On April 2, the National Health Commission issued the "National Third-level Public Hospital Performance Appraisal Operation Manual (2022 Edition)" (hereinafter referred to as the "Operation Manual").
The release of the new version of the operation manual also kicked off the new phase of the performance appraisal of tertiary public hospitals (hereinafter referred to as the "National Examination").
Since the General Office of the State Council issued the Opinions on Strengthening the Performance Appraisal of Tertiary Public Hospitals in January 2019, the "National Examination" has been conducted for two rounds.
In order to ensure the standardization, standardization and homogenization of performance appraisal work, the "Operation Manual" came into being. Since the first edition was released in 2019, the first revision was made in 2020, and this is the second revision.
In this revision, a new indicator is added to "focus on monitoring the proportion of revenue of high-value medical consumables". The 41 indicators have been revised, and the revisions involve extending the indicators, supplementing the requirements of the newly released documents, and further clarifying the connotation of the indicators.
The basis of this revision is mainly the opinions and suggestions collected through multiple channels such as on-site research, conference discussions, platform feedback, and self-assessment reports. "Thanks to the valuable opinions and suggestions from all over the world, these opinions and suggestions are the basis for improving the operation manual, and they are also a booster for solid and high-quality promotion of the performance appraisal of tertiary public hospitals." The Office of the Leading Group for Performance Appraisal of Tertiary Public Hospitals of the National Health Commission wrote in the preface to the revision.
"Income from high-value medical consumables" is included in the assessment
The new indicator is "focus on monitoring the proportion of high-value medical consumables revenue", that is, the revenue of 18 kinds of medical consumables published in the first batch of national high-value medical consumables key governance list.
Improving the clinical application management of high-value medical consumables is the reason for joining this indicator.
In 2019, the General Office of the State Council, the National Health Commission, and the State Administration of Traditional Chinese Medicine have successively issued documents requiring comprehensive and in-depth governance of high-value medical consumables, standardizing medical service behavior, and controlling unreasonable growth in medical expenses.
"Strengthen the standardized management of high-value medical consumables, clarify the scope of governance, and take high-value medical consumables with relatively high unit price and resource consumption as the key governance objects." The indicator below the indicator indicates the significance of one.
The first batch of national high-value medical consumables key governance list
The revision covers 41 indicators and covers three main parts
The revision specifically involves 41 indicators, including adding or revising the extension indicators, supplementing the requirements of the newly released documents, and further clarifying the connotation of the indicators.
1. Add or revise extension indicators:
First, on the basis of the original content of indicators 18-19 (proportion of basic drug prescriptions for outpatients and the use rate of basic drugs for inpatients), the assessment content for "the proportion of the number of varieties of essential drugs used in prescriptions" is added, that is, the proportion of the number of essential drug varieties used in outpatient/discharged patients' prescriptions/hospitalizations to the number of drug varieties used in the same period, so as to strengthen the allocation and use of essential drugs in public hospitals.
On top of the original content of indicator 21 (proportion of drugs used in the centralized procurement of drugs organized by the state), the assessment content of the "completion ratio of selected drugs in centralized procurement (the number of selected drug procurement completed varieties / the total number of selected drug varieties)" of the national organization of drugs is added to strengthen the procurement rate of hospitals through the provincial centralized drug procurement platform.
In addition to the original content of indicator 45 (proportion of anesthesia, pediatrics, critical care, pathology, and traditional Chinese medicine physicians), the assessment content of "proportion of infectious disease physicians (number of infectious disease physicians registered in hospitals / total number of physicians in the same period of the hospital)" is added, which means that infectious disease physicians have become the same urgently needed professionals as anesthesia, pediatrics, critical care, pathology, and traditional Chinese medicine physicians.
Second, on the basis of the extension of indicator 37 (increase in medical income), the "increase in medical income after excluding relevant items" is revised to exclude bulk Chinese medicine tablets, small packages of Chinese medicine drinking tablets, Chinese medicine formula granules, medical institutions' traditional Chinese medicine preparations, rare disease drug revenue, drug revenue generated by long-term prescriptions, and income from negotiated drugs included in the national medical insurance catalogue, so as to avoid the restriction of "annual overall growth requirements for medical expenses".
The above exclusions are also applied to indicators 38-41 (increase in average outpatient/inpatient costs, increase in average drug costs in outpatient/inpatient visits).
2. Supplement and update relevant policy documents:
The latest normative documents for 2020 and 2021 have been added to the latest edition of the Operation Manual as the basis for the significance of the indicators.
24 indicators are involved. For example, in the indicator significance of indicator 3 (proportion of day surgery in elective surgery), the Opinions of the General Office of the State Council on Promoting the High-quality Development of Public Hospitals (Guo Ban Fa [2021] No. 18) has been added to promote the day surgery model as an important part of the comprehensive reform of public hospitals.
At the same time, the "Opinions" also require that, under the premise of ensuring the quality and safety of medical care, eligible tertiary hospitals should steadily carry out day surgery, gradually expand the scope of day surgery diseases, increase the proportion of day surgery in elective surgery year by year, shorten the waiting time and waiting time for patients to be hospitalized and waiting for surgery, improve the efficiency of medical services, and alleviate the problems of "difficult hospitalization" and "difficult surgery" of patients.
The "Operation Manual" integrates the 708 day surgeries issued by the General Office of the National Health Commission on the Publication of the Recommended Catalogue of Day Surgery (2022 Edition) as Annex 1, and published it with the new version of the document.
3. Further clarify the connotation of indicators.
According to the relevant questions raised by the hospital in the report, the first is to refine the list of supporting materials for indicator 42 (comprehensive budget management), involving 8 links such as organization management, system construction, and budget preparation.
List of supporting materials for the "Total Budget Management" indicator
Second, the denominator in the new indicator (focusing on monitoring the proportion of revenue from high-value medical consumables) was revised from "total consumables revenue in the same period" to "health material income in the same period" (including outpatient emergency and inpatient health material income), which is consistent with the Supplementary Regulations implemented by hospitals.
The third is to further refine the indicator description according to the work situation. There are 23 indicators involved in 10, 12, 17-21, 28, 30-31, 33, 36-42, 45-46, 49-50, and an increase of 1.
For example, in the indicator description of Indicator 10 (Quality Control of Single Disease Species), not only the requirements of the "National Clinical Edition of the Surgical Operation Classification Code 2.0" that need to be met for the extraction of the single disease species were improved to the "National Clinical Edition of the Surgical Operation Classification Code 3.0", but also added a "gradual expansion of the scope of diseases monitored according to the progress of the work, and carry out specialized ability evaluation based on key diseases."
In the indicator description of indicator 28 (proportion of outpatient income from the health insurance fund), "income from the health insurance fund in outpatient income" has been added to the content of "excluding the personal account part".
In the indicator description of indicator 33 (personnel indicating the proportion of operational expenditure), "personnel expenses" has been added to the content of "excluding the expenses incurred by personnel in financial project appropriations and science and education funds".
In indicator 50 (scientific research project funds per 100 health technicians), the content of "scientific research project funds" is added to "does not include in-hospital projects and in-hospital matching funds, and does not include appropriate technology promotion, new technology introduction, discipline construction, platform construction, studio construction, science popularization, scientific research-related awards and other funds".
Updating or adding footnotes to indicators 1, 8, 10-12, 21, 25-26, 28, 33-35, 37, 49 in total;
For example, in the indicator statement of indicator 28 (proportion of outpatient income from the health insurance fund), a new footnote has been added to the indicator "income from the health insurance fund in outpatient income": "Income from the medical insurance fund in outpatient income" for the assessment year calculated on an accrual basis does not include previous years' disbursements from medical insurance institutions.
In the definition of the indicator for indicator 33 (personnel indicating the proportion of operational expenses), the footnote to the proportion of personnel expenses has been changed from "changes in the expression of income and expenditure accounts" to "changes in the expression of income and expense accounts".
Updated the interpretation of indicators, involving 3 indicators 21, 50 and 52;
For example, in Indicator 21 (Proportion of Drugs Used in Centralized Procurement organized by the State), the interpretation of the indicator was changed from "Provincial Health Commission" to "Provincial Health Commission, Provincial Medical Insurance Department"
In indicator 50 (scientific research project funding per 100 health technicians), the interpretation of the indicator was changed from "provincial health commission" to "national health commission, provincial health commission"
In Indicator 52 (Comprehensive Public Credit Rating Scale), the interpretation of the indicator was changed from "National Public Credit Center" to "National Public Credit Information Center".
Update the source of indicators, covering 8 indicators 21, 28, 30, 37-41.
For example, in indicator 21 (the proportion of drugs used in the centralized procurement of drugs organized by the state), the source of the indicator is based on the hospital's report, and the content of "extended indicators need to be filled in according to the situation displayed by the provincial recruitment platform" has been added.
In Indicator 28 (Proportion of Outpatient Income from Medicare Fund), the source of the indicator was changed from "Financial Annual Statement (current year's report by the hospital)" to "Hospital Report, Financial Annual Statement"
In Indicator 30 (proportion of hospitalization income from medicare funds), the source of the indicator was changed from "Financial Annual Statement" to "Hospital Filing and Financial Annual Statement"
In addition, in order to make the relevant data comparable and implement dynamic monitoring, if the provinces have carried out medical service price adjustments, payment method reforms, etc., which have a greater impact on the assessment indicators, the hospital can provide corresponding explanatory materials.
"The Performance Appraisal Operation Manual for Grade III Public Chinese Medicine Hospitals will be issued separately." The Office of the Leading Group for Performance Appraisal of Tertiary Public Hospitals of the National Health Commission wrote in the last sentence of the preface to the revision.
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Written by | Valley Will