With the development of DRG DIP, medical institutions are gradually moving away from the comfort zone of pay-per-project and entering a new stage of packaged payment. In recent years, people have gradually gained a first-hand understanding of DRG DIP, and various controversies have followed.
However, many of these controversies tend to be subjective emotional venting, without in-depth research on the connotation of DRG DIP. Fundamentally speaking, DRG and DIP are both paid in a package according to diagnosis and **, and they are very different in terms of grouping principle, grouping scheme design and implementation details.
As a coder in a DIP payment hospital, the author also has a deeper understanding of the reform of DIP payment methods in his daily work.
1.DIP is more suitable for the current healthcare environment
We know that DRG** is based on Western medical logic, so it is easy to adapt to the soil and water in the process of application. DIP is our own original, which is a purely original grouping method randomly cobbled together using the ICD-10 of the World Health Organization (WHO) and the ICD-9-CM-3 of the United States, which is more suitable for the current medical practice.
2.DIP requires less time to develop and demonstrate
Time is money, efficiency is life. DRG needs to waste a lot of time in development and demonstration, and the development of DRG took nearly 20 years from the beginning of the 60s of the 20th century to the application in the 80s.
From the 2nd DRG DIP Payment Reform Conference, we can know that after DRG was introduced into China, the DRG Technical Guidance Group of the National Health Insurance Administration, together with the Chinese Medical Association, the Chinese Stomatological Association and other relevant professional groups, carried out a lot of clinical demonstration work, and gradually completed 10-1.1-2.The iterative update of version 0 is gradually adapted to the clinical practice.
DIP avoids this complex development and demonstration process, and the brain-door grouping scheme is formed, and a third-party company subdivision group is found, which saves a lot of time.
3.DIP helps to improve the quality of the code
DRG DIP is not only a payment tool, but also a management tool, which helps to force medical institutions to strengthen refined management and improve medical quality.
Compared with DRG, DIP has a more obvious improvement in encoding quality. The DIP score table provides a set of coding errors for disease and surgical operations for the majority of coders, including coding errors that occur more than 15 times in the region, which provides valuable information for coders to learn Xi in their daily lives.
In addition, in countries and regions where DRGs are implemented, the accuracy rate of primary diagnostic coding is usually around 50%-90%. Due to the coarse DRG grouping, minor errors in coding do not affect enrollment and subsequent payments, which makes medical institutions less motivated to improve the accuracy of primary diagnostic coding.
However, DIP is more dependent on the accuracy of the main diagnostic code, and even if the accuracy rate reaches 100%, it may not be able to meet the requirements of accurate grouping, so it can force medical institutions to increase the accuracy of the main diagnostic code to more than 100%.
4.DIP can reduce the cost of communication between health insurance and medical institutions
In the 2nd DRG DIP Payment Reform Conference, a teacher introduced the formation process of the DRG grouping plan, which incorporated a large number of related issues from medical institutions, including policy level, coding level, etc. The grouping of experts will incur a lot of communication costs for sorting, eliminating, discussing, and incorporating these issues. DIP does not have these problems, and the problem is the problem of historical data.
5.DIP prevents "policies at the top, countermeasures at the bottom".
The DRG is the same across the country at the ADRG level, and the difference at the DRG level is not very large, which undoubtedly helps the counterparts in various regions to communicate and take corresponding countermeasures.
The grouping principle of DIP is more scientific, basically doing the difference between local and foreign, this year and next year are different, people can't feel the law, and the partners in various regions are confused and difficult to reach a consensus.
6.DIP helps to reduce undertreatment
DRG and DIP are both paid in packages, which is prone to undertreatment. For example, in DRG, if an operation does not affect the grouping, and the payment criteria are the same, the medical institution will have a stricter grasp of the indications for this operation.
However, due to the large number of groups, DIP may enter the group with a higher score if one more operation is done, so it is less likely to underdiagnose and treat than DRG. This is also one of the more scientific aspects of DIP, which can guide medical institutions to provide more medical services by giving more points, without increasing the expenditure of medical insurance**.
Original title: What are the advantages of DIP compared to DRG?
* |Lao Xu coded.
Edit |Zhang Chenxuan, Liu Xinyu.
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