Recently, under the guidance of the National Medical Security Bureau, the Notice of the Fujian Provincial Medical Insurance Bureau on the Trial Implementation of the Charging Policy for Pharmaceutical Services in Provincial Public Hospitals (hereinafter referred to as the "Notice") was made public, clarifying the price list of pharmacy medical services in public hospitals, setting prices for 16 clinical pharmacy services, and trying them for one year from July 1, 2022.
No.1
Background of the Trial Implementation of the Notice
Pricing of pharmaceutical services is the trend of the times
The "Notice" proposes that pharmacy services are an important part of medical services, and the transformation of clinical pharmacists' service models and the direct provision of pharmacy services to patients are of great significance for promoting rational clinical medication, ensuring the safety of patient medication, and improving the level of drug treatment, and are also an inherent requirement for promoting the high-quality development of public hospitals.
At the same time, the Notice takes into account that the policy of charging for pharmaceutical services is related to the vital interests of the people, which is a relatively complex and sensitive issue. At present, the existing technical specifications and evaluation standards of pharmacy services in Fujian Province are not perfect, the content and service methods of pharmacy services are still relatively general, the number of clinical pharmacists is not sufficient enough, the system of comprehensively supporting the direct provision of pharmacy services for patients alone has not yet been formed, and the sense of identity and acquisition of patient experience services needs to be further enhanced.
To this end, under the guidance of the National Medical Security Bureau, the provincial public hospitals in Fujian Province have taken the lead in exploring the charging policy for pharmaceutical services, so that patients can feel the value of pharmaceutical services.
No.2
5 key takeaways
Effectively ensure the effectiveness of the trial implementation of the Notice
The Notice explains the importance and necessity of the pharmacy service charging policy from five aspects, and stipulates the positioning, scope, price, payment and effect evaluation process of the Notice on a trial basis, the specific contents are as follows:
1. There is no separate medical service price, and the provincial hospital will pilot it first
Clarify the basic positioning. The pharmacy service charging policy adheres to the basic positioning of "output-oriented, quality and price matching", and the clinical pharmacists of medical institutions who meet the prescribed qualifications apply pharmaceutical professional knowledge and technology for the purpose of promoting rational and economic drug use, and take the clinical pharmacy services for patients, independent content and direct provision as the price items of pharmaceutical medical services, so as to prevent the price items with insufficient service content and the nature of "head fee" and "threshold fee".
For the matters that should be fulfilled by hospitals such as traditional prescription review and adjustment, as well as service matters that belong to the internal management of hospital pharmacies, when designing policies, it is clearly considered as the comprehensive operating costs of public hospitals, and medical service price items are not set up separately.
2. TCM is not within the scope of "additional collection"
Clarify the scope of the pilot. The "additional collection" of drug treatment outpatient clinics, multidisciplinary comprehensive outpatient clinics and inpatient consultation examination fees is limited to the collection of pharmacy services such as clinical drug treatment provided by public hospitals in Fujian Province for patients, but does not include traditional Chinese medicine treatment. Public medical institutions provide pharmacy services such as serum drug concentration determination, screening of various types of drugs of abuse, drug sensitivity tests, intravenous drug dispensing fees, and genetic testing for medication guidance.
3. Under certain circumstances, the "additional collection" policy may be implemented
It is necessary to clarify the price items and add new drug treatment outpatient items; sort out and improve the charging items related to pharmaceutical services in the current price items, and standardize and integrate the price items of pharmaceutical medical services, including but not limited to serum drug concentration determination, screening of various types of drugs of abuse, drug sensitivity tests, genetic testing for medication guidance, intravenous drug allocation fees, and other items;
Adjust the inpatient consultation fee and multidisciplinary comprehensive outpatient price project, clinical pharmacists who meet the prescribed qualifications participate in inpatient rounds and multidisciplinary comprehensive outpatient clinics, provide interpretation of drug test results and clinical drug recommendations, put forward opinions on drug reorganization or drug intervention, and implement an "additional fee" policy on the basis of inpatient consultation fees and multidisciplinary comprehensive outpatient clinics.
4. Within your means, drug abuse screening cannot be paid for using Medicare
Clarify medical insurance payments, include drug treatment outpatient projects in the scope of medical insurance payment, and be paid by basic medical insurance in accordance with regulations; price items for pharmaceutical medical services such as intravenous drug configuration, serum drug concentration determination, drug sensitivity testing, and genetic testing for medication guidance, as well as the charging standards after the inpatient consultation fee is "charged" in accordance with regulations, are included in the scope of medical insurance payment in accordance with regulations; all kinds of abuse drug screening and multidisciplinary comprehensive outpatient medical insurance are not paid.
5. Evaluate and monitor, show the value of pharmacists
Conduct effectiveness evaluations. Establish a monitoring and evaluation mechanism for pharmacy service charges, carry out tracking and monitoring of the charges and payments for pharmaceutical services in public hospitals in Fujian Province, focus on monitoring the safety, rationality, economy and influence of drug use, and choose the opportunity to analyze and evaluate the management of drug treatment, promote the rational use of drugs and safe use of drugs by medical institutions, and let patients feel the value of pharmaceutical services.
No.3
There should be a certain period of price adjustment
Step by step, avoid "one size fits all"
The "Notice" clearly requires that all pilot hospitals should strictly organize the implementation, adhere to the clinical needs and rational drug use as the guide, strictly implement the standard specifications of pharmacy services and the provisions of the clinical pharmacist system, study and formulate the clinical path of pharmacy services, and refine the content and methods of clinical pharmacists' services;
To strengthen drug management, it is necessary to effectively reflect and give full play to the role of pharmacy professional and technical personnel, incorporate pharmaceutical services into the medical quality management and control system of the institution, control irrational drug use, and reduce the risk of drug use;
To standardize the collection of fees, it is necessary to combine their own pharmaceutical service capabilities, provide services in accordance with regulations and collect fees according to facts, must not fictitious services or collude projects, and strictly implement the fee publicity system, and consciously accept social supervision.
The "Notice" also stipulates that the price of multidisciplinary comprehensive outpatient clinics should reflect the technical content of medical services and the degree of medical risk, take into account market supply and demand, comprehensively consider the masses and the level of local economic and social development and other factors determined by medical institutions independently, and maintain the price relatively stable in a certain period of time, the price adjustment cycle is not less than 6 months, the one-time increase shall not be higher than 20%, and the downward adjustment is not limited.
It is worth mentioning that the Notice divides two criteria in pricing: the top three and the bottom three. Among the 16 clinical pharmacy service items, the prices of serum drug concentration determination, humoral antibiotic concentration determination, various types of drug abuse screening, drug sensitivity testing, and genetic testing for medication guidance are higher than those of the top three.
Source: Fujian Provincial Medical Insurance Bureau official website, Zhonghong Network - Big Health, Huayi Network
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