新泰市人民医院在全省医保基金监管稽核政策座谈研讨会上作交流发言

Core Viewpoint - The meeting focused on the implementation of national and provincial medical insurance fund supervision policies, emphasizing the importance of regulatory compliance for the high-quality development of hospitals [1] Group 1: Payment Reform and Cost Management - The hospital is promoting standardized diagnosis and treatment and refined cost management through three measures: 1. Standardizing treatment behaviors by monitoring clinical pathways and insurance payment standards, aiming for a DIP payment rate of around 80% by mid-2025 [2] 2. Strengthening cost control, achieving a 7.08% reduction in average costs per case and a 9.39% decrease in patient out-of-pocket expenses, with a total savings of 183 million yuan in medical insurance funds from drug and consumable procurement [2] 3. Establishing a self-inspection mechanism to enhance fund security, reducing unreasonable charges by 7.86 million yuan annually [2] Group 2: Performance Distribution Optimization - The hospital is implementing differentiated assessments for medical insurance indicators, setting thresholds based on departmental disease characteristics and providing positive incentives, along with a dynamic data feedback mechanism to assist in clinical adjustments [3] Group 3: Recommendations for Regular Supervision - The establishment of a "supervision-hospital" collaborative mechanism is recommended to enhance risk prevention capabilities through training and case sharing, alongside the promotion of intelligent regulatory tools to improve self-inspection efficiency at the grassroots level [4] - The meeting was guided by the provincial medical insurance bureau, with representatives from various medical insurance bureaus and over forty designated medical institutions, highlighting the hospital's innovative "regulation embedded in service" model [4]