manajemen rumah sakit dalam pelaksanaan jaminan

Pengelolaan Dana JKN Secara
Efektif dan Efisien Untuk
Menjamin Mutu Pelayanan
Kesehatan
PENGALAMAN RS AN-NISA TANGERANG
dr. Ediansyah
Direktur
2014 : RUMAH SAKIT AN-NISA TANGERANG
KELAS C, 100 TT
RUMAH SAKIT AN-NISA TANGERANG
KELAS C, 160 TT
DATA KUNJUNGAN
800
700
700
600
600
500
awal 2014
400
akhir 2016
300
200
140
120
100
60
90
0
Rawat Jalan/hari
Rawat Inap/hari
Operasi/bulan
KOMPOSISI PASIEN TAHUN 2016
NON BPJS
17,57%
BPJS 82,43%
KOMPOSISI PENDAPATAN TAHUN 2016
NON BPJS,
19.56
BPJS 80.44
,
SIMULASI LABA RUGI RS
PENDAPATAN
: 10 M
HARGA POKOK PENJUALAN : 1,2 M (12%)
--------------------------------------------------------------------------------
LABA KOTOR
JASA MEDIS
GAJI KARYAWAN
BIAYA OPERASIONAL
: 8,8 M
: 2,5 M (25%)
: 1,8 M (18%)
: 0,8 M (8%)
------------------------------------------------------------------------------
EBITDA
DEPRESIASI
: 3,7 M
: 0,5 M (5%)
BUNGA BANK
: 3,2 M
: 0,1 M (1%)
-----------------------------------------------------------------------------
EBIT
-----------------------------------------------------------------------------
PENDAPATAN SEBELUM PAJAK : 3,1 M
PAJAK
:
-----------------------------------------------------------------------------
LABA BERSIH
:
(15% - 20%)
PRICE = UNIT COST + MARGIN
Tarif RS
: Rp. 1.300.000
Tarif INA CBG
: Rp. 1.200.000
RS Rugi……. Rp. 100.000 ??
Unit Cost RS : Rp. 1.000.000
Margin (30%) : Rp. 300.000
Tarif INA CBG
:Rp. 1.200.000
Sisa Rp. 200.000 (20%)
PRICE = UNIT COST + MARGIN
Tarif RS
Tarif INA CBG
: Rp. 1.000.000
: Rp. 1.200.000
RS untung….. Rp. 200.000 ??
• Tarif masih berdasarkan unit cost 2014
• Unit Cost 2017 : Rp. 1.500.000
Tarif INA CBG
:Rp. 1.200.000
Kurang Rp. 300.000
PROFITABILITY :
THE FORCES
IMPACT
WHY
Threat of entry
Profitability
Costs
Supplier power
Profitability
Costs
Buyer power
Profitability
Rivalry
Profitability
Substitutes
Prices
Costs
Costs
HEALTHCARE MEGATREND
Robert M Wachter MD, Professor and Chair of Department of Medicine, University of California,
San Francisco
1. Relentless Pressure to Deliver
• The highest quality
• Safest
• Most satisfying care
• The lowest possible cost
2. Paper Industry to Digital Industry
Value =
Benefit
----------------
Cost
Challanges in Implementing INA -CBG
1
• Business Strategy
2
• Growing Complexity
3
• Leadeship & Change Management
4
• Cost control & Quality control
5
• Information Technology
1. Business Strategy
Strategic question
1. What is our present situation?
•
•
•
Resources and Capabilities
Competitive strenghts and weaknesses
Changes in business environment
2. Where do we want to go from here?
•
•
•
Management vision of the company’s future direction
What new customer groups to satisfy
What capabilities to build
3. How are we going to get there?
•
•
•
Guidelines for development
Priorities for capital expenditure
Growth modes: organic growth, M & A, Alliances
Where to Compete
1. The product-market investment decision
(Product,Market,Competitor)
A BUSINESS
STRATEGY
How to Compete
2. Value proposition 3. Assets & competencies
4. Functional area strategy & program
(Aaker,2008)
RS AN-NISA: Where to Compete
Product/Service:
Market
A
• Spesialisasi lengkap,
• Penunjang medis lengkap
Peserta JKN-KIS
B
RS AN-NISA
C/D
FKTP
Competitor:
RS Kelas C
RS AN-NISA: How to Compete
1. Tidak ada diskriminasi pelayanan untuk pasien BPJS dan
non BPJS
2. Fleksibilitas jam pelayanan rawat jalan (08.00 WIB –
20.00 WIB)
3. Tidak ada kuota tempat tidur untuk pelayanan rawat
inap pasien BPJS
4. Tidak ada urun biaya
5. Mendapat Benefit non medis: Gift, antar pulang gratis,
foto copy gratis.
(Porter,1980)
2. Managing Growing
Complexity
GROWING COMPLEXITY (INTERNAL )
Manaje
men
Pemilik
Dokter
Berapa % Jasa medis?
Berapa % Obat?
Berapa % Penunjang?
Bagaimana Mengelola Tarif Paket ?
Kolaborasi Manajemen dan Staf Medis
• Jasa Medis
• Konsep
: Fee For Services
• Konsultasi : Rp. 70.000
• Visite
: Rp. 70.000 (kelas 3,2,1 sama)
• Kebijakan pemakaian obat dan pemeriksaan penunjang
Pasien yang butuh banyak diberikan banyak,
yang butuh sedikit diberikan sedikit.”
“
GROWING COMPLEXITY (EKSTERNAL)
Rumah Sakit
Kem
Pasien
Kes
BPJS
• Tarif INA-CBG
• Verifikasi Claim
• Rujukan Berjenjang
Kompleksitas
Memiliki keterkaitan dan saling
berhubungan antara satu pihak dengan
pihak lainnya. (tidak bisa hidup sendiri)
3. Leadership & Change
Management
LEADERSHIP: Transforming your Organisation
4. Cost Control & Quality
Control
The Meanings of Quality
(does higher quality cost more or does it cost less?)
1. Quality means those features of products which
meet customer needs and there by provide
customer satisfaction. The meaning of quality is
oriented to income.
2. Quality means freedom from deficiency. The
meaning of quality is oriented to cost.
(GRANT, 2013)
1 2 3 4 5 6 7 8 9 10 11
Output (in unit)
Total fixed costs
remain constant as
activity increases.
Cost per unit of output ($)
Fixed cost ($)
Total Fixed Costs Curve
1 2 3 4 5 6 7 8 9 10 11
Output (in unit)
Cost per unit
declines as
activity increases.
Cost per unit ($)
Total Cost ($)
Variable Costs Curve
1 2 3 4 5 6 7 8 9 10 11
Output (in Unit)
Total variable
costs increase as
activity increases.
1 2 3 4 5 6 7 8 9 10 11
Output (in Unit)
Cost per unit
is constant as
activity increases.
Costs and Revenue
in Dollars
Cost-Volume-Profit
Break-even
Point
Loss
Volume in Units
Profit
Contoh
FIX COST KAMAR OPERASI
JUMLAH OPERASI PER BULAN
: 100 JUTA
: 100
RATA RATA FIX COST PER OPERASI
: 1 JUTA
FIX COST KAMAR OPERASI
JUMLAH OPERASI PER BULAN
: 100 JUTA
: 500
RATA RATA FIX COST PER OPERASI
: 200 RIBU
POLIKLINIK ANAK
No
1
2
3
4
5
6
7
8
9
10
11
12
Jam
08.00 – 09.00
09.00 – 10.00
10.00 – 11.00
11.00 – 12.00
12.00 – 13.00
13.00 – 14.00
14.00 – 15.00
15.00 – 16.00
16.00 – 17.00
17.00 – 18.00
18.00 – 19.00
19.00 – 20.00
Dokter
Dr. Denok
Dr. Denok
Dr. Denok
Dr. Denok
Dr. Ari Mulyani
Dr. Ari Mulyani
Dr. Amin Husni
Dr. Amin Husni
Dr. Amin Husni
Dr. Arif Nasution
Dr. Arif Nasution
Dr. Arif Nasution
5. Information Technology
Momentum / Energi
Contoh
Dengan Bantuan Information Technology pekerjaan diselesaikan 2 kali
cepat.
Rumus
: E = m.V
100 =100.1
200 = 100.2
KESIMPULAN
• Financial performance di ukur menggunakan Laba Rugi
• Target market rumah sakit adalah peserta JKN-KIS
• Membangun value proposition sesuai target market
• Kompleksitas diatasi dengan meningkatkan kolaborasi dengan
seluruh stakeholder terutama dengan dokter
• Pemimpin mendapatkan trust dari seluruh stakeholder
• Pengendalian biaya bukan hanya di variable cost tetapi juga di
fix cost
• IT yang kuat sangat mendukung strategi efisiensi
TERIMA KASIH