新冠肺炎疫情期間運用病例組合指標提升策略於醫院持續營運計畫──以南部某醫學中心為例

Business Continuity Planning of Hospital with a Strategy for Revenue Improvement by Using Case Mix Index during the COVID-19 Pandemic

醫療院所因應COVID-19 疫情影響對其展開相關防疫對策，以確保全國醫療量能得以維護，但嚴格的規範導致醫療機構服務量下降，使醫院經營備受考驗。為減少疫情所造成的衝擊，希望透過醫院營運持續計畫中提升CMI 加成率以增加醫院DRG 之營收。個案醫院藉由成立工作小組，設定CMI 值目標，定期檢討病歷書寫，提供有效CC 清單，導入AI 智慧編碼系統等措施，以年度統計2019 年至2020 年，全院CMI 值提升4%。進階分析二次疫情大爆發， CD 區佔率相對增加5.5%， DRG 支付點數增加18%，個案數相較於2019 年同期減少3,865 人，平均年齡增加2.68 歲，反映住院年齡層的上升，亦同時增加疾病嚴重度和醫療費用的成長。透過本次研究發現，藉由經營管理策略及結合智慧化持續品質改善並善用大數據統計分析，不僅反映出疾病嚴重度，醫療費用的給付亦相對提升，改善CMI 值的面向絕對不是單一性的，必須各方整合分析，擬訂相對應之對策加上全員參與並且貫徹執行，以力求CMI 與營運費用最大化。

In response to the impact of COVID-19 epidemic, medical institutions have launched various relevant epidemic prevention measures to ensure that the national medical volume can be maintained at manageable level. However, more strict regulations have led to a decline in the service volume of medical institutions, which has put hospital operations to a severe test. In order to reduce the impact of the epidemic, it is hoped that the Case Mix Index bonus rate will be added through the hospital Business Continuity Planning to increase the revenue of the hospital. By setting up a working group, setting a CMI value target, regularly reviewing medical record writing, providing an effective complication or comorbidity (CC) list, and introducing an artificial intelligence coding system, the case hospital has developed an exciting annual statistics from 2019 to 2020, the CMI value of the hospital increased by 4% in the meantime. In an advanced analysis of the second outbreak of the epidemic, the proportion of CD area increased by 5.5%, The sum of diagnosis related group payments increased by 18%, while the number of cases decreased by 3,865 compared with the same period in 2019, and the average age of those infected increased by 2.68 years, reflecting the increase in the age group of hospitalization, but the severity of the disease and growth of medical costs also went upward. Through this research, it was found that through the management strategy and the combination of intelligent continuous quality improvement and a good use of big data statistical analysis, not only was the severity of the disease reflected, but the payment of medical expenses was discovered to have relatively increased as well, which improved the CMI. The value orientation is definitely not standing by its own. All parties should integrate and analyze ongoing data collections, formulate corresponding countermeasures, and fully participate and implement strategies in order to maximize CMI and the operating revenue.