Study On Localization Of RBRVS Performance Evaluation System

BackgroundPhysician 's performance salary is the main part of medical staffs salary,which is related to their living standard,work enthusiasm,work efficiency and work quality,so it is very important to develop scientific and reasonable performance distribution system.For a long time,the public hospitals in our country have been used a performance distribution system of the full cost accounting model,which has encouraged the income generating consciousness of doctors in a certain period of time,and encouraged the hospital's economic growth.However,the malpractice is also showing up:it can not reflect the change of physicians' workload and work quality as well as the technical,difficulty and risk difference of the different medical services,which make doctors' work enthusiasm,efficiency and even medical quality decrease,leading to serious brain drain in hospitals.Besides,the total cost accounting model has incorporated fixed cost into accounting and to some extent suppressed the work enthusiasm of the department.Therefore,it is urgent to develop a performance evaluation mechanism that conforms to the characteristics of medical and health industry,and can reasonably measure the workload,work quality,technical difficulty and risk degree of medical staff.In the late 1980s and early 1990s,professor Hsiao W C of Harvard University took nearly 10 years to create a new method of accounting the physician performance pay-Based on medical Resource consumption,namely the RBRVS(the Resource-based Relative Value Scale).The method can evaluate the performance salary from the perspective of the total amount of doctors' work,and it can objectively reflect the workload of doctors,the technical value and risk pressure of medical services,and was widely used.Developed countries such as Canada,Germany,Japan and South Korea,domestic hospitals such as Changgeng Hospital,Huaxi Hospital,Zhongshan University Tumor Hospital,Henan Provincial People's Hospital,and Qianfoshan Hospital in Shandong Province were also successively introduced and localized the RBRVS.However,the introduction of hospitals at home and abroad are only on the theoretical,empirical level,and fragmentation introduction,and lack a series of RBRVS localization research system.Therefore,it is the focus of domestic scholars to actively draw on the beneficial experience at home and abroad and build the RBRVS research system that is in line with our country.Purpose1.Build a performance evaluation index system based on RBRVS.2.Explore the localization research thoughts based on RBRVS performance evaluation system,analyze the problems existing in the localization process and propose improvement strategies.Methods1.Literature methodBy using the literature method,we search the documents in the database with some key words,and select the literature that is highly relevant to the theme to read,and then analyze,organize,induct and summarize the literature in order to build the theoretical foundation for the construction of workload evaluation index system which is based on RBRVS.2.Expert interview methodThrough interviews with middle-level cadres of all departments in a hospital of Guangzhou,the existing problems in the performance appraisal of hospitals and suggestions on the implementation of performance reform are given.3.Questionnaire survey methodWe made the investigation by means of stratified and cluster sampling method,and then analyzed the satisfaction status of 205 clinical physicians we selected from the whole recovery questionnaires.4.Brainstorming methodThrough brainstorming,the medical students from relevant subjects were selected to carry out a special discussion on the index pool,so as to improve the evaluation connotation of the workload of doctors and preliminarily construct evaluation indexes.5.Delphi methodThrough the Delphi method,20 experts from relevant subjects were selected in China to make a pre-consult of the index system,so as to perfect the indicators and the connotation of each indicator,and form a formal correspondence questionnaire.Through the Delphi method,we select 50 experts across the country in two rounds of expert consultation,request them to make a score of each indicator according to their importance,and ultimately formed an evaluation system of physician' s workload on the basis of the core ideas of RBRVS.6.The analytic hierarchy process methodThrough the analytic hierarchy process,we established the hierarchical structure model according to experts' ratings,constructed the judgment matrix,calculated the weight and conducted the consistency test.Content1.Through literature review,face-to-face interview and questionnaire survey,take N hospital as an example to understand the current status of clinical physician performance salary distribution,doctor satisfaction and existing problems.2.Through the brainstorming method,Delphi method,analytic hierarchy process(AHP),construct the based on RBRVS physician performance evaluation index system,and the medical services of China and the United States was three rounds of the preliminary comparison,discuss localization research way of RBRVS performance evaluation system,and and clear performance bonus econometric model;3.Analyzed the problems existing in the localization process of RBRVS performance evaluation system and put forward corresponding strategies.Results1.Interview resultsThis interview for floor,a total of 82 divisions or departments in-depth interviews,the actual interview 67 divisions or departments,according to the results of department in a distribution,working strength and unequal income,cost and risk,opinions are centered.2.Satisfaction statusDoctors' satisfaction with the implementation of the current bonus assessment scheme was the highest and the satisfaction rate was 77.3%,while the satisfaction of the current bonus assessment scheme was the lowest,only 60.4%.At the same time,it can be seen that the degree of implementation,fairness and rationality of the bonus assessment scheme,as well as the impact of the bonus assessment scheme on the department work,are relatively low.3.The evaluation index system of physician workload was constructed based on RBRVSThis study screened the index pool by the brainstorming method and expert consultation method,made two rounds of formal consultations by the Delphi method,and eventually built an evaluation system which includes 4 first-level indicators:time consumption(0.1600),labor cost(0.2772),technology(0.4669),and risk pressure(0.0953).And the second-level indexes were time-consuming of the preparation before operation(0.0475),time-consuming in the operation(0.0863),time-consuming of the follow-up work after the operation(0.0261),mental consumption(0.1848),energy consumption(0.0924),knowledge reserve cost(0.0748),technical titles(0.0300),the working years(0.0198),technical difficulties(0.1777),the complex degree of technical(0.1175),creativity(0.0471),risk(0.0635)and the responsibility pressure(0.0318).The positive coefficient of 1 round of pre-consultation and 2 rounds of formal expert consultations were 100%,84%and 83.33%respectively;The average authority coefficient of experts is 0.8829;The Kendall's W coefficient of the first level index in the two rounds of formal consultation is 0.272 and 0.536 respectively.The Kendall's W coefficient of the second-level index is 0.297 and 0.498 respectively.The consistency index of the first level indexes is 0.0364,less than 0.08,the consistency index of second level index of "time consumption" is 0.0079<0.05,the consistency index of "technology input" is 0.0197<0.1.4.Measured results of relative valuesThis article selects the general surgery,digestive internal medicine,obstetrics and gynecology and pediatrics new four departments,a total of 36 medical services was measured as an example,a preliminary comparison of three rounds of relative value,based on "appendectomy" benchmark project,identified including"appendectomy(10.6)","golden needle acupuncture(0.6)","abdominocentesis(1.88)","neonatal resuscitation(2.93)","special treatment of enteroscopy(5.3)","gastric cut bodies(10.95)","single fetal birth midwives(14.37)","radical mastectomy for ovarian cancer(37.13)",36 medical services such as relative value of the project.5.Results of measurement modelWith reference to the practice of domestic hospitals,discussed by experts,identified the clinician's performance bonus econometric model is:the physician performance bonus =(physician workload*performance rate-controllable costs)*quality firstResearch on Problems and StrategiesSome problems will appear in the process of RBRVS localization and applications such as translation,the imparity and misunderstanding of department stuff,the mismatch of medical services,unreasonable of relative value,the disunity of standard,the difference of surgery and internal medicine,medical work,information,and a series of problems,put forward the corresponding solution:organize medical students' translation,under the department instruction and develop RBRVS manuals,reference resource consumption of similar project value matching and to determine the relative value,formulate unified standard,the surgery,internal medicine and medical department personnel allocation for different performance standards,perfect the information system,etc.ConclusionsThe research background of the environment of China's current public hospital and the state of physician performance distribution situation,the introduction of RBRVS performance management tools,through the application of N in the hospital,trying to clarify the localization study path RBRVS performance evaluation system,and put forward a series of improvement measures,not only can effectively evaluate the workload of clinicians,the actual cost,but also can make the domestic hospital detours in the application of RBRVS system,so as to enhance the performance of the hospital management level,improve the level of medical services of doctors,let's return to the hospital public welfare.However,due to time constraints,index system of this study did not be validated,also did not comment on the effects of RBRVS application.Therefore,so the next step research is through the division within the experts on the basis of index system to quantify the medical services,make sure all the relative value of medical services,and collect data from the hospital HIS system and evaluate its effect after application,in order to verify and improve the localization research of RBRVS.