Daily surgery costs are included in medical insurance hospitalization expenses!Hebei fully implemented day surgery work

Recently, the official website of the Hebei Provincial Health Commission issued the latest notice ↓↓↓

The Hebei Provincial Health and Health Committee Hebei Provincial Medical Security Bureau's notice on further promoting day surgery work

All cities (including Dingzhou, Xinji City) Health and Health Commission (Bureau), Medical Security Bureau, Xiong'an New District Public Service Administration, Party Committee Management Medical Institution:

In order to implement the "Implementation Opinions of the General Office of the People's Government of Hebei Province on Promoting the High -quality Development of Public Hospitals" (Jizheng Office [2021] No. 124), promote day surgery. The Health Commission and the Provincial Medical Security Bureau decided to perform day -day surgery in the province's medical institutions. The relevant requirements are notified as follows:

1. Implement hospital conditions

The second or above medical institutions that meet the following conditions.

(1) Diagnosis and treatment requirements. A diagnosis and treatment subjects approved by the health and health administrative department are consistent with surgery.

(2) Requirements for diagnosis and treatment. Set up an independent day surgery center or day operating room, or reserve a fixed surgery room for the implementation of the day surgery in the existing operating room. Related surgical centers or operating rooms meet the "Hospital Surgery Department (Room) Management Specification (Trial)".

(3) Requirements on personnel. With regular training and completing the clinical application ability of the corresponding surgery operation, the registered physician and other necessary technical personnel of the hospital. There are at least 1-2 full-time personnel responsible for the unified management of patients with day surgery.

(4) Requirements for the auxiliary departments. Set up auxiliary departments such as anesthesiology, intensive guardianship rooms required for day surgery, and equipped with necessary professional and technical personnel and facilities.

1. Anesthesiology can perform heart, lung, and brain rescue and recovery, and have necessary first -aid equipment and medicines such as oxygen supply systems, anesthesia, defibriller, attractor, detector, etc.

2. The intensive care unit can carry out the creative pressure monitoring project and the treatment of ventilator, equipped with multi -functional monitor and ventilator, and have measures and equipment with patients with severe transit patients in the hospital. A full -time physician and nurse with professional training and more than 5 years of intensive care work can meet the needs of patients with severe patients.

2. Scope of implementation of diseases

(1) Surgery referred to this notice refers to surgery or operations completed and discharged in accordance with the diagnosis and treatment plan in accordance with the diagnosis and treatment plan, excluding outpatient surgery or examination operation. Special cases of delaying hospitalization due to the need to be postponed, and the hospitalization time does not exceed 48 hours.

(2) The Provincial Health Commission adheres to the principle of maturity of diagnosis and treatment technology and controllable quality and safety. The following is referred to as "Recommended Catalog") (Annex 1), guiding medical institutions to perform daytime surgery.

(3) Medical institutions combined with the actual situation, prioritize the implementation of day surgery and surgery from the recommendation directory, fill in the "Hebei Provincial Day Surgical Medical Institution File Form" (Annex 2), and report to the health and medical security department at the same level After the filing, the corresponding disease day surgery can be performed.

(4) Encourage third -level medical institutions to explore and carry out other diseases.

3. Daily surgery management

If the patient needs to perform daytime surgery after diagnosis, the medical institution and the patient signed the "Hebei Provincial Hospital Surgery Agreement" (Annex 3) in time to apply for the registration procedures for day surgery. For treatment and pre -hospital examination and evaluation before hospitalization, the relevant situation should be clearly recorded in the daily surgery medical records.

Fourth, medical insurance payment

The expenses of the insured during the day are in line with the scope of the medical insurance policy. Daily surgery costs include medical expenses during the hospitalization period in accordance with the diagnosis and treatment plan and the compliance outpatient expenses that do not exceed 1 week before and after discharge. After the medical insurance department implements DIP/DRG payment for designated medical institutions, the qualified day surgery costs are uniformly included in DIP/DRG payment management.

5. Organize implementation

(1) Strengthen organizational leadership. Daily surgery is of great significance to guide medical institutions to further strengthen internal management, optimize service processes, and improve service efficiency. Health and health administrative departments and medical insurance departments at all levels should effectively strengthen organizational leadership, establish a coordination and promotion mechanism for departments, and strengthen daily surgical management, guidance, supervision, and evaluation. Health and health administrative departments and medical institutions at all levels should strengthen the organization and management of day surgery, establish and improve the day surgery management system and technical documents, standardize diagnosis and treatment behaviors, and control medical expenses.

(2) Clarify the target responsibility. All localities and units must conscientiously implement the responsibility system. The Provincial Health and Health Committee and the Provincial Medical Security Bureau form a day of surgery quality management expert group (Annex 4) to regularly supervise and inspect the day surgery of various local and medical institutions, strengthen performance assessment Essence All medical institutions should formulate practical implementation plans, clarify target tasks and time progress, formulate and improve the management system and strictly implement, and complete various tasks on time and quality.

(3) Ensure quality and safety. Medical institutions that carry out day surgery shall set up a daily surgery leading group in the hospital to clarify the division of responsibilities, coordinate and coordinate the work of admission, surgery, discharge guidance and follow -up, and patient referral of patients. It is necessary to improve the quality management system of day surgery in combination with reality, formulate clinical paths for related diseases, improve quality control indicators, standardize diagnosis and treatment behaviors, and ensure medical quality and safety.

(4) Summary and evaluation in a timely manner.The Provincial Health and Health Committee and the Provincial Medical Security Bureau will establish a day surgery effect assessment mechanism and performance evaluation methods to comprehensively evaluate factors such as quality, safety, efficiency, economic and social benefits.It will gradually establish a daily surgery -related data information submission system, use information technology to carry out data analysis, timely discover and solve problems encountered in the work, and summarize and promote beneficial experience in a timely manner.All medical institutions should actively promote day surgery through various channels, and continuously improve the participation, satisfaction and gain of day surgery.Provincial Health and Health Committee Contact: Marco Heart Ding Rui

Contact number: 0311-66165716 66165702

Email: [email protected]

Provincial Medical Guarantee Bureau Contact: Hado Hadona Hanfeng

Contact number: 0311-66906603 66906509

Email: [email protected]

Hebei Province Health and Health Commission

Hebei Provincial Medical Security Bureau

July 11, 2022

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