Recently, the executive meeting of the State Council chaired by Premier Li Keqiang released information to normalize and institutionalize the centralized procurement of drugs and high-value medical consumables to further reduce the medical burden of patients.
In fact, orthopedic consumables, drug balloons, dental implants, etc., which are of public concern, have been collected at the national and provincial levels. When it comes to DRG paying by disease type, hospitals are less and less likely to choose "nationally sourced" foreign products.
Before the collection, as a pillar department in the hospital, the Department of Orthopedics was the mainstay of creating hospital revenue. Today, that's gone.
Relevant data show that after the collection, the average reduction in the "fracture price" of consumables reached nearly 90%. If spinal and joint-related equipment is included in the next round of collections, doctors' incomes may face further shocks.
Under the new environment and situation, how do hospital departments respond? In fact, this situation is far from a single department problem, but a challenge that hospitals, doctors and even the medical association need to face uniformly.
Post-harvest orthopedics have a job-hopping tide
A large number of orthopedic surgeons have taken the initiative to go to the market
Orthopedics has always been a department of "deep pockets". According to the 2021 medical autumn recruitment report released by Lilac Garden, among the departments where the autumn recruitment jumps, the orthopedic department has the most job-hopping. Starting from September 2021, talent background released orthopedic recruitment positions increased by 10% compared with 2020, and the number of non-fresh graduates also increased by 7%.
This data is interpreted by the industry as related to the beginning of national collection of high-value consumables for artificial joints.
The person in charge of the private orthopedic specialist chain said that the orthopedic experts of the previous top three hospitals were rarely willing to join the private hospital, but if the consumables bonus was cancelled, a large number of orthopedic doctors took the initiative to go to the market, which would be a high probability event, which would be a major positive for private hospitals.
On November 26, 2021, the National Medical Insurance Bureau issued the Three-Year Action Plan for the Reform of DRG/DIP Payment Methods, which requires that by the end of 2025, DRG/DIP payment methods will cover all eligible medical institutions in the country that carry out inpatient services.
This means that DRG/DIP payment will be officially implemented in all hospitals across the country.
"It turned out that the most profitable department was orthopedics, but after the total prepayment was implemented, overnight, orthopedics became a cost center." Liu Yuanli, counselor of the State Council and executive dean of the School of Health Management and Policy of the Chinese Academy of Medical Sciences and Peking Union Medical College, told the health community that the medical group established by the Shenzhen Luohu Social Welfare Center has long been prepaid for the total amount of social security hospitalization expenses.
Although there is a difference between the DRG prepayment system and the total prepayment system, it is to promote hospitals to actively control the growth of medical costs. According to Liu Yuanli, in the Luohu model, in order to avoid too many orthopedic patients, medical institutions went to more than 800 elderly homes in the community to install fall-proof facilities for free to control medical costs from the source.
Although DRG prepayments have different effects from total prepayments, the purpose of motivating hospitals to be patient-centered and provide quality medical services is consistent.
Luo Mingwei of Panzhihua Central Hospital and others once concluded on the "PERFORMANCE EVALUATION OF Orthopedic Professional Inpatient Services of Sichuan Top 3 Hospitals Based on DRG" and wrote that the cost consumption index and time consumption index are directly related to the hospital's treatment model, which is directly reflected in medical costs and hospital stay time.
Controlling cost and time consumption requires improving medical efficiency and accelerating patient turnover. So, in the case of fast turnover and high efficiency of orthopedic patients, how can we ensure the postoperative effect and effective rehabilitation of patients?
This therapy can cost patient rehabilitation
Reduced to 20% offline
"For orthopedics, postoperative rehabilitation is very important, but the capacity of the hospital rehabilitation department is indeed limited." Ma Xin, vice president of Huashan Hospital, told the health community.
"One of our 80-year-old female patients here, who has not even been hospitalized, has relied entirely on home rehabilitation and has achieved good results." Mao Yongpeng, a nurse in the orthopedic department of Beijing Shijitan Hospital, told the health community.
According to the health community, the female patient decided to take conservative treatment after visiting other hospitals. In the later stage, the family members placed orders through the online booking platform, and the team of Mao Yongpeng took the order.
"Our team went to the patient's home for an assessment, followed by post-treatment, and a series of home visits, and the patient's condition is still good." Mao Yongpeng introduced that Shijitan Hospital not only has a rehabilitation department, but also a rehabilitation team in his orthopedic department, and they will discuss together according to the specific cases of patients, make rehabilitation plans, and go door-to-door to do home rehabilitation for patients.
"The vast majority of patients are unable to recover in the hospital rehabilitation department. Medical resources are insufficient, patients have limited mobility, or live in remote distances... It could all be the reason." Zhao Qingyi, CEO of Shanghai Fumusculoskeletal, introduced.
"We really want our patients to rehabilitate in the rehabilitation department of the hospital, but we really can't take on (such a large number of rehabilitation needs)." Speaking of this, Ma Xin is not without regrets, "I can only let the vast majority of patients be discharged from the hospital and recover on their own."
In response to the needs of patients and the calls of doctors, multiple solutions are emerging in the industry. For example, the addition of digital therapy to rehabilitation of remobilized muscles and bones "can reduce the cost of patient rehabilitation to 1/5 of the line, and also provide convenience for some postoperative patients to come to the offline rehabilitation every time due to the long distance and inconvenience." Zhao Qingyi said.
In addition, "Internet + nursing" online booking platforms such as gold medal nurses are also a major way to provide door-to-door rehabilitation for patients by releasing the stock of hospital nurses. Mao Yongpeng said that in order to complete the postoperative rehabilitation of the above patient, he went to the patient's home more than a dozen times.
The surgery was done beautifully
Follow-up rehabilitation can not keep up with the white
As far as in-hospital rehabilitation is concerned, the rehabilitation department of most hospitals is mainly responsible for neurological rehabilitation, such as hemiplegia and cerebrovascular disease rehabilitation. The sports rehabilitation category alone also has a very professional hospital such as the Third Hospital of Peking University, but it is far from being able to meet the huge demand of society.
More people are working out, and more people need sports rehabilitation. Hua Yinghui, an expert at the Sports Medicine Center of Huashan Hospital, once said in public that 10 years ago, people were keen on fitness; 10 years later, people began to pay attention to rehabilitation.
Now, that 10 years have arrived. According to Mao Yongpeng, some hospitals (such as Beijing Shijitan Hospital) are now trying to do transformation and begin to do rehabilitation for patients in the undergraduate room, rather than directly handing over to the rehabilitation department or discharging patients.
Millennium Temple Hospital has also opened a professional orthopedic nursing clinic, where patients can continue to complete various rehabilitation knowledge guidance and home nursing points in the nursing clinic after medical treatment, which is a way to continue nursing, which can facilitate the answer to various orthopedic rehabilitation and nursing questions of patients.
"The usual idea of patients is that they can't move after surgery. In fact, the body does not move for a long time, and the problem will become more and more serious. Our aim is to allow patients to regain their autonomy as soon as possible, little by little, so that the doctor's surgery can be better." Mao Yongpeng introduced.
Ms. Hu, a 43-year-old woman in Chengdu, underwent surgery on her right patellar fracture, and during the recuperation period, she basically lay in bed all day, afraid to move her right knee joint or walk on the ground, and the right knee joint had only 40 degrees of motion after the fracture healed, and the right thigh muscle was also significantly atrophied.
Accompanied by her family, Ms. Hu went to Chengdu Gulian Jinchen Rehabilitation Hospital for rehabilitation treatment. After 4 professional rehabilitation treatments, Ms. Hu's right knee joint range of motion reached 70 degrees, and the shape and strength of her right thigh muscles also improved significantly, and after 1 month, she basically returned to normal.
According to the experts of the hospital, functional training is an indispensable part of the fracture rehabilitation process and cannot be replaced by any other treatment. Therefore, fracture patients can not only rely on surgery, in order to recover as soon as possible, but also actively carry out professional rehabilitation treatment.
"Completing surgery is 51% cured, while rehabilitation accounts for 49%. The lack of postoperative rehabilitation directly affects the treatment effect," Ma Xin said of the importance of post-orthopedic rehabilitation, "We worked hard to do a beautiful job of surgery, but the follow-up rehabilitation can not keep up, which is a great regret."
How are patient rehabilitation needs changing?
As a rehabilitation nurse, Mao Yongpeng, in the clinical nursing work of orthopedics, he deeply realized that for patients, the key to the success of surgery is whether they can restore their previous functions, "For example, after a fracture operation, the patient is brought about 2 to 3 months of bone fixation period, which may cause a certain joint function loss, mobility disorders, which have to rely on postoperative rehabilitation to help patients restore function." When the patient is unable to restore the function of the body, the operation, no matter how well done, is of limited significance."
Li Jian'an is the director of the Rehabilitation Medicine Center of the First Affiliated Hospital of Nanjing Medical University and a foreign academician of the National Academy of Medical Sciences. In September 2016, Li Jian'an accidentally fractured a bone during a morning run, and he decided to test whether exercising as early as possible after the fracture was beneficial for rehabilitation.
On the 5th day after the fracture, he walked for half an hour without crutches and walked nearly 6,000 steps. On the 80th day after the fracture, Li Jian'an completed his first "full horse" at the Guangzhou Marathon, with a result of 5 hours and 54 minutes. At this point, his fractured right foot had basically recovered.
"Most diseases cannot be completely cured, and even if the operation is successful, only bed rest will leave behind various types of dysfunctions, which require scientific and effective rehabilitation." From medical treatment to rehabilitation, from inside the hospital to outside the hospital, rehabilitation under the guidance of professionals is particularly important." Li Jianan introduced to the health community.
The prospects for rehabilitation medical associations are promising
In June 2021, eight ministries and commissions, including the National Health Commission and the National Medical Insurance Bureau, formulated the Opinions on Accelerating the Development of Rehabilitation Medical Work. The "Opinions" emphasize the importance of the construction of the three-level rehabilitation network, and put forward development opinions such as encouraging social medical institutions to participate in the construction of chain rehabilitation medical centers, encouraging the transformation of rehabilitation medical treatment in first- and second-level hospitals, and promoting the joint development of services between tertiary hospitals and grass-roots medical associations.
"As a district geriatric hospital, we cooperate with the community to take the initiative to do a good job in docking work, and promote graded diagnosis and treatment and two-way referral." Xu Lei, vice president of Shanghai Jing'an Geriatric Hospital, introduced that in order to improve the utilization rate and turnover rate of medical resources, combined with the management of chronic diseases, the rehabilitation hospital guided the community to carry out personalized rehabilitation capacity building.
The self-contained private rehabilitation group has also made a good layout and attempt in advance before the policy is transmitted. According to the understanding of the health community, the close-knit county medical community in Sanming, Fujian Province, or the "Luohu version" of the "hospital union", has realized the "integration of staffing, operation and management, and integration of medical services" of regional medical institutions.
A national rehabilitation hospital group like Gu Lian has also formed a similar effect due to the synergy and linkage within the group. According to Gulian staff, nursing and rehabilitation training after discharge from Gulian Rehabilitation Hospital can be carried out for community rehabilitation at the Yidekang Nursing Station, which belongs to The Same Fresh Air Health. For patients who need community rehabilitation, Gulian Rehabilitation Hospital can formulate a rehabilitation plan in advance, and the patient's responsible therapist will be connected to the nursing station, and then the nursing station will carry out the plan implementation. In this way, the seamless connection between rehabilitation specialist hospitals and community nursing stations has been completed, forming a "rehabilitation closed loop".
Not only orthopedics, but also patient-centered, out-of-hospital and in-hospital effective connection of complete medical services will become an inevitable trend.
While serving patients well, enhancing the value of medical staff and ensuring the decent income of medical staff is also a must-answer question in the medical system.
Based on this, the relevant industries will also find their own win-win opportunities with hospitals, doctors, patients and industry development in this value chain.
Sources | the health community
Written by | Shen Jia
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