On August 18, the National Medical Insurance Bureau issued the “Notice on Carrying out Special Treatment of Oral Implantation Medical Service Fees and Consumables Prices (Draft for Comment)”.
The “Notice” proposes to guide the formation of a reasonable price for dental implant crowns. Dental implant crowns are purchased online, and public medical institutions choose them independently according to clinical needs, and sell them at a “zero markup” rate on the actual purchase price. The Sichuan Provincial Medical Security Bureau organizes bidding for the mainstream clinical all-ceramic crowns in the province, and forms a reasonable market price through competition. Other materials refer to the price of all-ceramic crowns. The National Medical Security Administration instructs other provinces to implement price linkages, limit prices and hang on the Internet, and promote the transparency of dental crown prices. For medical institutions that manufacture dental implant crowns by themselves, the medical institutions shall independently determine the price based on material cost, processing services, etc., according to the appropriate cost recovery rate, and hang the price on the net. .
Notice on Carrying out Special Treatment of Oral Implant Medical Service Charges and Consumables Prices
(Draft for comments)
Problems such as irregular charges and heavy cost burden in the field of oral implantation have existed for a long time. In order to implement the decisions and deployments of the CPC Central Committee and the State Council, ensure that the people receive high-quality, efficient and affordable dental restoration services, satisfy the people’s yearning for a better life, and promote the healthy and orderly development of oral implants, in accordance with the joint efforts of nine ministries and commissions. Print and distribute the requirements of “Key Points of Correcting Unhealthy Practices in the Field of Pharmaceutical Purchases and Sales and Medical Services in 2022”, and carry out special treatment of charges for dental implant medical services and prices of consumables. The relevant work requirements are hereby notified as follows:
1. Standardize the charging methods for dental implant medical services and consumables
(1) Promoting the “separation of technology and consumption” in dental implant medical services in an orderly manner.Public medical institutions provide dental implant medical services, mainly adopting a separate pricing method of “service items + special consumables”. That is, the implant placement fee is priced separately from the price of the implant consumables system; the dental crown placement fee is priced separately from the price of the dental crown product; the bone graft operation fee is priced separately from the bone meal price. For the current situation that consumables are combined in the price of medical service items, when the “separation of technology and consumption” is implemented, the project price should be synchronously reduced in accordance with the method of deducting the average online purchase price of related consumables.
(2) Guide the formation of a reasonable price for dental implant crowns.Dental implant crowns are purchased online, and public medical institutions choose them independently according to clinical needs, and sell them at a “zero markup” rate on the actual purchase price. The Sichuan Provincial Medical Security Bureau organizes bidding for the mainstream clinical all-ceramic crowns in the province, and forms a reasonable market price through competition. Other materials refer to the price of all-ceramic crowns. The National Medical Security Administration instructs other provinces to implement price linkages, limit prices and hang on the Internet, and promote the transparency of dental crown prices. For medical institutions that manufacture dental implant crowns by themselves, the medical institutions shall independently determine the price based on material cost, processing services, etc., according to the appropriate cost recovery rate, and hang the price on the net. .
(3) Standardize and integrate the price items of dental implants.According to the basic principle of “output orientation”, integrate the medical service price items involved in oral implantation. Among them, the first-stage implantation surgery (implant placement) and the second-stage surgery (placement of the healing abutment) are combined into implant placement; dental crown placement services, including impression taking, jaw relationship recording and transfer, Abutment and crown installation, debugging and modification, etc., are combined into implant crown placement; bone graft surgery, soft tissue repair, implant repair and removal, etc., which are implemented in support of dental implants, set independent medical service price items . For complex implant surgeries such as full arch restoration implants and maxillary sinus bone grafting, differences can be reflected in the price of medical services. In order to ensure the accuracy of missing teeth restoration, medical institutions use various inspection methods such as medical imaging, digital technology, artificial intelligence, etc. to construct virtual 3D models, make lesion models or surgical guides, and set up corresponding medical service price items according to service output. . The specific guidelines for the establishment of dental implant and other missing tooth restoration medical services will be issued separately by the National Medical Security Administration. Each provincial medical security department will issue a document before the end of 2022 to standardize and integrate local price items.
2. Strengthen the price regulation of medical services such as dental implants
(4) Do a good job in price regulation around the whole process of dental implants.Local medical security departments should focus on single conventional implantation, clarify the price control objectives of the whole process, guide centralized procurement with volume, standardize medical service price items, and strengthen the price control of dental implant medical services. In areas where the whole process price of “inspection design + implant placement + crown placement + special consumables” for single conventional implantation is more than **** yuan, targeted measures should be taken to import the whole process price to no more than At the same time, the proportion of implant placement surgery and crown placement in the whole process price is controlled at about 60%, and the proportion of inspection design price is controlled at about 10%, which highlights the entire dental implant. The value of technical labor in the service.
(5) Strengthen policy guidance on the price of medical services in public medical institutions.In areas where government-guided price management is implemented for oral implant projects such as implant placement fees, crown placement fees, and bone grafting fees, the medical security department will re-formulate and announce government-guided prices while standardizing the price items. All provincial medical security departments should complete the price adjustment of dental implant medical services by the end of 2022. In areas where the independent pricing of public medical institutions is implemented, the medical security department shall, in accordance with the whole-process price regulation target, organize medical institutions to re-announce the price within the first month of the implementation of the new price project in accordance with the project establishment guidelines, so as to promote the pricing level and hospital grade, Professional status and functional positioning are matched, and the average level of independent pricing of public medical institutions in the region is regularly released.
(6) Adhere to the ups and downs, and straighten out the relationship between the prices of related medical services.Implants, crowns, and bone grafts are mainly due to the strong feedback from the masses and the heavy cost burden. Among them, if the government-guided price of public medical institutions is significantly higher than the average price of private medical institutions in the region, the principle of public welfare should be adhered to, special demonstrations, and key price reductions; if the independent pricing of public medical institutions differs greatly between hospitals, the price order should be supervised and supervised. Medical institutions that were significantly higher than the average level took the initiative to pull back. Items with high technical difficulty and high risk such as zygomatic surgery and complex bone grafting are allowed to open an appropriate gap between the price of conventional dental implant surgery. The price of medical services in fixed dentures, removable dentures and other methods of restoration of missing teeth shall maintain a reasonable price parity with oral implants, and medical institutions are encouraged to provide patients with appropriate restoration services for missing teeth. For technical labor-based projects such as tooth extraction, periodontal scaling, and filling, if the historical price is low, the price can be appropriately increased.
(7) Strengthen the supervision and guidance of dental implant prices in private medical institutions.The prices of services such as dental implants in private medical institutions shall be adjusted by the market, and the pricing shall follow the principles of fairness, lawfulness, good faith and consistent quality and price, and proactively publicize the price level in obvious areas, and ensure the authenticity, timeliness, and integrity of the public information. . Private medical institutions should strictly regulate their own price behavior, and must not use false subsidies or low-price publicity and other price means to deceive and defraud patients. For private medical institutions in the region that have a high rate of collection and reporting of dental implants, a high rate of use of selected products, outstanding economic advantages in oral implant costs, and top evaluations, the local medical security bureaus will display prices and costs on their official websites. Provide medical guidance to patients.
3. Carefully organize the centralized procurement of dental implant consumables
(8) To form an inter-provincial procurement alliance for dental implant consumables.The Sichuan Provincial Medical Security Bureau led the establishment of an inter-provincial procurement alliance for dental implant consumables, and all provinces should participate. The centralized procurement of dental implant consumables adheres to the basic principle of integrating recruitment and procurement and linking volume and price. In accordance with the general idea of government organizations, alliance procurement, and platform operation, and fully considering the characteristics of dental implant consumables production, supply, and clinical use, guide Enterprises compete fairly. The specific procurement plan is formulated and implemented by the Sichuan Provincial Medical Security Bureau in conjunction with the medical security departments of the alliance provinces. The centralized procurement is based on a complete set of implant systems, including implants, restoration abutments, and accessories such as covering screws, healing abutments, transfer rods, and substitutes.
(9) Extensively mobilize medical institutions at all levels to participate.In principle, the number of medical institutions (including private individuals) participating in this centralized procurement in each overall planning area should account for more than 40% of the medical institutions providing dental implant services, or the proportion of the total reported demand in the region to the total actual use in the previous year. more than 50%. All localities extensively mobilize medical institutions with dental implant service capabilities within their jurisdictions, organize all public medical institutions (including military medical institutions) to participate in the centralized procurement of dental implant consumables, fully mobilize private medical institutions to participate, and clarify policy requirements to medical institutions, the masses Looking forward to the social responsibility of medical institutions, analyzing the changing trend of the industry pattern and patients’ medical behavior after centralized procurement, emphasizing relevant supporting and regulatory measures, etc., and guiding medical institutions to obtain development opportunities in the same frequency resonance with national advocacy and people’s expectations . If doctors in public medical institutions practice in multiple locations in private medical institutions and serve as the principal or business backbone, the public medical institution shall urge them to participate in centralized procurement in a standardized manner. Medical institutions need to reply in writing to participate or not to participate in this collection, and to explain the reasons for not participating.
(10) Fill in the demand for implant procurement truthfully and accurately.Each province organized the public and private medical institutions participating in this centralized procurement to fill in the procurement requirements of dental implant consumables. The contents of the report include the actual purchase quantity and purchase demand of dental implant consumables of the unit in the previous year. In principle, the reported demand should not be lower than the actual purchase volume of the previous year, and at the same time, the factors that increase the demand for dental implants should be considered forward-looking, so as to ensure the accuracy and reasonableness of the reported volume, promote the better realization of the exchange of price with volume, and facilitate the selection of enterprises to ensure the supply. A differentiated price policy is implemented for public medical institutions that provide dental implant services but refuse to report the volume or the reported volume rate is less than 80% of the actual usage in the previous year. In regions, the actual charges of the above-mentioned public medical institutions shall not exceed 80% of the government-guided price; in areas where self-pricing management is implemented, the actual charges of the above-mentioned public medical institutions shall not exceed 80% of the average level of self-pricing by public medical institutions in the region.
4. Implement comprehensive management of dental implant charges
(11) Explore the establishment of an abnormal price warning system for oral implants.Local medical security departments should establish an abnormal price warning system for oral implants on a prefecture-level basis, and list medical institutions at all levels and various types of medical institutions that report more price complaints, price significantly higher than the local average, and refuse or passively participate in the collection of dental implants. It will be included in the price abnormality warning list, and it will be publicly notified on the official website of the local medical security bureau every quarter. Medical institutions that have entered the warning list for many times during the year will be notified by the provincial medical security department; if the circumstances are serious, the National Medical Security Administration will uniformly expose them. For medical institutions listed on the price abnormality warning list, comprehensive use of monitoring and early warning, letter inquiries and interviews, reminders and warnings, cost investigations, information disclosure, public exposure and other regulatory means to promote the formation of a good market order; belong to public medical institutions, should Restrictive measures have been adopted in adjusting medical service prices and accepting declarations for new medical service price items.
(12) Continue to carry out special investigation and inspection of dental implant prices.In the start-up stage of the special governance (August 2022), in accordance with the principle of “horizontal to side, vertical to the bottom, and full coverage”, a comprehensive investigation and registration of dental implant charges and medical service prices will be carried out, laying a solid foundation for standardizing projects and prices and implementing centralized and volume-based procurement. Solid foundation. Investigate the clues of illegal charges found during the registration period and investigate and correct them in a timely manner. In the implementation stage of the special governance (2022 **), the medical security department will focus on monitoring, and pay close attention to the implementation of the prices of dental implant medical services in various medical institutions at all levels and the actual procurement of implants and other consumables, as well as dental implant consumables. Changes in key indicators such as the price of dental implant surgery and the average patient cost to ensure the implementation of various treatment measures are detailed, and the provincial medical security department forms a report on a province-by-province basis and reports it to the National Medical Security Administration. Starting from January 2023, the “look back” work on the price management of dental implants will be carried out. The local medical security departments will work with relevant departments to rank the highest in the region, with more complaints and reports from the masses, refusing to participate in the centralized procurement of dental implants or concealing reports. A large number of medical institutions are the focus of the inspection. During the inspection process, any clues to violations of laws and regulations such as repeated charges, price gouging, false publicity, etc., as well as unreasonable and non-standard inspection and diagnosis behaviors in the process of providing dental implant medical services are found in the inspection process, and timely report to the competent industry authorities, Administrative law enforcement department notification.
All localities should attach great importance to the special management of the prices and consumables of dental implants and other missing teeth restoration medical services, earnestly perform the industry-wide pharmaceutical service price management responsibilities, organize special forces, earnestly promote the implementation of various measures, and achieve full coverage of public and private medical institutions. It is necessary to implement the people-centered governance concept, strengthen the coordination of dental implant medical services and the centralized procurement of consumables, effectively reduce the inflated prices of dental implant medical services and consumables, and reduce the cost of the people.