subsidies." Han Binbin believes that with more support from the financial department and the development and reform department, the existing problems of public hospitals can be solved more quickly.

In addition, under the guidance of the Medical Quality and Evaluation Department of the Medical Administration Bureau of the National Health Commission, the National Case Management Quality Control Center has been surveyed by the national medical quality data network for many years, and the survey results of 5439 medical institutions in 2020 show that including tertiary hospitals, secondary hospitals, public hospitals, and private hospitals, the average full-time coder in each hospital is only 2.46 people, of which 1.88 are second-level public general hospitals and 1.09 are second-level private general hospitals.

Some hospitals do not set the case department as an independent department, and the lack of manpower and insufficient ability are superimposed on each other, which is in stark contrast to the huge number of discharge medical records, resulting in insufficient mastery of the requirements for filling in the first page of the case, which affects the correct rate of coding.

With the improvement of the level of informatization and the improvement of data quality, the future national examination report card will be more detailed. "And more and more abundant data can explain the current situation of secondary public hospitals more comprehensively and objectively." Han Binbin said.

The announcement of the results of this national examination is the end, but also the beginning, and it is the beginning of the further self-improvement of the second-level hospital according to the data.

For how to improve the overall assessment results, Tang Honglei suggested that the secondary hospital needs to decompose the relevant tasks into various departments according to the assessment indicators, scientifically and reasonably set the target value and implementation path, create a set of guarantee system, and gradually improve the ranking through performance rewards, the use of management tools and other refined management methods.

Sources | the health community

Written by | Li Zijun Yang Ruijing