Hospital inspections have been intensively launched, and rebates for medical equipment, high-value consumables, and large-scale equipment management are all focused.
The inspection of large hospitals in Gansu was launched
A few days ago, the Gansu Health Commission issued the "Implementation Plan for the Inspection of Large Hospitals in Gansu Province (2024-2026)" (at the end of the complete attachment), announcing the key points of inspection and the list of hospitals.
According to the plan, this round of inspections will start in April 2024 and be completed by the end of October 2026. In principle, the inspection time shall not be less than 7 days for tertiary general hospitals, and in principle, it shall not be less than 5 days for tertiary specialized hospitals, maternal and child health care hospitals, infectious disease hospitals and secondary hospitals.
The fifth round of large-scale hospital inspections kicked off in December last year, and according to incomplete statistics, at least 10 provinces have made specific arrangements for local hospital inspections.
Drafting: Cyberblue
In all the inspections of large hospitals, corruption has been one of the key points.
Gansu's plan includes a number of violations of hospital integrity such as "commercial commissions", "fraud and insurance fraud" and "accepting red envelopes" as the focus of inspections, and whether to establish and improve the monitoring and early warning system and supervision mechanism covering key posts, key personnel, key medical behaviors, important drug consumables, large medical equipment, infrastructure construction, large-scale repair projects and other key nodes is also specifically mentioned.
By combing the content of the plan, it can be seen that a number of inspection priorities, including illegal debt borrowing, bidding, etc., can be linked with recent national documents to supervise medical corruption in the form of a "combination of punches".
List of hospitals to be inspected in Gansu from 2024 to 2026:
According to the plan, the inspection team does not interfere in the daily work of the hospital, does not deal with specific affairs, and does not undertake specific cases. It is strictly forbidden to engage in deception, formalism, and going through the motions in the inspection work. And according to the needs of the work, organize inspections of the inspected hospitals to "look back", and track the effectiveness of problem rectification.
Multi-department cohesion and cooperation, hospital supervision has been comprehensively upgraded
Since the beginning of the year, the breadth and depth of supervision and assessment of hospitals have ushered in a comprehensive upgrade.
In March, the National Health Commission issued the "National Performance Appraisal Operation Manual for Third-level Public Hospitals (2024 Edition)" and "Performance Appraisal Operation Manual for National Second-level Public Hospitals (2024 Edition)", which include "key monitoring of the proportion of high-value medical consumables revenue", "asset-liability ratio" and "positive rate of large-scale medical equipment inspection", and manage the configuration and procurement of equipment and consumables through the form of assessment.
The problem of hospital arrears has also been rectified.
On April 12, the Henan Provincial Medical Security Bureau and the Henan Provincial Department of Finance issued a notice on the "Implementation Plan for the Direct Settlement of Centralized Procurement of Drugs and Medical Consumables in Henan Province by the Medical Insurance Fund and Pharmaceutical Enterprises", which clearly stated:
Starting from April 2024, each co-ordinating region will start with the centralized procurement of selected drugs, and select one tertiary medical institution and some pharmaceutical companies with wide coverage and strong distribution capacity to carry out direct settlement pilots.
According to the progress of the pilot, the selected products in the centralized procurement of medical consumables will be included in the direct settlement in a timely manner, and the pilot scope of medical institutions and pharmaceutical enterprises will be gradually expanded, and the direct settlement will be implemented in the province in a timely manner.
According to incomplete statistics, Tianjin, Shandong, Fujian, Jiangxi, Inner Mongolia, Hunan, Liaoning, Anhui and other regions are exploring and promoting the direct settlement model of medical insurance to solve the problem of "triangular debt".
Focusing on the integrity of practice involved in the inspection of large hospitals, many places have recently strictly investigated the relevant notices of drug and device rebates, named various types of rebates, and gradually upgraded the management of medical representatives' admission to hospitals.
With the deepening of supervision, the trend of multi-departmental joint inspections is becoming more and more obvious.
On April 16, the National Health Insurance Administration, together with the Supreme People's Court, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance, and the National Health Commission, issued the "Notice on Carrying out Special Rectification of Violations of Laws and Regulations in Medical Insurance Funds", comprehensively carrying out self-examination and self-correction in key areas such as orthopedics, hemodialysis, cardiology, examination, inspection, and rehabilitation physiotherapy, and continued to promote the rectification of problems.
National unannounced inspections, provincial-level unannounced inspections, and municipal-level cross-inspections should all focus on the above six areas.
With the entry of discipline inspection departments into medical insurance supervision, the deterrent effect of centralized rectification of corruption in the pharmaceutical field has been significantly improved. Based on the cohesion and cooperation of multiple departments, the line of defense of "pre-reminder, in-process review, and post-supervision" has gradually taken shape. And with the blessing of intelligent means, the granularity of supervision is more refined.
According to the data disclosed by the National Health Insurance Administration, in 2023, 2.324 billion yuan of non-payment will be realized through the in-process review. In 2023, more than 300 million yuan of medical insurance funds will be verified and recovered only through the verification of suspicious clues screened by the "false hospitalization" big data model.
Based on the cohesion and cooperation of various means, the accuracy and effectiveness of the supervision of medical institutions have achieved an overall leap, and the industry atmosphere is gradually being eliminated.
Full text attached:
Source: Cyberblue Instruments