The centralized procurement of low-value consumables alliance starts: medical insurance code + direct settlement, guarantee quantity and insurance payment?

Radius expanded: from 5 cities to the whole province

In February, the Liaoyang Municipal Medical Insurance Bureau released an "Implementation Plan for the Procurement of Some Medical Consumables in 2022 by the Inter-City Procurement Alliance (Draft for Comments" (hereinafter referred to as the "Draft for Comments") on the Liaoning Provincial Centralized Purchasing Network for Drugs and Medical Consumables.

Three months later, on May 9, the "2022 Implementation Plan for the Centralized Procurement of Medical Consumables in Medical Institutions" (hereinafter referred to as the "Plan") was officially released on the Liaoning Provincial Centralized Purchasing Network of Medicines and Medical Consumables, and the "Draft "The 5 cities in the scope are expanded to the whole province.

The "Plan" clarifies that the purchase targets are infusion sets and pre-filled catheter irrigators that have obtained national medical insurance codes. Led by the Liaoyang Municipal Medical Security Bureau and relying on the Liaoning Provincial Medical Institutions Drug and Medical Consumables Purchasing Alliance to carry out this volume purchase.

With 90% of the actual purchase volume reported by medical and health institutions in 2021 as the intended purchase volume, the "2022 Partial Medical Consumables with Volume Purchase Catalog" will be formed, and the procurement cycle is 2 years.

The main body of procurement is the province's public medical and health institutions, and medical insurance designated social medical institutions are encouraged to participate. The participating medical and health institutions uniformly implement the relevant regulations and procurement results of Liaoning Province's centralized procurement with volume.

For the "Plan", Cyberblue Equipment contacted the relevant person in charge of the procurement of the medical insurance bureau of a city in Liaoning Province, who made an exclusive interpretation of the overall situation such as the shortlisted conditions, negotiation process, and procurement cycle in the centralized procurement documents.

The person in charge told Cyberblue Equipment: "Liaoyang, Jinzhou, Panjin, Benxi, and Fuxin were the five cities to carry out bulk procurement work when the draft was first solicited, and later the clinical substitutability of these two types of low-value consumables was considered. Stronger and more competitive in the market, we decided to do it together in the whole province."

It is understood that at first the "Draft" wrote that "the top two products in the total number of purchases in the alliance region in 2021 and the product with the largest number of purchases in each alliance region will directly enter the quotation link after being confirmed by the review team", while The "Plan" has been changed to "The top five products in the total number of purchases in the alliance region in 2021, the first product in each alliance region, and the top two products in Shenyang and Dalian in the number of purchases. After the review team After confirmation, go directly to the quotation link."

The reason for this change, the person in charge explained, is because the scale of each city is different, and the products with larger coverage in big cities will also be purchased in larger quantities at the provincial level. However, related products with relatively large coverage in some small cities may not be ranked so high in purchase volume in the province, but they are still products with good quality and stable supply. Even if this product does not rank in the top five in the province It ranks first in the number of purchases in a single alliance area, and can directly enter the quotation link after being confirmed by experts.

"The purpose is to ensure the continuity of supply of products in medical institutions in each city," he said.

Collecting hidden line: medical insurance consumables code

In the original "Draft of Comments", the purchase targets were blood glucose test strip products and infusion sets, syringes and pre-filled catheter irrigators that had been included in the "Liaoning Province Centralized Purchasing Network for Drugs and Medical Consumables" and obtained national medical insurance codes. In the final "Plan", there are only two purchase targets: infusion sets and pre-filled catheter irrigators that have obtained national medical insurance codes.

"Because these two products have been covered by the national medical insurance code, this provides great convenience for centralized procurement," the person in charge explained, "The medical insurance consumables code is one item and one code. When reporting the historical purchase volume this time, we All procurement objects will be filtered out through the medical insurance code database of the National Medical Insurance Bureau. As long as medical institutions enter the national medical insurance code, they can immediately search for related products, which can be mapped one by one. For enterprises, when applying for participation in purchasing with volume When it comes to products, as long as there is a national medical insurance code, we will locate in detail which company and variety we want to participate in."

He said that in the next step, experts will be organized to classify the two types of purchases with quantity, such as infusion sets, in detail. The two types of products will be specific to the specifications and models, and the purchase volume of each specification and model will be clearly stated.

How to check the quality?

It is mentioned in the selection method of the "Plan" that the evaluation team will vote on the declared products in turn based on the application documents and samples provided by the enterprise. Products with more than or equal to two-thirds of the total votes will enter the quotation link, and those with less than one-third of the total votes will enter the quotation process. The second product is eliminated directly.

In this regard, he said that compared with high-value consumables, the threshold for low-value consumables is relatively low. In order to ensure the quality, we will let the manufacturer send samples by mail, and then organize experts to select the samples and check their quality.

Pulling out the "nail": Solving the crux of payment collection

On the issue of payment collection, Liaoning Province's "Plan" can be said to be firm.

The "Plan" pointed out that this project adopts two methods of direct settlement of the medical insurance fund or prepaid payment. If the prepaid payment is adopted, the medical insurance agency shall prepay no less than 50% of the total purchase amount in the annual agreement of the medical and health institutions. For medical and health institutions, the payment for goods shall be settled before the end of the month following the delivery acceptance.

In other words, there are two payment methods for this purchase with volume, direct medical insurance settlement or 50% prepayment settlement, and the settlement will be completed before the end of the next month. Medical institutions have become "supporting roles" in the payment relationship.

"One amount and one payment must be guaranteed." The person in charge said that while requiring medical institutions to guarantee the amount, they must also guarantee the "payment".

He introduced that because the settlement methods of each city are different, if direct medical insurance settlement is not adopted, the prepayment settlement method must be adopted. The medical insurance agency will allocate 50% of the funds to medical institutions before the implementation of the procurement cycle, and set up special It is specially used for purchasing with quantity to pay for the goods.

"The implication is not to let the hospital default on the payment," he said.

Is there a big difference in payment efficiency between the two methods?

"Direct settlement will be faster. Because a company may target multiple hospitals, but no matter how many hospitals, the direct settlement of medical insurance will uniformly collect the payment of all hospitals into one and send it to the distribution company."

He said that although the current level of progress varies from place to place, the direct settlement of medical insurance funds is the future direction.
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