XX医院DRG运营绩效考核分配方案.docx

XX医院DRG运营绩效考核分配方案经济支付方向标对公立医院发展具有十分重要的引领作用，伴随DRGs医保支付方式的实施，多地医院已经开始探索将DRG引人到内部绩效考核分配中。未来适应医保支付政策的绩效考核制度和薪酬制度必然成为医院管理的主流。本方案通过对国内相关研究进行查阅和整理，及时了解当前国内各省市公立医疗机构薪酬分配做法和实践，对DRG在公立医疗机构绩效考核和薪酬分配的应用模式进行全面、系统分析，从而为医疗机构绩效分配改革提供参考与建议。1 DRG考核指标选取标准1.1 入组率入组率作为评价按病种付费改革成果的重要指标之一，体现政府对于DRG结算工作的满意度；与此同时，入组率作为过程管理的评价体现，不仅表明结算病案数量，同时体现流程管理的理念，提高入组率增加各部门协作，同时不断改进服务工作，缩短结算周期提高患者满意度。1.2 时间消耗指数时间消耗指数代表治疗同类疾病所花费的时间，是评价住院医疗服务效率的重要指标，临床科室可参照标杆值，将时间消耗指数控制在合理的范围内，有针对性地提升收治病种难度、降低平均住院日和平均费用。1.3 费用消耗指数和时间消耗指数一样，费用消耗指数代表治疗同类疾病所花费的费用，是评价住院医疗服务效率的又一重要指标。临床科室同样可参照标杆值，将费用消耗指数控制在合理的范围内，有针对性地提升收治病种难度、降低平均住院日和平均费用。1.4 CMI值CMI值是DRG指标体系的一项重要指标，处于体系的枢纽位置，主要体现医院及科室的资源消耗强度及复杂程度，并可在一定程度上反映收治疾病的疑难复杂程度和医疗服务的整体技术难度。医院管理者要充分理解CMI内涵，有效应用CMl进行不同层级及不同类别住院费用的预测、评价与控制，并合理使用CMI对其他管理指标进行调整后再评价。L5药品耗材占比药品耗材占比该指标可以深入各科室，尤其是DRG亏损科室，通过横向和纵向的对比分析各病组的用药情况、出院带药、手术耗材使用等，为合理用药、合理用耗提供指引。2 DRG运营绩效考核分配规则科室实发DRG运营绩效二科室应发DRG运营绩效基数*（DRG运营考核分数/100）;DRG运营考核分数（IOo）=入组率（15）+时间消耗指数（20）+费用消耗指数（20）+CMI值（30）+药品耗材占比（15）其中入组率、时间消耗指数、费用消耗指数、CMI以及药品耗材占比量化规则详见表1。表1DRG相关指标评分量化规则指标评分标准入组率时间消耗指数费用消耗指数CMI值药品耗材占比各科室以99%作为考核基数（重症医学科为90%）,本考核期间各考核单元每增加（减少）1%加（减）1分，每个考核单元当期最多加1分。各考核单元以1为基数，本考核期间各考核单元每增加（减少）1%扣（加）0.1分，每个考核单元当期最多加2分。各考核单元以1为基数（重症医学科以0.65权重对费用消耗指数进行校正），本考核期间各考核单元每增加（减少）1%扣（加）0.2分，每 个考核单元当期最多加2分。各考核单元以行业标杆CMI值为基数,本考核期间各考核单元每增加（减少）1%加（减）2分，每个考核单元当期最多加4分。各考核单元以行业标杆药品与耗材占比值为基数，本考核期间各考核 单元每增加（减少）3%加（减）1分，每个考核单元当期最多加2分。表2详细列举了各科室分别对应的CMI值和药品耗材占比行业标杆。表2各科室分别对应的DRG考核指标参照标准科室CMI行业标杆值药品耗材占比行业标杆值产科0.5623.82儿科0.3632.28耳鼻咽喉科0.6738.93妇科0.6927.34肝胆胰外科1.2748.26感染肝病科0.8928.85骨科一区1.1136.36骨科二区1.8955.00骨科三区1.3150.32呼吸内科0.7938.63甲乳血管外科0.9452.01康复医学科0.7519.63口腔科1.1333.31泌尿外科1.0441.87内分泌科0.5720.58皮肤科0.3528.44普通外科1.0749.23全科医学科0.6923.01神经内科0.6437.81神经外科2.1148.36肾脏血液内科0.7734.49疼痛科1.0823.23消化内科0.6735.35心血管内科1.1548.05新生儿科0.3525.10胸心外科1.8549.22眼科0.5438.69中医（老年）科0.5931.43中医肛肠科0.8736.47肿瘤科0.8452.14重症医学科1.5044.38注：急诊科暂不纳入DRG考核。此外，CMI行业标杆值和药品耗材占比行业标杆值参照的是艾登基于重庆市10家三级医院测算的平均值。3 DRG运营绩效考核分配测算过程3.1 2022年19月总测算3.1.1 各科室改革前应发运营绩效分布本次DRG运营绩效测算数据范围为2022年19月，对标同期应发运营绩效。表3详细罗列了2022年19月期间各科室改革前应发运营绩效分布。表3各科室改革前应发运营绩效分布科室应发总绩效（万元）总人数人均绩效（元）产科703.9561411464.99儿科362.87333.510880.70耳鼻咽喉科325.64262.512405.39妇科416.4927115368.60肝胆胰外科247.96202.512244.87感染肝病科297.8825311773.93骨科一区358.91232.815417.19骨科二区206.01149.413789.24骨科三区178.23167.810621.71呼吸内科445.4140610970.80甲乳血管外科261.0321012430.11康复医学科332.3127911910.67口腔科472.55255.518494.99泌尿外科284.8521313373.38内分泌科310.1721914163.11皮肤科235.14140.8216698.38普通外科257.9619413296.77全科医学科169.00121.1813945.67神经内科539.4946611577.06神经外科329.9328711495.90肾脏血液内科392.1935810955.11疼痛科41.142914187.92消化内科360.2425714017.23心血管内科714.32518.513776.70新生儿科285.03214.513287.98胸心外科163.72115.7314147.34眼科126.4610312277.92中医（老年）科203.6016912047.13中医肛肠科139.23101.2713748.05肿瘤科272.85209.513023.79重症医学科321.4226412174.993.1.2 各科室DRG运营考核分数测算表4详细罗列了2022年19月期间各科室DRG运营考核分数测算细则。其中DRG运营考核分数最高的科室为新生儿科，总得分109.26；DRG运营考核分数最低的科室为中医肛肠科，总得分85.02。表4各科室DRG运营考核分数测算细则入组入组科室7rfl率得分时间消时间消耗M晨嚣CMlCMI值药品耗材运营考耗指数指数得分值得分胃占比得分核分数指数得分占比新生儿科99.0615.06神经内科99.1315.130.8521.50.8321.70.56348.8317109.260.8921.10.8721.30.913440.114.24105.77普通外科99.0515.051.0519.50.8321.71.1130.839.1218.37105.42肿瘤科99.3115.310.8921.10.7922.10.9532.255.7613.79104.5耳鼻咽喉科99.2915.290.8521.50.79220.628.633.1116.94104.33肾脏血液内科99.2415.241.0619.40.8421.60.9533.636.2414.42104.26肝胆胰外科99.6215.620.9220.80.9320.71.273042.2816.99104.11重症医学科89.3114.310.9420.61.1818.21.743437.617104.11消化内科99.4615.460.9420.60.8421.60.6830.232.4515.97103.83胸心外科95.7611.760.8321.70.6623.41.853043.4316.93103.79骨科二区99.0815.080.73220.8821.21.893054.8515.05103.33儿科100161.0219.80.71220.363031.7715.17102.97心血管内科99.3415.340.9620.40.8221.1329.648.5514.83102.17骨科三区97.5713.570.8121.90.9120.91.313048.6915.54101.91产科99.315.31.2180.9920.10.613116.3317101.4骨科一区97.0113.010.8221.80.9220.81.113036.1115.08100.69全科医学科99.5215.520.8921.10.9520.50.6128.425.6514.1299.64皮肤科97.5313.531.1518.50.9820.20.353019.951799.23眼科99.6715.671.1318.70.9210.529.239.7614.6499.21甲乳血管外科98.5714.571.1918.10.9320.70.943049.8115.7399.1呼吸内科99.0415.041.1191.0119.90.7629.438.2415.1398.47中医（老年）科98.1514.151.0819.20.9520.50.630.233.514.3198.36神经外科94.110.11200.9320.72.443454.0813.0997.89内分泌科98.8114.811.0519.50.9220.80.5930.428.5412.3597.86泌尿外科99.515.51.1318.71.0519.50.992941.9414.9897.68感染肝病科98.7914.791.0519.50.8321.70.726.229.3714.8397.02口腔科98.8814.880.67220.53220.6620.617.31796.48疼痛科98.9114.911.0819.20.6220.8124.621.6815.5296.23康复医学科99.3215.321.5151.3170.6728.46.171792.72妇科90.076.071.1818.20.8621.40.7130.428.4914.6290.69中医肛肠科95.7511.751.4915.11.1918.10.622536.2715.0785.02注：重症医学科费用消耗指数校正系数为0.653.1.3 各科室DRG运营绩效改革前后对比测算若以总运营绩效的45%作为DRG运营绩效考核基数，则改革前后各科室绩效对比如表5所示。其中DRG改革前后人均绩效减少最多的科室为中医肛肠科,人均绩效减少926.73元；人均绩效增加最多的科室为新生儿科，人均绩效增加553.7元。此外改革前2022年1-9月应发总绩效的45%为4390.17万元，DRG改革后2022年19月的应发总绩效为4417.10万元，累计增加26.93万元，平均每月增加2.99万元。表明改革前后医院应发总绩效金额几乎没有变化，但达到了DRG的考核效果。表5改革前后各科室绩效对比科室应发总绩效45%（万元）总人数人均绩效45%（tl）得分DRG考核人均绩效改革前后人均绩效差异中医肛肠科62.65101.276186.4385.025259.7-926.73妇科187.422716915.8790.696272-643.87康复医学科149.542795359.8692.724969.66-390.2口腔科212.65255.58322.996.488029.93-292.97疼痛科18.51296382.7696.236142.13-240.63感染肝病科134.052535298.4297.025140.53-157.89泌尿外科128.182136017.8497.685878.23-139.61内分泌科139.582196373.5297.866237.13-136.39神经外科148.472875173.1797.895064.02-109.15中医（老年）科91.621695421.398.365332.39-88.91呼吸内科200.434064936.798.474861.17-75.53皮肤科105.81140.827513.8599.237455.99-57.86甲乳血管外科117.462105593.3399.15542.99-50.34眼科56.911035525.2499.215481.59-43.65全科医学科76.05121.186275.7999.646253.2-22.59骨科一区161.51232.86937.71100.696985.5847.87产科316.786145159.28101.45231.5172.23骨科三区80.2167.84779.5101.914870.7991.29心血管内科321.44518.56199.42102.176333.95134.53儿科163.29333.54896.25102.975041.67145.42骨科二区92.7149.46204.82103.336411.44206.62肾脏血液内科176.493584929.89104.265139.9210.01重症医学科144.642645478.79104.115703.97225.18肝胆胰外科111.58202.55510.12104.115736.59226.47胸心外科73.67115.736365.68103.796606.94241.26消化内科162.112576307.78103.836549.37241.59耳鼻咽喉科146.54262.55582.48104.335824.2241.72肿瘤科122.78209.55860.62104.56124.35263.73神经内科242.774665209.66105.775510.26300.6普通外科116.081945983.51105.426307.82324.31新生儿科128.26214.55979.49109.266533.19553.73.2 2022年9月单月测算3.2.1 各科室改革前应发运营绩效分布以2022年9月为例，对标同期应发运营绩效。表6详细罗列了2022年9月期间各科室改革前应发运营绩效分布。表6各科室2022年9月改革前应发运营绩效分布科室应发总绩效（万元）总人数人均绩效（元）产科89.076713294.18儿科23.7405925.79耳鼻咽喉科28.15299706.16妇科47.012916209.7肝胆胰外科29.232213284.38感染肝病科34.382812279.83骨科二区27.4417.315862.48骨科三区15.718.58487.92骨科一区44.4128.215749.99呼吸内科32.55457234.12甲乳血管外科24.132410055.22康复医学科40.223312187.39口腔科53.272918368.61泌尿外科30.892214043.13内分泌科36.872614181.36皮肤科26.9916.9715901.49普通外科25.92112334.58全科医学科16.1712.0313445.58神经内科54.325210445.25神经外科41.43212937.63肾脏血液内科46.684310856.77疼痛科4.14313811.09消化内科42.273113634.81心血管内科71.275812287.35新生儿科34.742414474.82胸心外科19.9613.4714815.23眼科12.191210160.6中医（老年）科14.78188212.45中医肛肠科11.3210.5310753.86肿瘤科43.12815394.35重症医学科38.753112499.813.2.2 各科室DRG运营考核分数测算表7详细罗列了2022年9月期间各科室DRG运营考核分数测算细则。其中DRG运营考核分数最高的科室为新生儿科，总得分05DRG运营考核分数最低的科室为中医肛肠科，总得分81.16。表7各科室2022年9月DRG运营考核分数测算细则科室入组率入组率得分时间消耗指数时间消耗指数得分费用消耗指数费用消耗指数得分CMI值CMI值得分药品耗材占比药品耗材占比得分运营考核分数新生儿科100160.8521.50.81220.563410.4517110.5肝胆胰外科100160.8121.90.8221.3331.241.717108.1肿瘤科99.6715.670.9120.90.7922133.248.616.18107.95神经内科100160.9320.70.9421.20.853436.6915.37107.27消化内科100160.9220.80.76220.7631.831.1416.4107骨科二区98.7314.730.68220.89221.9130.450.1316.62105.75普通外科99.2415.240.9920.10.78221.1431.438.3317105.74儿科100160.9220.80.61220.3329.426.1917105.2中医（老年）科99.0315.030.8421.60.7220.643129.7215.57105.2全科医学科100160.8121.90.85220.6729.623.2214.93104.43肾脏血液内科100161.3216.80.9221.023535.9314.52104.32皮肤科100161.0619.40.9820.40.3830.620.7517103.4心血管内科98.2114.210.9520.50.79221.1630.245.4215.88102.79骨科三区98.4514.450.72220.84221.2729.249.9815.11102.76产科99.7115.711.1818.20.9620.80.613115.7717102.71耳鼻咽喉科97.213.20.8921.10.82220.628.629.9517101.9眼科100161.0619.40.86220.5229.639.1414.85101.85甲乳血管外科97.9513.951.0419.60.84220.9730.654.8814.04100.19泌尿外科100161.0719.31.0319.41.043041.4515.1499.84内分泌科97.4513.451.0519.50.87220.630.622.7914.2699.81骨科一区95.2411.240.8521.50.89220.9827.427.911799.14感染肝病科98.5514.551.1318.70.9620.80.8829.830.2914.5298.37呼吸内科99.3115.311.2317.71.0718.60.8130.434.7916.2898.29胸心外科95.5911.590.8220.69221.6325.640.281798.19康复医学科100161.5614.41.3712.60.8331.65.161791.6疼痛科98.0814.081.2317.70.81220.682220.9915.7591.53重症医学科88.2413.241201.346.81.913438.091791.04神经外科86.362.361.0119.91202.873450.4514.390.56口腔科88.894.890.57220.46220.732214.671787.89妇科82.5401.1718.30.95210.6128.425.0415.7783.47中医肛肠科94.6410.641.5614.41.2315.40.622534.315.7281.16注：重症医学科费用消耗指数校正系数为0.653.2.3 各科室DRG运营绩效改革前后对比测算同样以2022年9月总运营绩效的45%作为DRG运营绩效考核基数，则改革前后各科室绩效对比如表8所示。其中DRG改革前后人均绩效减少最多的科室为妇科，人均绩效减少1205.81元；人均绩效增加最多的科室为新生儿科，人均绩效增加683.94元。此外改革前2022年9月应发总绩效的45%为477.45万元，DRG改革后2022年9月的应发总绩效为478.02万元，累计增加0.57万元。同样表明改革前后医院应发总绩效金额几乎没有变化,但达到了DRG的考核效果。表8改革前后2022年9月各科室绩效对比科室应发总绩效45%（万元）总人数人均绩效45%（t）得分DRG考核人均绩效改革前后人均绩效差异妇科21.1545297294.6683.476088.85-1205.81口腔科23.9715298266.0387.897265.02-1001.02中医肛肠科5.09410.534837.6181.163926.2-911.41神经外科18.63325821.8890.565272.29-549.59疼痛科1.8633621091.535684.01-525.99重症医学科17.437531562591.045121-504康复医学科18.099335484.5591.65023.84-460.7胸心外科8.98213.476668.1598.196547.46-120.69感染肝病科15.471285525.3698.375435.29-90.06骨科一区19.984528.27086.799.147025.76-60.95呼吸内科14.647545325598.293199.34-55.66内分泌科16.5915266381.3599.816369.22-12.12泌尿外科13.9005226318.4199.846308.3-10.11甲乳血管外科10.8585244524.38100.194532.978.6耳鼻咽喉科12.6675294368.1101.94451.182.99眼科5.4855124571.25101.854655.8284.57骨科三区7.06518.53818.92102.763924.32105.4儿科10.665402666.25105.22804.9138.65心血管内科32.0715585529.57102.795683.84154.27产科40.0815675982.31102.716144.43162.12中医（老年）科6.651183695105.23887.14192.14肾脏血液内科21.006434885.12104.325096.15211.04皮肤科12.145516.977157.04103.474(X).38243.34全科医学科7.276512.036048.63104.436316.58267.95普通外科11.655215550105.745868.57318.57神经内科24.444524700.77107.275()42.52341.75骨科二区12.34817.37137.57105.757547.98410.41消化内科19.0215316135.971076565.49429.52肝胆胰外科13.1535225978.86108.16463.15484.29肿瘤科19.395286926.79107.957477.47550.68新生儿科15.633246513.75110.57197.69683.943.3 2022年1月单月测算3.3.1 各科室改革前应发运营绩效分布以2022年1月为例，对标同期应发运营绩效。表9详细罗列了2022年1月期间各科室改革前应发运营绩效分布。表9各科室2022年1月改革前应发运营绩效分布科室应发总绩效（万元）总人数人均绩效（元）产科76.327210599.94儿科47.563513588.73耳鼻咽喉科40.223013406.23妇科42.323113650.83肝胆胰外科30.092313083.93感染肝病科29.052810376.24骨科二区20.816.512605.32骨科三区22.2819.211604.01骨科一区35.8225.813882.81呼吸内科53.584511905.96甲乳血管外科31.082214127.94康复医学科34.013110972.16口腔科49.272817597.8泌尿外科22.59249413.13内分泌科32.062413359.08皮肤科21.6214.4514966.76普通外科31.982214537.11全科医学科20.7615.5513346.81神经内科54.695210516.83神经外科39.043212201.28肾脏血液内科45.643911701.65疼痛科5.32317746.07消化内科39.392814069.52心血管内科75.275713205.4新生儿科36.452415188.62胸心外科15.5612.7412216.31眼科12.921111744.01中医（老年）科20.111910582.33中医肛肠科15.211.2613494.86肿瘤科22.7218.512280.08重症医学科31.852811374.583.3.2 各科室DRG运营考核分数测算表10详细罗列了2022年1月期间各科室DRG运营考核分数测算细则。其中DRG运营考核分数最高的科室为新生儿科，总得分H0.6；DRG运营考核分数最低的科室为口腔科，总得分8349。表10各科室2022年1月DRG运营考核分数测算细则科室入组率入组率得分时间消耗指数时间消耗指数得分费用消耗指数费用消耗指数得分CMI值CMI值得分药品耗材占比药品耗材占比得分运营考核分数新生儿科100160.8421.60.78220.55349.0617110.6普通外科99.2415.241200.78221.363439.3517108.24神经内科100160.8321.70.8220.873442.3313.49107.19肝胆胰外科100160.9420.60.9920.21.4333.246.315.65105.65骨科三区98.4514.450.8121.90.9820.41.563451.2114.7105.45皮肤科100161.0819.20.87220.3630.221.517104.4儿科100160.9620.40.74220.3930.632.215.03104.03肾脏血液内科100161.0919.10.83220.9433.43