RBRVS and DRG performance evaluation system

The system evaluates clinical staff contributions using workload, quality, cost and case-mix data. It supports RBRVS, DRGs, APGs and CCHI, together with Palline’s RVUI and PCCI indices. Hospitals can align assessment rules with their strategy, research and teaching responsibilities, and applicable Chinese policies.

Policy background

The Opinions of the General Office of the State Council on Strengthening Performance Assessment of Tertiary Public Hospitals (Guo Ban Fa [2019] No. 4) call for performance assessment to shift tertiary public hospitals from scale expansion to quality and efficiency, and from extensive administrative management to comprehensive performance management. The Notice on Issuing Guiding Opinions on Further Standardizing Medical Practice and Promoting Rational Medical Examinations ([2020] No. 29), issued jointly by eight ministries, states that methods and experience such as diagnosis-related groups (DRGs) and the resource-based relative value scale (RBRVS) should be drawn upon, and that technical level, case difficulty, work quality, positive examination rate, and patient satisfaction should be used as key indicators in performance distribution.

Core capabilities

• Cloud performance applications: performance assessment, performance-based pay allocation and payment, cost and KPI management, HR data, reporting, configurable scoring and formulas, and user access controls.
• Platform administration: unified platform management center, automated publication management, data integration platform, and data center, with a process engine and a rules engine.
• Performance evaluation model: key performance indicators (KPIs); performance for physicians, nursing, technical, and pharmacy staff using RBRVS and DRG as primary tools; and administrative performance using a modified Hay method.

Product strengths

The system connects to HIS, EMR, LIS, PACS, OA, and other systems for deep multi-source data collection. Workload and composite indicators are aggregated in real time, and every report and data point can be traced backward to verify the source data and the authenticity of the calculation. Modules support several scoring methods, including qualitative indicator assessment, fixed-target assessment, peer department comparison, and comparison against the prior-year average. A configurable rules engine and a highly extensible formula designer support RBRVS workload accounting, DRG/DIP workload accounting, indicator assessment, economic accounting, and other performance calculation methods.