PENGALAMAN IMPLEMENTASI PROGRAM JKN DI RSJPDHK

PENGALAMAN IMPLEMENTASI PROGRAM JKN DI RSJPDHK DISAMPAIKAN DALAM DISKUSI TERBUKA: KOMPETENSI MANAJER RUMAH SAKIT DI ERA JAMINAN KESEHATAN NASIONAL DI INDONESIA

dr. LIES DINA LIASTUTI, SpJP (K), MARS 30 SEPTEMBER 2015

GAMBARAN UMUM RSJPD HARAPAN KITA

Visi dan Misi

3

Visi RSJPD HK 2019: “Leader in Cardiovascular Care, Education, and Research” Misi: 1. Melaksanakan pelayanan kardiovaskular yang berkualitas. 2. Meningkatkan riset dan mengembangkan teknologi. Kardiovaskular. 3. Menciptakan wahana pendidikan/pelatihan yang berkualitas bagi peserta didik atau peserta pelatihan. 4. Mengampu pertumbuhan rujukan wilayah (lintas propinsi). 5. Menjadi arm-length Kemenkes dalam mengelola pencapaian indikator kesehatan jantung nasional.

.

Pelayanan JKN, telah dilaksanakan 1 Januari 2014

Pelaksanaan tarif JKN PMK 059/2014 telah dilakukan sejak September 2014 bertepatan dengan pemberlakuan Penyesuaian tarif RS BLU 2014

Dukungan RS terhadap Program JKNprogram2 Kendali mutu & kendali biaya

Kerjasama /koordinasi antara RS dengan BPJS. Pembentukan samsat JKN di RS

RS Khusus kardiovaskular kelas A  PUSAT RUJUKAN NASIONAL  MENANGANI KASUS SULIT  PERSAINGAN / PASAR GLOBAL KEMAMPUAN BERSAING DG TINGKAT MORBIDITAS &MORTALITAS RENDAH  TEKNOLOGI TINGGI, KOMPETENSI TINGGI, BIAYA TINGGI PERLU  SUSTAINIBILITAS KEUANGAN  EFISIENSI

Tantangan RSJPDHK era JKN - RS Khusus kelas A - Kendali mutu dan kendali biaya : -

PPK, CP FORMULARIUM SDM Monev Masalah verifikasi dan fraud

- Sistem rujukan dan rujuk balik - COB

Tantangan Strategis 1.

7

Belum optimalnya dukungan dari Kemenkes kepada RSJPD Harapan Kita sebagai Pusat Rujukan Nasional dan PJN 2. Globalisasi dan persaingan bebas 3. Kualitas dan kuantitas SDM yang terbatas 4. Biaya impor (pajak) pengadaan alkes tinggi sehingga tarif tindakan tinggi 5. Tarif INA CBGs terbatas dan ketidaksiapan sistem rujukan berjenjang 6. Penambahan penyakit KV dalam MDGs 7. Integrasi IT 8. Proses bisnis belum terintegrasi 9. Integrasi dengan vendor 10. Kehandalan sarana dan prasarana

Jakarta Cardiovascular Networking RSJPDHK RSUD JKT

PJN

Pelayanan Tertier & Sekunder

SATELIT METROPOLITAN

Pelayanan Sekunder & Primer RSUD Koja RS Swasta

RSUD Tarakan

RSUD Cengkareng

RSJPDHK

RSUD Pasar Rebo

RSUD Budi Asih RS Swasta RSUD Tangerang

Dasar Pemikiran : 1. RSUD

RSJPDHK

2. Pelayanan Jantung melibatkan 44 puskesmas di Jakarta 3. Pelayanan Jantung Swasta di Jakarta

40 RS Swasta

STRATEGY MAPS - CORPORATE Sustainable Outstanding Financial Performance

KEUANGAN

Berkurangnya Biaya

Revenue Growth Optimal Fixed Assets Utilization

CUSTOMER

PROCESS

Pasien Trustworthy Healing Information

Payers/ Employers Cost Effective & Excellent Health Care

Proses Pengelolaan Operasi RS berbasis Teknologi Informasi

Implemente d SCM System

Peserta Didik Jasa Pendidikan Kardiovaskular Bertaraf Intl.

Masyarakat Dunia Riset Kardiovaskuler Bertaraf International

Terbangunnya Proses

Pengelolaan Pelanggan

State of the Art Cardiovascular Facilties

Terbangunnya Risk Management Process

Best Company Image

Terbangunnya Regulatory & Social Process

Implemente d SRM System Terbangunnya Proses Pengelolaan Inovasi Layanan

Implemented EAM System

LEARNING & GROWTH

Closed Customer Relationship

Meningkatnya Kompetensi & Komitmen Personel

Terbangunnya Infrastruktur Teknologi Informasi Terpadu

Terbangunnya Organisasi Nirbatas dan berkapabilitas

Background

Very High Patient Flow

National Cardiovascular Center

Data

Capacity Burden

Analysi s

High Morbidity Resources Burden Complex Cases National Health System (Government Insurance)

Financial Burden

Eficien cy

Clinical Practice Guidelines & Clinical Pathway

Monitori ng & Evaluati on

KENDALI MUTU & BIAYA  Memastikan pelayanan tetap sesuai standar yg ditetapkan  Mengefisiensikan biaya operasional RS

 Terbit/ tetapkankan : PPK, CP, Formularium RS, alur monev mutu (alos, D2BT, inhouse mortality ima, rehospitalisasi, audit medis  SDM : Sistem remunerasi (reward n punishment), Latbang,  Revitalisasi utk tekan biaya pemeliharaan, standarisasi obat dan alkes, monev utilisasi sarana

Quality ASSURANCE  Clinical Practice Guidelines  Clinical Pathway

QUALITY IMPROVEMENT INITIATIVES

         

Panduan Praktik Klinik Clinical Pathway Indikator Mutu Pelayanan Medical Staff by Law Kompetensi Klinik Kebijakan Pedoman / Panduan SPO Audit medik, audit surgikal FMEA

Clinical Governance

STANDAR AKREDITASI RS 1. Standar Pelayanan Berfokus Pada Pasien (7) 2. Standar Manajemen Rumah Sakit (6) 3. Sasaran Keselamatan Pasien (6)

Hospital Directors + All Medical Staff organize Clinical Practice Guidelines, Clinical Procedure Guidelines, Clinical Pathway, and Clinical Privilledge.

Strategy :

Clinical Practice Guideline

Clinical Procedu re Guidelin e

Clinical Pathwa ys

Clinical Privilledg e

Clinical Pathway in NCVC Harapan Kita History 

Ongoing Process

2009 – 2011  8 CP implemented with reference benchmarking from St.Vincent

Hospital

Sydney

and

Cincinnati Children Hospital USA. 

Advantage : Good Compliance and Good

Monitoring,

minimizing

of

Length of Stay. 

Disadvantage : Unintegrated with patient administration and billing system, and nonspecific medication dosage.

 5 CP implemented based on High Volume, High Cost, and High Risk.  CP Acute Coronary Syndrome (10% of total cases in hospital, 2.106 cases annually)  CP CABG (56% of total surgery in hospital, 798 surgery annually)  CP Valve Surgery (27% of total surgery in hospital, 384 surgery annually)  CP TOF Repair (10% of total procedure in hospital, 95 children procedure annually)  CP Septal Defect (45% of total cases in pediatric, 441 pediatric cases annually)

CP Acute Coronary Syndrome 100,00%

100,00% 90,00%

77,68%

80,00% 70,00%

65,24%

63,06% 57,14%

60,00%

60%

50,00% 41,50% 37,83% 37,14%

40,00% 30,50% 30,00% 18,37%

20,00% 10,00% 0,00% Compliance

Completeness January

February

March

LOS Conformity April

57,14%

CP Coronary Artery Bypass Graft 100%

100,00% 88,89%

90,00%

85,25%

80,00% 70,00%

65,38% 58,33% 56,67%

60,00% 50% 50,00% 40,00% 28,49%

30,00% 20,04%

23,00%

20,00% 10,00%

10,14%

8,89%

0,00% Compliance

Completeness January

February

March

LOS Conformity April

Clinical Pathways Improvement Initiatives  Training, Education, and Socialization about Clinical Pathway to every unit, especially the entry point unit.  Training, Education, and Socialization about Clinical Pathway for Case Manager, Medical Staff, and other related person.  Intensive discussion and analysis.

Sistem Samsat RSJPDHK Dokter Resume Rawat inap

SAMSAT Tim Medrec Tim keuangan

Diagnosis tatalaksana rawat jalan

Tim Medik Tim BPJS

Dokter

klaim

KLAIM JKN DALAM PROSES VERIFIKASI OLEH BPJS PER 30 AGUSTUS 2015

NO

TAHUN

JENIS LAYANAN

JUMLAH PASIEN

BILLING

PERKIRAAN TAGIHAN

1

2

4

5

6

7

1

2014

2

2015

Rawat Inap Rawat jalan Rawat Jalan Rawat Inap

153 18 5.938 2.386

8.935.287.927 170.928.320 5.861.277.249 92.538.440.896

7.421.986.591 99.933.729 5.466.100.900 87.042.463.247

8.495

107.505.934.392

100.030.484.467

JUMLAH TOTAL PERKIRAAN TAGIHAN PIUTANG (1 +2 + 3)

KET: 1. Tagihan tahun 2014 per 31 Desember 2014 sebesar Rp. 16.184.961.061 per tanggal 30 Agustus 2015 tersisa Rp. 7.521.920.320 2. Sisa berkas dalam proses verifikasi sebesar Rp. 100.030.484.467 (berkas sdh di BPJS)

DATA PELAYANAN 2014

Data Kunjungan Pasien Rawat Inap 2013 vs 2014 2014 1400 1200 1000 800 600 400 200 0

PRIBADI; 1312; 9%

2014

GAKIN; 258; 2% PERUSAHAAN ; 968; 7% JKN; 11746; 82%

JAN PEB MAR APR MEI JUN JUL AGS SEP OKT NOP DES ASKES/JKN

PERUSAHAAN

GAKIN

PRIBADI

2013

2013

Pribadi; 2458; 20%

Gakin; 2894; 23%

Perusahaan; 1310; 10%

Askes; 5864; 47%

1.200 1.000 800 600 400 200 -

Askes

Perusahaan

Gakin

Pribadi

Data Jumlah Pasien Rawat Inap 2014

URAIAN Jumlah TT

JAN

PEB

MAR

APR

MEI

JUN

JUL

AGS

SEP

OKT

NOP

DES

331

331

331

331

331

331

331

331

331

331

331

331

Jumlah pasien HP AvLOS (hari)

1173 6070 5,43

1189 6003 5,01

1283 6763 5,27

1.181 6.582 5,70

1189 6.775 5,64

1.300 6630 5,0064

957 6074 5,78

1228 6394 5,5172

1.314 6944 5,46

1.244 6.914 5,61

1.153 6.648 5,65

1.073 6363 5,99

BOR (%) TOI (hari) BTO (Kali)

59,16 3,82

66,22 2,61

65,91 2,8

66,28 2,91 3,47

66,03 2,80 3,77

66,767 2,6421 3,7734

59,2 3,891 3,251

62,314 3,407 3,429

69,93 2,32 3,88

67,38 2,63 3,84

66,95 2,82 3,51

62,01 3,52 3,35

NDR (‰)

29,14

22,52

27,98

31,33

27,27

16,813

39,96

28,194

24,90

25,94

24,10

27,98

GDR (‰)

42,81

27,52

33,57

38,29

32,88

21,617

43,68

36,123

33,46

30,66

32,70

34,30

TREND JUMLAH TOTAL PASIEN RAWAT INAP RSJPDHK TAHUN 2014 1400 1200 1000 800 600 400 200 0

1173

1189

1283

1181

1189

1300

1228

1314

1244

1153

957

JAN

PEB

MAR

APR

MEI

JUN

JUL

AGST

SEPT

OKT

NOP

1073

DES

Data Kunjungan Pasien Poliklinik Umum Tahun 2014 Mulai diberlakukan kebijakan RUJUK BALIK

10000 9000 8000 7000

Gakin

6000

Perusahaan

5000

JKN

4000

Pribadi

3000 2000 1000 0

JAN

PEB

Perusahaan; 1778; 2%

MAR

APR

MEI

JUN

JUL

AGS

SEP

OKT

NOP

DES

Gakin; 1821; 2% Pribadi; 12840; 12%

JKN; 86329; 84%

Terdapat peningkatan pasien Rujuk Balik dari RSJPDHK pasien rujuk balik sejak Bulan Juli – Desember 2014  14 %

Data Antrian Pasien Operasi Dewasa & Anak Antrian Bedah Dewasa s/d 25 Sept 2014 DIAGNOSA CAD ASD/VSD CAD + KATUP DVR DISEKSI AO MS AR/AS LAIN-LAIN TOTAL

JUMLAH 130 15 4 4 2 52 13 5 225

JAMINAN JKN PERUSAHAAN PRIBADI TOTAL

JUMLAH 208 11 6 225

Antrian Bedah Anak Periode 1 Okt 2014 s/d 6 Sept 2015 TAHUN 2014 2015 2016 TOTAL

JAN

PEB MAR APR

MEI

JUN

TAHUNA JUL AGST SEPT OKT NOP DES N 84

63

30

45

50

41

47

41

44

8

76

74

234 369 603

TOP 10 RANAP DIAGNOSIS 2014 Deskripsi KEGAGALAN JANTUNG SEDANG

Jumlah Pasien 1100

KEGAGALAN JANTUNG BERAT

477

ANGINA PEKTORIS DAN NYERI DADA SEDANG

447

INFARK MYOKARD AKUT SEDANG

382

GANGUAN KATUP JANTUNG KONGENITAL SEDANG

249

ANGINA PEKTORIS DAN NYERI DADA RINGAN

210

INFARK MYOKARD AKUT BERAT

209

KEGAGALAN JANTUNG RINGAN

188

ANGINA PEKTORIS DAN NYERI DADA BERAT

167

INFARK MYOKARD AKUT RINGAN

166

TOP 10 RANAP PROSEDUR 2014 Deskripsi

Jumlah Pasien

PROSEDUR KATETERISASI JANTUNG SEDANG

1088

PROSEDUR KATETERISASI JANTUNG RINGAN

992

PROSEDUR KARDIOVASKULAR PERKUTAN RINGAN

979

PROSEDUR KARDIOVASKULAR PERKUTAN SEDANG PROSEDUR PEMBEDAHAN BYPASS PEMBULUH KORONER TANPA KATETERISASI JANTUNG SEDANG

802

PROSEDUR KATUP JANTUNG TANPA KATETERISASI JANTUNG SEDANG

222

PROSEDUR KARDIOTORASIK LAIN SEDANG

221

PROSEDUR KARDIOVASKULAR PERKUTAN BERAT

186

PROSEDUR KATUP JANTUNG TANPA KATETERISASI JANTUNG BERAT PROSEDUR PEMBEDAHAN BYPASS PEMBULUH KORONER TANPA KATETERISASI JANTUNG BERAT

182

223

158

Perbandingan kelas 1 pada TOP 10 PROSEDUR DENGAN BIAYA TERBESAR Sebelum & sesudah perubahan tarif inacbgs

DATA PERIODE JAN-AGS 2014 DESKRIPSI PROSEDUR KARDIOVASKULAR PERKUTAN RINGAN PROSEDUR KARDIOVASKULAR PERKUTAN BERAT PROSEDUR PEMBEDAHAN BYPASS PEMBULUH KORONER TANPA KATETERISASI JANTUNG BERAT PROSEDUR KATUP JANTUNG TANPA KATETERISASI JANTUNG BERAT PROSEDUR KATUP JANTUNG TANPA KATETERISASI JANTUNG SEDANG PROSEDUR PEMBEDAHAN BYPASS PEMBULUH KORONER TANPA KATETERISASI JANTUNG SEDANG PROSEDUR KATETERISASI JANTUNG RINGAN PROSEDUR KARDIOVASKULAR PERKUTAN BERAT PROSEDUR KATETERISASI JANTUNG SEDANG PROSEDUR KARDIOTORASIK LAIN BERAT

Sum of Sum of biayars biaya_verif

SELISIH

Average of biayars

Average of biaya_verif

SELISIH

443 23.791.896.966 21.396.252.102 (2.395.644.864)

53.706.314

48.298.537 (5.407.776)

347 21.016.797.690 32.149.962.056 11.133.164.366

60.567.140

92.651.187 32.084.047

92 9.947.245.953 13.837.197.440 3.889.951.487

108.122.239

150.404.320 42.282.081

64 9.780.033.624 10.819.775.232 1.039.741.608

152.813.025

169.058.988 16.245.963

87 9.551.963.210 9.207.002.070 (344.961.140)

109.792.681

105.827.610 (3.965.071)

101 9.401.868.758 10.029.704.303

627.835.545

93.087.809

99.304.003

6.216.194

644 9.113.388.154 10.014.680.165

901.292.011

14.151.224

15.550.746

1.399.522

97 6.734.091.957 11.397.914.905 4.663.822.948

69.423.628

432 6.531.540.475 8.923.556.868 2.392.016.393

15.119.307

20.656.382

5.537.075

108.546.650

117.255.512

8.708.862

53 5.752.972.432 6.214.542.136

461.569.704

117.504.277 48.080.649

DATA PERIODE SEP-DES 2014 DESKRIPSI PROSEDUR KARDIOVASKULAR PERKUTAN SEDANG PROSEDUR KARDIOVASKULAR PERKUTAN RINGAN PROSEDUR PEMBEDAHAN BYPASS PEMBULUH KORONER TANPA KATETERISASI JANTUNG SEDANG PROSEDUR KARDIOTORASIK LAIN SEDANG PROSEDUR KATUP JANTUNG TANPA KATETERISASI JANTUNG SEDANG PROSEDUR PEMBEDAHAN BYPASS PEMBULUH KORONER TANPA KATETERISASI JANTUNG RINGAN PROSEDUR KATETERISASI JANTUNG SEDANG PROSEDUR KATUP JANTUNG TANPA KATETERISASI JANTUNG BERAT PROSEDUR KATETERISASI JANTUNG RINGAN PROSEDUR KARDIOTORASIK LAIN BERAT

Sum of biayars

Sum of biaya_verif

SELISIH

Average of biayars

Average of biaya_verif

SELISIH

316

19.496.741.640 13.757.023.778 (5.739.717.862)

61.698.549

43.534.885 (18.163.664)

239

15.146.682.436 20.960.879.014

63.375.240

87.702.423

5.814.196.578

24.327.182

73

9.557.743.435 6.922.976.900 (2.634.766.535) 130.927.992

94.835.300 (36.092.692)

60

7.061.735.231 5.701.726.764 (1.360.008.467) 117.695.587

95.028.779 (22.666.808)

33

4.905.567.882 3.335.158.200 (1.570.409.682) 148.653.572 101.065.400 (47.588.172)

34

4.375.178.940 2.613.597.000 (1.761.581.940) 128.681.734

76.870.500 (51.811.234)

200

3.763.127.308 3.066.014.244

15.330.071

(3.485.565)

22

3.641.072.669 3.551.928.600

(89.144.069) 165.503.303 161.451.300

(4.052.003)

207 22

(697.113.064)

3.415.177.978 2.386.183.208 (1.028.994.770) 3.285.760.002 2.463.538.000

18.815.637

16.498.444

11.527.455

(4.970.989)

(822.222.002) 149.352.727 111.979.000 (37.373.727)

2015

Clinical Area Key Indicator Door to Balloon Time < 90 minutes 80,00% 75,00% 70,00%

70,00%

70,00%

70,00%

70%

70,00%

Feedback to medical staff

65,00% 60,00% 55,00%

64,52% 60,53%

57,45%

50,00% 45,00%

68,75%

Indicator implemen ted

51,43%

Targeted time for Emergency Dept. and Cathlab Dept

Intensive Discussion and Analysis

40,00% Jan

Feb

Mar Door to Balloon Time

Apr

Mei

Target

Definition

Door to balloon time / door-to-device time is the time from the patient entered the emergency room doors with Acute Coronary Syndrome until Coronary angioplasty is done for the first time, or thrombus suction first attempt. Door to Balloon Time targeted by the hospital is <90 minutes.

Numerator

The number of ACS patients with Door to Balloon Time <90 minutes

Clinical Area Key Indicator Outpatient Initial Assessment in The First 24 hours 100,00% 90,00%

100%

100%

Feedback to medical staff

80,00% 70,00% 60,00% 50,00%

56,16% 50,68%

20,00% 10,00%


54,32% 48,93%

40,00% 30,00%

100%

41,98% 34,04%


0,00% Jan

Feb Doctor

Nurse

Mar Target

Definition

Complete initial assessment include patient history, physical examination, nutritional status, pain screening, and special need.

Numerator

Number of complete initial assessment

Denumerator

Number of initial assessment

Clinical Area Key Indicator Acute Myocardial Infarction (AMI) Feedback Mortality 10,00% 9,00% 9,00% 8,00%

8,00%

8,00%

8,00% 7,70%

7,00% 6,00%

to medical staff 8,00% 7,70%

6,90%

5,00% 4,00% 3,00%


2,00% 1,00% 0,00% Jan

Feb AMI Mortality

Mar Target (< 8%)

Definition

Inhospital mortality rate for AMI

Numerator

Number of AMI mortality patient Number of patient diagnosed with AMI

Denumerator

Apr

Clinical Area Key Indicator Heart Failure Readmission Rate 20,00% 18,00% 16,00%

15,00%

15,00%

15,00%

14,00% 12,00% 10,00%

Plan to change Indicator

8,00% 6,00% 4,00% 2,00%

3,85%

3,70% 1,84%

0,00% Jan

Feb HF Readmission

Definition

Numerator

Mar Target (< 15%)

Readmission of patients with heart failure who are hospitalized within 1 month (30 days) Number of patients with heart failure who are hospitalized within

Clinical Area Key Indicator Critical Lab Result < 30 minutes 100,00%

100,00%

100,00%

100,00%

100,00%

99,00%

Develop ment of Laborato ry Informati on System

98,00% 97,00% 96,00% 95,00% 94,00% 93,00% 92,00%


95,90%

93,60% 91,20%

92,20%


91,00% 90,00% Jan

Feb Compliance

Mar Target

Definition

Critical lab result reported < 30 minutes

Numerator

Number of critical lab result reported < 30 minutes Number of critical lab result

Denumerator

Apr

Clinical Area Key Indicator Waiting Time for Radiology Examination 100,00% 95,00% 90,00%

90,00%

90,00%

90,00%

90,00% 89,76% 85,00% 80,00%

Indicator implemen ted 78,98%

75,00%

88,77%

75,47%

Meeting with Staff

70,00% Jan

Feb Rontgent

Mar Target

Apr

#REF!

Definition

Waiting time since patient registration until radiology expertise in working hours < 3 hours

Numerator

Number of radiology expertise in working hours < 3 hours

Denumerator

Clinical Area Key Indicator Elective CABG Mortality 8% 7% 6,67%

6%

Feedback to medical staff Feedback and Encourage medical staff

5% 4% 3%

3,00%

3%

3,00%

3,00%

3,17%

2% 1% 0% Jan 0


1,85%

Feb CABG Mortality

Mar Target (< 3%)

Definition

Inhospital mortality rate for elective CABG

Numerator

Number of elective CABG mortality patient Number of patient undergo CABG surgery

Denumerator

Apr

Clinical Area Key Indicator Compliance to National Formularium 100,00% 98,00%

97,31%

97,07% 96,11%

96,02% 96,00%

Plan to change indicator

94,00% 92,00% 90,00% 88,00%

90,00%

90,00%

90,00%

90,00%

Jan

Feb

Mar

Apr

86,00% 84,00% 82,00% 80,00% Compliance

Target

Definition

Compliance to National Formularium prescribed by doctor for National Health Coverage patient

Numerator

Number of prescription matched National Formularium Number of prescription

Denumerator

Clinical Area Key Indicator Compliance to Patient Safety Reporting Time 100,00% 100,00%

100,00%

100,00%

100,00%

80,00%

60,00%

40,00%


Encourage Staff Feedback to hospital staff

Trainin g and socializ ation

38,46%

20,00% 0,00%

0,00%

Feb

Mar

0,00% Jan

Ketepatan

Apr

Target

Definition

Compliance to report patient safety incident in 2x24 hours

Numerator

Number of patient safety incident reported in 2x24 hours Number of patient safety incident

Denumerator

Clinical Area Key Indicator Inpatient Medical Record 100,00% 90,00% 90,00%

90,00%

90,00%

90,00%

80,00% 70,00% 60,00% 50,00% 40,00%


Feedback to hospital staff

Trainin g and socializ ation

Encourage Staff

36,48% 32,73% 29,11%

30,00% 20,00% Jan

Feb Kelengkapan

Mar

Apr

Target

Definition

Complete medical record include patient history, physical examination, diagnostic test result, patient summary

Numerator

Number of complete medical record

Denumerator

Number of medical record

Management Area Key Indicator Stock of Drugs in Hospital 102,00% 101,50% 101,00% 100,50% 100,00%

100,00%

100,00%

99,84%

99,84%

100,00%

100,00% 99,50%

99,67% 99,41%

99,00% 98,50%


98,00% Jan

Feb Compliance

Mar

Apr

Target

Definition

Important drugs according to national formularium

Numerator

Number of national formularium prescription available in 24 hours

Management Area Key Indicator Respond to Complain 110,00% 105,00% 100,00%

100,00%

100,00%

100,00%

100,00%

100,00% 100,00% 95,00% 90,00%

92,00%

85,00% 85,00% 80,00%


75,00%

91,00%

Feedba ck to PR Staff

90,91%

Meetin g with Staff

70,00% Jan

Feb

Mar Ketepatan

Apr Target

Definition

Complain responded appropriately in 24 hours

Numerator

Number of complain responded appropriately in 24 hours

Denumerator

Number of complain

Mei

Management Area Key Indicator Ratio of Operational Revenue and Cost 115,00%

110,00% 109,41% 105,00%

100,00%

97,29%

95,00% 90,00%

90,00%

90,00%

90,00%

90,00%

90,00%

91,03% 88,40% 87,05%

85,00%

80,00% 2010

2011

2012 POBO

2013

Target

Definition

Ratio between operational revenue and operational cost

Numerator

Number of operational revenue

Denumerator

Number of operational cost

2014

Indikator mutu : door to balloon time

INDIKATOR MUTU : DOOR TO BALLOON TIME

KEPUTUSAN MANAJEMEN : CATHLAB DI IGD

Indikator mutu : in-house mortality MCI

Indikator mutu : re-hospitalisasi gagal jantung

Waktu utilisasi cathlab

Indikator mutu : utilisasi cathlab

KINERJA RAWAT INAP RSJPDHK AGUSTUS 2015 KOMPOSISI PENJAMIN AGUSTUS 2015

DATA BULANAN PASIEN PER JAMINAN TAHUN 2015

JAMINAN

JAN PEB MAR APR MEI JUN JUL AGUST

1.064 935 1.068 JKN PERUSAHAA 69 63 62 N 15 18 9 GAKIN PRIBADI TOTAL RS

71

69

70

919 948 969 823 1.032 58

48

49

46

41

12

8

11

5

8

90

76

68

51

90

1.2191.085 1.209 1.079 1081.097 925 1.171

PRSHN 3%

GAKIN 1%

PRIBADI 8%

JKN 88%

 Rata rata peserta JKN per bulan : 575 ps  tertinggi dg level of severity II dan III  trend th 2015 sedikit menurun  Rujukan berjenjang RS Sekunder ke RS Tertier  Seleksi pasien JKN Mandiri diperketat  beberapa kasus ternyata kepesertaan JKN tidak lengkap / tidak taat bayar  kesulitan saat penagihan.

GRAFIK KINERJA UNIT PROFIT CENTER Periode Januari s.d Agustus 2015

Pendapatan Usaha Lainnya

5.017.293.735

17.770.475.563 21.194.911.073

Farmasi & Apotik

39.530.880.000

9.733.766.205

Diagnostik Non Invasif

9.577.976.251

164.472.306.657

7.327.132.507

11.577.920.000

188.135.528.197

59.421.483.755

Rawat Intensif & Kegawatan…

25.186.711.707

32.648.120.000 34.669.596.117 54.990.996.000

Bedah Dewasa & intensif Pasca… 8.800.691.812

Pavilun Sukaman Rehabilitasi Kardiologi Pediatrik dan PJB

74.514.816.184

9.739.300.000

155.971.365.000 110.927.178.000

10.581.169.712

12.841.565.000

4.994.485.572

11.112.722.500

5.203.029.336

1.808.380.000 4.264.899.576 2.648.500.000 11.322.364.749

6.722.910.000

Keterangan  Total pendapatan Januari sd Agustus 2015 sebesar Rp. 666.003.816.511, Total Biaya Januari sd Agustus 2015 sebesar Rp. 446.704.658.697, Selisih antara pendapatan dengan biaya sebesar Rp. 219.299.157.814,-

Biaya

Pendapatan

Efisiensi biaya obat, alkes, BMHP  Prinsip Obat bermutu dengan harga bersaing  Memenuhi syarat dan kriteria yg ditetapkan dengan melalui kajian HTA, Kajian subkomite obat dan alkes, dibutuhkan dalam CP/PPK standarisasi  Sistem IT terintegrasi untuk kontrol logistik inventory

Kesimpulan dan saran MANAJEMEN RS  PELAJARI DAN KUASAI UU PRAKTEK KEDOKTERAN , UU RS, PERATURAN MENKES  TETAPKAN CP, PPK  SAMBIL MENUNGGU PNPK. DISESUAIKAN DG TIPE RS MASING2 (KELAS A-B-C-D)  EFISIENSI KAN BIAYA OPERASIONAL , STANDARISASI

KEMENTRIAN  PERBAIKAN INACBG’S KRN DATA BANYAK ASUMSI SHG KELUAR UNIT COST DAN COST WEIGHT YG BENAR

OPERASIONAL SARANA DAN FASILITAS

SDM

Kendali mutu & kendali biaya

OBAT &ALAT MEDIS

STANDAR PELAYANAN MEDIS KEPERAWATAN

Terima kasih

PENGALAMAN IMPLEMENTASI PROGRAM JKN DI RSJPDHK

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