Public hospitals are in charge of economic management for years! The National Health Commission has put forward four major tasks

Empower hospitals and focus on economic operation management

The Year of Economic Management for Public HealthCare Institutions is here again!

On the eve of May Day in 2022, the National Health Commission issued the Notice on Continuing to Carry Out the "Year of Economic Management of Public Medical Institutions" nationwide (Guowei Financial Letter [2022] No. 72, hereinafter referred to as the "Notice"), which set the tone for the economic management reform of public hospitals this year.

Image courtesy of: Department of Finance, National Health Commission

The "Notice" clearly pointed out that the activities of the 2022-2023 Economic Management Year will continue to continue the theme of "standardized management, improving quality and efficiency, and strengthening supervision" in 2021, focusing on key and difficult issues, making up for shortcomings and weaknesses, and focusing on promoting "the construction of operation and management with the integration of industry and finance as the focus, helping to improve the quality of medical services and improving the efficiency and efficiency of resource allocation". The so-called industry-finance integration refers to the integration of medical business, finance and information technology based on the hospital's business process and the use of management accounting tools and methods.

Under the impact and impact of the epidemic,

The economic operation of hospitals faces five major challenges

In fact, the birth of the year of economic management of public medical institutions is closely related to the background of the epidemic.

For more than two years, the operating costs of the hospital around the two main lines of prevention and control and medical treatment have increased significantly, the medical income has been affected and impacted by the epidemic, the income increase is weak, and it coincides with the reform of the medical insurance payment method, the hospital income encounters the "ceiling" bottleneck, the hospital loss surface and the amount of loss are expanding, and the pressure on the hospital's economic operation is prominent.

The pressure of economic operation is mainly reflected in five aspects:

First, the increase in the number of hospitalized patients has declined

Affected by the epidemic, fear of nosocomial infection, the willingness of patients to be hospitalized has declined.

Second, the task of public welfare epidemic has increased significantly

The epidemic situation in various places has been sporadic, resulting in public welfare epidemic prevention and control tasks such as testing, card points, and support, and a large number of hospital personnel have been transferred while also undertaking a large amount of public welfare expenditure.

Third, the growth rate of medical revenue has declined

The impact of the epidemic, coupled with the reform of medical insurance DRG/DIP payment methods, the strict supervision of medical insurance funds, the treatment of irregular medical service behaviors and illegal medical charges, and the superposition of various factors have led to a decline in the growth rate of medical income of hospitals.

Fourth, the cost of prevention and control has increased significantly

The increase in duty personnel at the hospital gate card point, the increase in the number of duty personnel in the ward card point, the strict disinfection of infection control in the hospital, etc., led to an increase in the cost of hospital prevention and control, and promoted the increase in hospital operating costs.

Fifth, the hospital balance rate declines or loses money

Undoubtedly, the increase in the number of patient visits and income has declined, the hospital's prevention and control and operating costs have risen, and the result is the decline in the balance of hospital medical revenue and expenditure, if the financial subsidies of governments at all levels cannot keep up, many hospitals will have an expansion of losses, which undoubtedly accelerates the economic tension of hospitals.

The four key tasks of the year of economic management of public medical institutions

In this context, the Notice emphasizes that the key tasks and contents of the continuous implementation of the "Year of Economic Management of Public Medical Institutions" mainly include four aspects.

1. Accelerate the improvement of the operation and management system of public hospitals

The "Notice" deeply implements the "Guiding Opinions on Strengthening the Operation and Management of Public Hospitals" (Guo Wei Financial Development [2020] No. 27), and puts forward a timetable, making it clear that by the end of 2022, efforts will be made to achieve full coverage of tertiary public hospitals nationwide; and strive to achieve full coverage of secondary public hospitals nationwide by the end of 2023, and the operation and management capabilities of grass-roots medical institutions will be significantly improved.

Second, actively explore specific measures for the integration of industry and finance in line with the actual situation of the hospital

The "Notice" requires that the overall design, organization and implementation, quality control, cost control, etc. be carried out in accordance with the "project management" method, pay attention to scientific, normative and adaptive evaluation from the aspects of business quality improvement and resource allocation, use, evaluation, etc., strengthen the use of management accounting tools and methods, emphasize the coordination of relevant internal departments, improve the working mechanism, optimize business processes, improve the efficiency of resource allocation and use efficiency, and promote the high-quality development of business work. It is clearly required that no less than 2 pilot projects be determined by pilot hospitals for high-quality development of public hospitals and hospitals managed by the National Health Commission and the State Administration of Traditional Chinese Medicine; no less than 1 pilot project for provincial-level tertiary public hospitals and second-level public hospitals.

Third, further prevent the economic operation risks of public hospitals

The "Notice" pointed out that it is necessary to strengthen risk awareness, establish bottom-line thinking, focus on key areas and key links, identify and assess risks, clarify measures, accurately prevent and control, and improve mechanisms to ensure the healthy and sustainable operation of public hospitals. The relevant notice will be issued separately.

Fourth, continue to implement the activity task requirements for the year of economic management in 2020-2021

The "Notice" proposes to check the deficiencies and gaps in the activities of the economic management year in 2020-2021, and continue to implement the 24 key task requirements in 5 aspects set forth in the Notice on Carrying Out the "Economic Management Year of Public Medical Institutions" (Guowei Financial Letter [2020] No. 262). Continue to do a good job in the supervision and management of the legality and compliance of the use of financial funds and basic medical insurance funds, as well as the rectification and rectification of problems found.

24 key tasks in 5 aspects require:

(1) Sort out and analyze problems, and promptly rectify and plug loopholes.

1. Carefully sort out the outstanding problems of economic management and economic behavior found in the external supervision work such as various audits, inspections, and inspections before, as well as the shortcomings of economic management found in the process of internal operation and management, and timely rectify and implement them.

2. Scientifically analyze the causes of problems, establish rules and regulations, and prevent problems before they occur. Focus on matters that include economic behavior (that is, the activity can obtain income or consume resources such as human property and other resources), focus on key links and process control, and establish and improve the system and measures for internal control management and risk monitoring, so that they not only meet the requirements of business management standardization, but also meet the needs of risk prevention and control precision.

(2) Strengthen price management and standardize business and price behavior.

3. Strictly implement the rules and regulations such as the specification of medical service items and the management of price behavior, and establish and improve self-examination and self-correction and internal supervision mechanisms.

4. Standardize the management of fees, and strictly prohibit problems such as duplicate charges, serial exchange of project charges, decomposition charges, over-standard charges, and custom project charges.

5. Standardize the behavior of medical services, and strictly prohibit the use of drugs and consumables beyond the scope, admission to the hospital without indication, or excessive diagnosis and treatment.

6. Standardize the management of pharmaceutical equipment, strictly manage the purchase, sale and inventory of pharmaceutical consumables, strictly prohibit the use of equipment is not standardized, medical records are not standardized, and mandatory services other than medical treatment are provided for patients.

7. In accordance with the changes in the government's medical service price policy, timely adjust the price (including public price) standards of the hospital price management system, effectively improve price transparency, standardize the price behavior of hospitals, and publicize the price information of drugs, medical materials and medical services in a conspicuous position.

(3) Strengthen financial management and consolidate the foundation of economic management.

8. Establish and improve the internal budget, cost, procurement, assets, internal control, operation, performance and other systems and systems within the unit, regulate economic activities in accordance with laws and regulations, improve the level of economic management, and give play to the role of economic management in service, guarantee and control.

9. Firmly establish the concept of "too tight days", combine daily business management with strict control of general expenditures, resource cost savings and deployment, implementation, supervision and evaluation, to ensure full participation and whole process control.

10. Strengthen procurement management. Complete government procurement management systems, standardize procurement processes, and gradually form a management system that is compliant in accordance with law, efficient in operation, and unified in rights and responsibilities, to achieve effective restraints on the operation of internal powers in government procurement activities, and to ensure that government procurement work operates in accordance with laws and regulations.

11. Strengthen donation management. Improve the donation management system, clarify the work procedures, ensure that the procedures for receiving donated funds and materials are complete, register and make records, special account management, special person is responsible, the accounts are consistent, and the accounts are clear; ensure that the donated funds and materials are used in accordance with the law, the special funds are dedicated, and accept the supervision of donors and society.

12. Focus on weak links such as cost management, operation management, internal control, performance management, etc., adhere to the strengths and weaknesses of the short board, improve the full cost accounting system, operation management system measures, internal control of the whole process system, budget performance management target indicator orientation, etc., promote the formation of economic management value creation, improve the quality and efficiency of business activities and economic activities.

13. Strengthen the financial management of subsidy funds and budget performance management of national basic public health service projects. (This item only applies to primary medical and health institutions)

(4) Promote the integration of business and finance, and promote the improvement of economic management quality and efficiency.

14. Integrate the requirements of economic management into all aspects of business process control and quality control such as medical education, research and production prevention, and promote the deep integration of business management and economic management.

15. Take the improvement of quality and efficiency as the main line, change the status quo of emphasizing business over management, improve the awareness of full implementation of the system and attach importance to internal control, and continuously improve the overall level of unit economic management.

16. The hospital may set up an operation management department separately, or determine an internal organization with the leading operation management function, actively implement the operation assistant, price coordinator system, etc., and assist the clinical business department to strengthen the internal operation and price management work of the department.

17. Strengthen the construction of organization and management, tertiary hospitals and qualified secondary hospitals should allocate chief accountants to assist the president in responsible for the work related to hospital economic management and operation management; strengthen the integration of economic management, improve the functions of internal institutions, and form a joint force for economic management; strengthen the construction of economic management talents, and pay attention to cultivating and using professional and composite management talents.

18. Promote the construction of informatization, promote the interconnection and interoperability of the unit's internal operation management platform system and business systems such as medical teaching and scientific research, and data sharing and sharing.

19. Strengthen data management and analysis applications, strengthen the integration of data resources, regularly carry out comprehensive data analysis and research, and provide scientific references and suggestions for leadership decision-making.

(5) Reform and innovation to strengthen supervision, and improve long-term mechanisms.

20. Conscientiously implement the requirements of deepening the task of medical reform, adopt pragmatic and effective measures, and effectively maintain the public welfare attributes of public medical and health institutions.

21. Promote the construction of a long-term mechanism for internal management of medical service prices, promptly declare new medical service projects and strictly implement them; conscientiously implement the requirements of the task of payment method reform, and promote the quality of medical services, reduce costs, and increase efficiency.

22. Refine and implement the internal control system and regulatory measures for economic behavior connotations in various business activities, establish a daily supervision mechanism for joint inspection and joint inspection of medical, price, financial and other management departments, and regularly and irregularly carry out standardized management inspections of medical services to avoid violations of laws and disciplines.

23. Strengthen internal audit oversight. Give play to the role of internal audit and improve the long-term supervision mechanism.

24. Strengthen regulatory measures. Actively use information technology to explore intelligent supervision, standardize diagnosis and treatment, and collect fees, so as to ensure the economic security of units.