地區(qū)醫(yī)院DRG統(tǒng)計呂嵐欽

1、1地區(qū)醫(yī)院地區(qū)醫(yī)院DRGDRG統(tǒng)計統(tǒng)計呂嵐欽呂嵐欽 2l依據中央健保局民國94年12月30日發(fā)函內容，經94年9月20日協(xié)商結論，修訂第三版DRGs，共為969項DRGs及支付原則草案，同時亦表示依行政院衛(wèi)生署指示95年7月導入DRGs支付方式。3l部分DRG參考專家意見略作修正。l969969個DRGs，排除條件修正為l分類架構已函請相關醫(yī)學會檢視。l以以9494年年1-61-6月資料計算相對權重月資料計算相對權重TW-DRG V34導入時程MDC2範圍住院人次醫(yī)療費用費用占率CV100DRG數CV100之DRG數(扣除case100之DRG數(扣除case100DRG數CV100之DRG數

2、(扣除case100之DRG數(扣除case60日，採核實申報，得切帳l山地離島醫(yī)院依一般原則計算加計 2%l新生兒合併媽媽計算23支付原則RW *( SPR*25% + Hospital Base Rate *75%)(1+基本診療加成*25%+兒童加成)1.二者比例逐年改變，分4年達到PR 100%、HBR 0%、SPR、HBR由健保局統(tǒng)一計算後公告費用下限臨界點 費用上限臨界點方案一: P97.5方案二: RW*SPR*2.11方案三: RW*SPR+47,838核實核實定額支付定額支付定額定額+ +超過部分超過部分* *0.60.6FABC24兒童加成率l內科系：lAge6m +19%

3、l6mAge2y +14%l外科系lAge6m +30%l6mAge60天核實申報改為30天l95年7月先實施 6個MDClDRG案件保障點值32統(tǒng)計分析33方案三l醫(yī)院家數: 31 家l案 件 數: 9,847 件lDRG 項目: 499 l申請醫(yī)療點數:306,999,770l支付點數:292,515,763l差異數: -13,444,741l差異率: -4.38%34方案三 by MDC3MDC356ABCF總計案件數23 5 141 127 1 8 305 平均住院日2.3 1.6 2.9 5.0 12.0 1.1 3.7 醫(yī)療點數184,692 41,531 1,448,688 1,

4、953,429 93,791 56,578 3,778,709 支付點數163,649 20,472 2,005,215 1,444,223 35,711 56,578 3,725,848 差異數-30,756 -20,738 556,527 -509,206 -58,080 0 -62,254 35方案三 by MDC9MDC956ABCF總計案件數5 11 211 117 5 6 355 平均住院日3.4 4.0 4.6 7.9 24.6 1.5 5.9 醫(yī)療點數56,512 209,956 2,844,018 2,851,522 480,738 23,478 6,466,224 支付點數

5、26,834 140,249 4,597,730 1,943,035 231,771 23,478 6,963,097 差異數-34,969 -72,315 1,753,712 -908,487 -248,967 0 488,974 36方案三 by MDC11MDC1156ABCF總計案件數20 24 336 159 23 14 576 平均住院日5.0 4.5 5.0 8.4 25.1 1.5 6.5 醫(yī)療點數382,011 755,696 5,040,895 5,337,766 3,160,284 84,353 14,761,005 支付點數273,652 436,969 8,119,1

6、37 3,674,201 1,620,255 84,353 14,208,567 差異數-118,989 -329,352 3,078,242 -1,663,565 -1,540,029 0 -573,692 37方案三 by MDC13MDC1356ABCF總計案件數3 50 57 8 118 平均住院日4.7 4.4 5.5 3.4 4.9 醫(yī)療點數125,238 1,431,545 2,193,334 152,878 3,902,995 支付點數82,548 1,752,336 1,789,684 152,878 3,777,447 差異數-42,690 320,791 -403,650

7、 0 -125,548 38方案三 by MDC23MDC2356ABCF總計案件數2 2 24 1 29 平均住院日3.0 9.5 14.8 28.0 14.1 醫(yī)療點數14,977 38,897 685,843 59,297 799,014 支付點數41,704 47,471 1,234,145 52,715 1,376,036 差異數26,727 8,574 548,302 -6,582 577,022 39方案三 by MDC24MDC2456ABCF總計案件數3 2 13 4 3 25 平均住院日1.3 4.0 6.5 14.5 4.0 6.7 醫(yī)療點數17,893 102,114

8、541,333 241,336 56,903 959,579 支付點數24,934 60,109 1,059,071 206,785 56,903 1,407,803 差異數-5,896 -42,005 517,738 -34,551 0 435,286 40主要影響因素l轉科l感染控制l超長住院l病歷記錄l編碼41實務討論MDC3,MDC1142MDC3 案例一l出院診斷l(xiāng)COM(382.9)lmastiditis (383.9)l處置(19.4,20.49)MDC3DRG05302總費用:42902住院天數2l出院診斷l(xiāng)COM(382.9)lmastiditis (383.9)lOld T

9、B(137.0) (cc)l處置(19.4,20.49)MDC3DRG05301總費用:42902住院天數243MDC3 案例二l出院診斷l(xiāng)COM(382.9)l處置Tympanoplasty(19.4) (單側)MDC3DRG05502總費用:31707住院天數3l出院診斷l(xiāng)COM(382.9)l處置Tympanoplasty(19.4) (雙側)MDC3DRG05502總費用:52738住院天數344MDC3 案例三l出院診斷l(xiāng)Deep neck infection(478.22)lH/T(401.9)l處置(86.04,99.05)MDC3DRG06302總費用:125246住院天數10

10、l出院診斷l(xiāng)Deep neck infection(478.22)lH/T(401.9)lAbscess(682.1) (cc)l處置(86.04,99.05)MDC3DRG06301總費用:125246住院天數1045MDC3 案例四l出院診斷l(xiāng)Mandibular fracture(802.20) l處置lIMF+ORIF+Wire fixation (76.76,24.7)MDC3DRG:06302總費用:73335住院天數:9(4.5)MDC3DRG:06301l出院診斷l(xiāng)Mandibular fracture(802.20) lAlveolar fracture(802.8)cclH

11、ead injury with brain concussion(854.09)ccl處置lIMF+ORIF+Wire fixation (76.76,24.7)46MDC3 案例五MDC3DRG04901總費用:215616住院天數:37(10.6)l出院診斷l(xiāng)ORN of mandibule with pathologic Fr.(526.89,733.19)lMouth floor CA(144.0)losteomyelitis(730.28)lChronic periodontitis(523.4)l處置(25.59,27.56,76.31,23.19,93.59,99.04)l出院診

12、斷l(xiāng)Mouth floor CA(144.0)lORN of mandibule with pathologic Fr.(526.89,733.19)losteomyelitis(730.28)lChronic periodontitis(523.4)l處置(25.59,27.56,76.31,23.19,93.59,99.04)跳出DRG47MDC11 案例一l出院診斷l(xiāng)UTI(599.0) lPneumonia(MRSA)(482.41) lUGI bleeding(578.9)lCOPD(496)lSLE(710.0)lCAD(414.01)lAdrenal insufficiency(

13、255.4)lFatty liver(571.8)lOld CVA(438.9)l處置(96.72,96.04,45.13,99.04,99.05,99.07)MDC11DRG320住院天數:34總費用:384998未完成48修正修正MDC4DRG47501總費用:384998住院天數:34l出院診斷l(xiāng)Pneumonia(MRSA)(482.41) lUTI(599.0) lUGI bleeding(578.9)lCOPD(496)lSLE(710.0)lCAD(414.01)lAdrenal insufficiency(255.4)lFatty liver(571.8)lOld CVA(43

14、8.9)l處置(96.72,96.04,45.13,99.04,99.05,99.07)完成49MDC11 案例二二MDC5DRG14401總費用:89555住院天數:19MDC11DRG31601總費用:89555住院天數:19l出院診斷l(xiāng)Per-cath infection(996.62)lESRD (585)lUTI(599.0)lUGI bleeding(578.9)lhyperkalemia(276.7)l處置(38.95,86.05,39.95,99.04)l出院診斷l(xiāng)ESRD (585)lPer-cath infection(996.62)lUTI(599.0)lUGI blee

15、ding(578.9)lhyperkalemia(276.7)l處置(38.95,86.05,39.95,99.04)50MDC11 案例三三MDC11DRG320總費用:139489住院天數:23l出院診斷l(xiāng)UTI(599.0)lJejunostomy wound infection(E-coli)(569.61,041.4)lLeukocytosis reaction of Gastric CA(288.8,151.2)lCRI with AE(584.9,582.9)lDM nephropathy(250.40)lOld CVA(438.9)lCOPD(496)51修正修正 一一MDC6

16、DRG18804總費用:139489住院天數:23l出院診斷l(xiāng)Jejunostomy wound infection(E-coli)(569.61,041.4)lUTI(599.0)lLeukocytosis reaction of Gastric CA(288.8,151.2)lCRI with AE(584.9,582.9)lDM nephropathy(250.40)lOld CVA(438.9)lCOPD(496)52修正修正 二二跳出DRGl出院診斷l(xiāng)Leukocytosis reaction of Gastric CA(151.2,288.8)lUTI(599.0)lJejunos

17、tomy wound infection(E-coli)(569.61,041.4)lCRI with AE(584.9,582.9)lDM nephropathy(250.40)lOld CVA(438.9)lCOPD(496)假設53MDC11 案例四四l出院診斷l(xiāng)DM poor control(250.02)lAcute on renal failure(584.9,585)lHCVD(404.93)lUTI(599.0)lAsthma(493.90)lPleural effusion(511.9)MDC10DRG29501l出院診斷l(xiāng)DM nephropathy poor contro

18、l(250.42)lAcute on renal failure(584.9,585)lHCVD(404.93)lUTI(599.0)lAsthma(493.90)lPleural effusion(511.9)MDC11DRG331RW:0. 295854MDC11 案例五五l出院診斷l(xiāng)UTI(599.0) lepidydimitis(604.90)lDM(250.00)lIleus(560.1)lEpilepsy(345.90)lOld CVA(438.9)l處置Cystostomy(57.17)MDC12DRG35001總費用:91148住院天數:14l出院診斷l(xiāng)epidydimitis

19、(604.90)lUTI(599.0)lDM(250.00)lIleus(560.1)lEpilepsy(345.90)lOld CVA(438.9)l處置Cystostomy(57.17)MDC11DRG321總費用:91148住院天數:1455費用分析費用分析 MDC11MDC1156腎內腎內Drg320 腎及泌尿道感染年齡大於等於腎及泌尿道感染年齡大於等於18歲歲 有合併癥或併發(fā)癥有合併癥或併發(fā)癥 57腎內腎內Drg320 案例費用分析案例費用分析58診斷Sepsis，Pneumonia，RLLHematuriaProstate CA s/p TURPDM with nephropathyCRIHCVDBed sore ， sacral area 5*6 cm CVA （ischemic strock with globle aphasia） 59藥品藥品lcravitd抗感染用藥,6*QD,金額10