data penyakit jantung, pembiayaan dan strategi perki ......7 i-1-40-ii prosedur kardiovaskular...

Data Penyakit Jantung, Pembiayaan dan Strategi PERKI

Menghadapi JKN

DR. Dr. Isman Firdaus, SpJP(K)

FIHA, FAPSIC, FAsCC, FESC, FSCAI

Riskesdas 2018

Cardiovascular Risk factor

Diabetes Melitus

Hipertensi

Merokok

Dislipidemia Kolesterol total > 200 mg/dL = 39,8%

12

57

30

8 15

8 5 8 4

13

128

67

190

254

60

37

8 4

8

18 9

4 3

29

1 4 4

18

1 6

1 1

36

4

SEBARAN 1055 DOKTER SPJP DI INDONESIA - UPDATE PERKI PER-OKTOBER 2018

SEBARAN 1250 DOKTER SP.JP DI INDONESIA

CARDIAC CATHETERIZATION IN

INDONESIA 2018

10

7

10 22 3

1

2

11

3

2

1 3

Bata

m 3

3

51

22

1

3 2

1

3

4

Number of Cardiac Catheterization Lab Total: + 256 Cath Lab in 160 hospital

Jumlah Biaya Katastropik pembebanan Januari s.d. Desember 2018 sebesar

Rp 20.429.409.135.197

Belum Optimalnya Pembangunan Kesehatan di “Hulu”

9

Biaya % Cost %

JANTUNG 9,276,267,344,082 50% 10,545,485,639,809 52%

KANKER 3,180,153,003,444 17% 3,406,308,675,470 17%

STROKE 2,187,832,772,884 12% 2,565,601,469,065 13%

GAGAL GINJAL 2,339,685,661,564 13% 2,395,347,020,362 12%

THALASSAEMIA 532,866,127,320 3% 490,997,712,556 2%

HAEMOPHILIA 258,346,002,706 1% 358,121,722,285 2%

CIRRHOSIS HEPATIS 319,755,809,334 2% 334,220,059,770 2%

LEUKAEMIA 326,468,733,400 2% 333,326,835,880 2%

Total by katastrofik 18,421,375,454,734 100% 20,429,409,135,197 100%

Total by pelkes 84,481,518,703,972 94,399,526,592,896

% by katasr dr pelkes 22% 22%

2018KATASTROPIK

2017

Pembiayaan penyakit jantung dan stroke menempati urutan 1 dan 3 terbesar dalam pembiayaan penyakit katastrofik tahun 2018

10

KASUS BIAYA KASUS BIAYA KASUS BIAYA KASUS BIAYA

CIRRHOSIS HEPATITIS 97,015 236,972,653,998 135,220 273,451,622,378 152,803 281,901,854,362 155,956 287,226,732,134

GAGAL GINJAL 1,504,657 2,386,644,531,086 2,370,133 3,246,900,790,370 2,620,298 3,434,981,436,663 1,536,686 2,060,005,927,710

HEMOFILIA 19,981 70,616,801,524 33,206 120,606,736,633 39,360 144,083,229,768 41,976 234,810,590,900

JANTUNG 4,105,829 4,959,183,543,448 6,391,291 6,771,806,433,377 8,077,027 7,965,874,510,857 9,730,577 8,550,887,881,553

KANKER 910,595 1,945,589,362,117 1,474,336 2,528,289,269,887 1,712,001 2,751,221,021,974 1,792,131 2,822,557,674,534

LEUKAEMIA 42,986 166,497,706,768 71,731 199,448,082,034 87,505 231,092,487,200 91,166 289,717,384,300

STROKE 572,165 1,011,906,985,166 929,171 1,273,304,568,952 1,287,172 1,571,181,590,236 1,602,698 2,036,140,839,375

THALASSEMIA 85,789 302,552,264,617 121,561 471,160,535,915 143,665 516,225,162,948 151,045 455,251,083,500

TOTAL 7,339,017 11,079,963,848,724 11,526,649 14,884,968,039,546 14,119,831 16,896,561,294,008 15,102,235 16,736,598,114,006

KATASTROPIK2014 2015 2016 2017

Biaya Penyakit Katastropik

Tahun Kasus Biaya

2016 46.949 1.427.298.301.100

2017 55.242 1.560.424.006.000

TOTAL 102.191 2.987.722.307.100

Data Pelayanan Cathlab Tahun 2016-2017

PERBANDINGAN PENGGUNAAN STENT DI BEBERAPA NEGARA

Negara Penduduk Jumlah stent/year Rasio

Stent/ penduduk

USA 328.000.000 1.800.000 1:182

China 1.300.000.000 500.000 1:2600

Eropa 742.000.000 1.500.000 1:495

India 1.339.000.000 594.000 1:2254

Indonesia* 280.000.000 26.000 1:10.770

* Data BPJS

REPERFUSION OR NO REPERFUSION?

13

No Kd Ina CB

Gs Nama INA CBG's Kasus

1 O-6-10-I OPERASI PEMBEDAHAN CAESAR RINGAN 134.740

2 A-4-14-I PENYAKIT INFEKSI BAKTERI DAN PARASIT LAINLAIN RINGAN 88.459

3 K-4-17-I NYERI ABDOMEN GASTROENTERITIS LAINLAIN RINGAN 85.106

4 K-4-18-I DIAGNOSIS SISTEM PENCERNAAN LAINLAIN RINGAN 52.852

5 A-4-13-I INFEKSI NON BAKTERI RINGAN 47.592

6 P-8-17-I NEONATAL, BBL GROUP5 TANPA PROSEDUR MAYOR RINGAN 42.011

7 J-4-16-I SIMPLE PNEUMONIA WHOOPING COUGH RINGAN 36.581

8 O-6-13-I PERSALINAN VAGINAL RINGAN 30.817

9 P-8-17-I NEONATAL BBL GROUP5 TANPA PROSEDUR MAYOR RINGAN 25.014

10 W-4-16-I GANGGUAN ANTEPARTUM RINGAN 23.963

11 L-1-40-I PROSEDUR PADA KULIT, JARINGAN BAWAH KULIT DAN PAYUDARA RINGAN 21.952

12 J-4-15-I PERADANGAN DAN INFEKSI PERNAFASAN RINGAN 19.965

13 O-6-10-II OPERASI PEMBEDAHAN CAESAR SEDANG 19.731

14 D-4-13-I GANGGUAN SEL DARAH MERAH SELAIN KRISIS ANEMIA SEL SICKLE RINGAN 19.396

15 L-1-50-I PROSEDUR PADA PAYUDARA RINGAN 17.650

16 W-1-11-I PROSEDUR DILATASI, KURET, INTRAUTERIN SERVIK RINGAN 17.140

17 I-4-12-I KEGAGALAN JANTUNG RINGAN 16.886

18 E-4-10-I PENYAKIT KENCING MANIS GANGGUAN NUTRISI/ METABOLIK RINGAN 16.567

19 K-1-13-I PROSEDUR APPENDIK RINGAN 16.424

20 N-4-10-II TUMOR GINJAL SALURAN URIN GAGAL GINJAL SEDANG 15.748

20 GROUPING INA CBG’S Kasus Terbanyak Rawat Inap Pelayanan Tahun 2018

Wilayah Jabodetabek

14

Kode

CMG Nama CMG Biaya

Q Ambulatory GroupsEpisodic 2.390.567.278.192

I Cardiovascular system Groups 1.812.827.938.846

N Nephrourinary System Groups 1.638.202.483.440

J Respiratory system Groups 1.503.231.376.878

O Deleiveries Groups 990.324.059.800

K Digestive system Groups 806.022.806.822

Z Factors influencing health status other contacts with health services Groups 790.940.987.800

M Musculoskeletal system connective tissue Groups 752.758.268.395

H Eye and Adnexa Groups 742.456.917.620

G Central Nervous System Groups 584.545.827.464

P Newborns Neonates Groups 521.630.318.000

A Infectious parasitic diseases Groups 511.702.451.480

C Myeloproliferative system neoplasms Groups 427.266.718.100

L Skin subcutaneous tissue breast Groups 383.484.750.183

W Female reproductive system Groups 378.194.194.700

U Ear nose mouth throat Groups 364.322.907.078

E Endocrine system nutrition metabolism Groups 254.606.785.600

D Haemopoeitic immune system Groups 237.269.099.523

B Hepatobiliary pancreatic system Groups 192.205.005.060

V Male reproductive System Groups 102.009.299.900

F Mental Health and Behavioral Groups 85.406.880.800

S Injuries poisonings toxic effects of drugsGroups 12.073.743.600

T Substance abuse dependence Groups 10.180.000

CASEMIX MAIN GROUPS (CMG) dengan Biaya terbesar tahun 2018 Wilayah Jabodetabek : Data BPJS Jobodetabek

15

NoKd Ina CB

GsNama INA CBG's Biaya

1 O-6-10-I OPERASI PEMBEDAHAN CAESAR RINGAN 764.974.513.200

2 J-1-02-III VENTILASI MEKANIKAL LONG TERM TANPA TRAKEOSTOMI BERAT 250.042.208.426

3 I-1-40-III PROSEDUR KARDIOVASKULAR PERKUTAN BERAT 237.599.070.800

4 A-4-14-I PENYAKIT INFEKSI BAKTERI DAN PARASIT LAINLAIN RINGAN 224.731.042.200

5 J-1-20-III PROSEDUR SISTEM PERNAFASAN NON KOMPLEKS BERAT 203.143.646.176

6 I-1-40-I PROSEDUR KARDIOVASKULAR PERKUTAN RINGAN 199.691.240.500

7 I-1-40-II PROSEDUR KARDIOVASKULAR PERKUTAN SEDANG 191.947.125.900

8 P-8-17-I NEONATAL, BBL GROUP5 TANPA PROSEDUR MAYOR RINGAN 167.417.340.800

9 K-4-17-I NYERI ABDOMEN GASTROENTERITIS LAINLAIN RINGAN 151.858.657.300

10 J-4-16-I SIMPLE PNEUMONIA WHOOPING COUGH RINGAN 145.606.280.560

11 L-1-50-I PROSEDUR PADA PAYUDARA RINGAN 121.250.987.100

12 O-6-10-II OPERASI PEMBEDAHAN CAESAR SEDANG 120.733.278.400

13 L-1-40-I PROSEDUR PADA KULIT, JARINGAN BAWAH KULIT DAN PAYUDARA RINGAN 105.040.565.700

14 J-1-01-III VENTILASI MEKANIKAL LONG TERM DENGAN TRAKEOSTOMI BERAT 103.309.103.242

15 P-8-17-I NEONATAL BBL GROUP5 TANPA PROSEDUR MAYOR RINGAN 99.766.379.000

16 W-1-20-I PROSEDUR PADA RAHIM ADNEKSA RINGAN 95.364.022.000

17 A-4-13-I INFEKSI NON BAKTERI RINGAN 94.643.526.700

18 J-4-15-I PERADANGAN DAN INFEKSI PERNAFASAN RINGAN 91.817.638.700

19 N-1-40-I PROSEDUR PADA URETRA DAN TRANSURETRA RINGAN 89.578.813.800

20 J-1-20-II PROSEDUR SISTEM PERNAFASAN NON KOMPLEKS SEDANG 88.609.919.874

20 GROUPING INA CBG’S Biaya Terbesar Rawat Inap Pelayanan Tahun 2018 Kedeputian Wilayah Jabodetabek

2569

2006

1356

933

763

690

560

474

463

389

0 500 1000 1500 2000 2500 3000

PROSEDUR KARDIOVASKULAR PERKUTAN

KEGAGALAN JANTUNG

KATETERISASI JANTUNG

PROSEDUR KATUP JANTUNG TANPA KATETERISASIJANTUNG

ANGINA PEKTORIS DAN NYERI DADA

PROSEDUR KARDIOTORASIK LAIN

PROSEDUR BYPASS KORONER TANPA KATETERISASIJANTUNG

INFARK MYOKARD AKUT

PENYAKIT JANTUNG KONGENITAL DAN KATUP JANTUNG

PROSEDUR SISTIM PEREDARAN DARAH LAIN-LAIN

Sepuluh Group Rawat Inap dengan Jumlah Kasus Terbanyak Tahun 2018

11.3

5.3

5.0

33.8

2.8

9.2

1.3

1.2

1.6

10.5

40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 5.0


KEGAGALAN JANTUNG


PROSEDUR KATUP JANTUNG TANPA KATETERISASI JANTUNG



PROSEDUR BYPASS KORONER TANPA KATETERISASI JANTUNG

INFARK MYOKARD AKUT



Bill VS Klaim Sepuluh Group Rawat Inap dengan Kasus Terbanyak

Tahun 2018 (Dalam Milyar Rupiah)

10 Group Rawat Inap Terbanyak di RSJPDHK (Prosedur dan Perawatan)

10 Group Prosedur Terbanyak

2569

1356

933

690

560

389

363

209

108

91

0 500 1000 1500 2000 2500 3000







OPERASI KARDIOTORASIK KOMPLEKS PADA JANTUNGANOMALI

PEMASANGAN PACEMAKER JANTUNG PERMANEN

PROSEDUR PEMBULUH DARAH TORASIK KOMPLEKS

LIGASI DAN STRIPPING PEMBULUH DARAH VENA

Sepuluh Group Prosedur dengan Jumlah Kasus Terbanyak Tahun 2018

140

25

139

78

71

34

52

15

10

3

- 50 100 150







OPERASI KARDIOTORASIK KOMPLEKS PADA JANTUNGANOMALI




Dalam Milyar Rupiah

Total Bill Sepuluh Group Prosedur Terbanyak Tahun 2018

139.7

138.6

77.8

71.1

52.1

33.7

24.7

21.2

15.4

10.2

- 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0





OPERASI KARDIOTORASIK KOMPLEKS PADA JANTUNG ANOMALI



KEGAGALAN JANTUNG



Sepuluh Group Rawat Inap dengan Bill Terbesar Tahun 2018

(Dalam Milyar Rupiah)

Bill VS Klaim Group Prosedur

(11.3)

(5.0)

(33.8)

(9.2)

(1.3)

(10.5)

(28.0)

(1.0)

(4.8)

0.3

(40.0) (35.0) (30.0) (25.0) (20.0) (15.0) (10.0) (5.0) 0.0 5.0







OPERASI KARDIOTORASIK KOMPLEKS PADA JANTUNG ANOMALI




Bill vs Klaim Sepuluh Group Prosedur Terbanyak Tahun 2018 (dalam Milyar Rupiah)

Group Kardiovaskular Perkutan

2009

338

138

82

2

0 500 1000 1500 2000 2500

PCI

Ablasi

Balloon Valvuloplasty

EP Study

BAS

Jumlah Tindakan Grup Kardiovaskular Perkutan Tahun 2018

7.26

(17.82)

(0.07)

(0.68)

0.05

(20.00) (15.00) (10.00) (5.00) 0.00 5.00 10.00

PCI

Ablasi

Balloon Valvuloplasty

EP Study

BAS

Bill vs Klaim Tindakan Grup Kardiovaskular Perkutan

Tahun 2018 (dalam Milyar Rupiah)

Case Mixed Groups

11.3

5.3

5.0

33.8

2.8

9.2

1.3

1.2

1.6

10.5

40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 5.0


KEGAGALAN JANTUNG






INFARK MYOKARD AKUT



Bill VS Klaim Sepuluh Group Rawat Inap dengan Kasus Terbanyak

Tahun 2018 (Dalam Milyar Rupiah)

Severity Level I 59%

Severity Level II 33%

Severity Level III 8%

Proporsi Severity Level Tindakan Diagnostik Invasif dan Intervensi Non Bedah Coroner

Tahun 2018

RS Jantung Harapan Kita

Severity Level ??

RS Tipe A RS Tipe B/C

NO. Case-Mix Main Groups (CMG) CMG Codes

1 Central nervous system Groups G

2 Eye and Adnexa Groups H

3 Ear, nose, mouth & throat Groups U

4 Respiratory system Groups J

5 Cardiovascular system Groups I

6 Digestive system Groups K

7 Hepatobiliary & pancreatic system Groups B

8 Musculoskeletal system & connective tissue Groups M

9 Skin, subcutaneous tissue & breast Groups L

10 Endocrine system, nutrition & metabolism Groups E

11 Nephro-urinary System Groups N

12 Male reproductive System Groups V

13 Female reproductive system Groups W

14 Deleiveries Groups O

15 Newborns & Neonates Groups P

16 Haemopoeitic & immune system Groups D

CMG = MDC

NO. Case-Mix Main Groups (CMG) CMG Codes

17 Myeloproliferative system & neoplasms Groups C

18 Infectious & parasitic diseases Groups A

19 Mental Health and Behavioral Groups F

20 Substance abuse & dependence Groups T

21 Injuries, poisonings & toxic effects of drugs Groups S

22

Factors influencing health status & other contacts with health

services Groups Z

23 Ambulatory Groups-Episodic Q

Alur Proses Re-Klasifikasi INA-CBG

EXPERT PANEL MEETING

Hierarchy of DRG Classification

MD

C

Surgical

Procedure or Diagnosis Cluster (PDC)

Disease Cluster DRG


Disease Cluster

DRG

DRG

Disease Cluster DRG


Disease Cluster DRG

Medical


Disease Cluster DRG


Disease Cluster

DRG

DRG

DRG

Disease Cluster DRG

INA-CBG EXISTING

15 Group Dx CBGs

INA-CBG EXISTING

17 Procedures CBGs

LIST MAPPING ICD

Medical Group 16 N0 DIAGNOSIS

1 Acute myocardial infarction

2 Infective endocarditis

3 Heart failure & shock

4 Venous thrombosis

5 Skin ulcer for circulatory disorders

6 Peripheral vascular

7 Coronary atherosclerosis

8 Hypertensi

9 Congenital heart disease

10 Valvular disorders

11 Major arrhythmia and cardiac arrest

12 Non-major arrhytmia and conduction disorders

13 Unstable angina

14 Syncope and collapse

15 Chest pain

16 Other circulatory system diagnosis

N0 DIAGNOSIS

1 Acute myocardial infarction

2 Infective endocarditis

3 Heart failure & shock

4 Venous thrombosis

5 Skin ulcer for circulatory disorders

6 Peripheral vascular

7 Coronary atherosclerosis

8 Hypertensi

9 Congenital heart disease

10 Valvular disorders

11 Major arrhythmia and cardiac arrest

12 Non-major arrhytmia and conduction disorders

13 Unstable angina

14 Syncope and collapse

15 Chest pain

16 Other circulatory system diagnosis

N0 PROCEDURES

1 PROSEDURE VALVULAR PERKUTAN MAYOR

2 PROSEDUR KARDIOVASKULAR PERKUTAN MAYOR

3 PROSEDUR VASKULAR MAYOR PERKUTAN

4 PROSEDUR DEVICE PERKUTAN MAYOR

5 PROSEDUR KORONER PERKUTAN MAYOR

6 PROSEDUR KONGENITAL PERKUTAN MAYOR

7 PROSEDUR VASKULAR PERKUTAN KONGENITAL

8 PROSEDUR ELEKTROFISIOLOGI PERKUTAN MINOR

9 PROSEDUR PERKUTAN LAINNYA

10 prosedur diagnostik kongenital perkutan mayor

11 prosedur diagnostik perkutan vaskular mayor

12 prosedur diagnostik perkutan coronary mayor

13 prosedur diagnostik kongenital perkutan minor

14 prosedur diagnostik perkutan vaskular minor

15 prosedur diagnostik perkutan coronary minor

16 prosedur interveni non invasif kardiovaskular

17 prosedur diagnostik non invasif kongenital mayor


19 prosedur diagnostik non invasif kongenital minor

20 prosedur diagnostik non invasif kardiovaskular minor

21 prosedur intervensi bedah kardiovaskular pada neonatus

22 rosedur intervensi non bedah kardiovaskular pada neonatus

23 prosedur diagnostik kardiovaskular pada neonatus

24 prosedur diagnostik kardiovaskular lainnya

PROCEDURES Group 24 Groups

N0 PROCEDURES

1 PROSEDURE VALVULAR PERKUTAN MAYOR

2 PROSEDUR KARDIOVASKULAR PERKUTAN MAYOR

3 PROSEDUR VASKULAR MAYOR PERKUTAN

4 PROSEDUR DEVICE PERKUTAN MAYOR

5 PROSEDUR KORONER PERKUTAN MAYOR

6 PROSEDUR KONGENITAL PERKUTAN MAYOR

7 PROSEDUR VASKULAR PERKUTAN KONGENITAL

8 PROSEDUR ELEKTROFISIOLOGI PERKUTAN MINOR

9 PROSEDUR PERKUTAN LAINNYA

10 prosedur diagnostik kongenital perkutan mayor

11 prosedur diagnostik perkutan vaskular mayor

12 prosedur diagnostik perkutan coronary mayor

13 prosedur diagnostik kongenital perkutan minor

14 prosedur diagnostik perkutan vaskular minor

15 prosedur diagnostik perkutan coronary minor

16 prosedur interveni non invasif kardiovaskular



19 prosedur diagnostik non invasif kongenital minor

20 prosedur diagnostik non invasif kardiovaskular minor

21 prosedur intervensi bedah kardiovaskular pada neonatus

22 rosedur intervensi non bedah kardiovaskular pada neonatus

23 prosedur diagnostik kardiovaskular pada neonatus

24 prosedur diagnostik kardiovaskular lainnya

RESUME • Penyakit kardiovaskular masih menjadi tantangan kesehatan nasional terkait tingginya faktor risiko di

Masyarakat

• Selain angka kematian tertinggi, Biaya penyakit KV masih tinggi dan terus meningkat dari tahun-ketahun

• Pembiayaan JKN terus membengkak di layanan KV

• Masalah-masalah yang muncul dalam Klaim (diluar permasalahan regulasi/aturan/appropriateness

/Necessary or unnecessary Procedures) :

• Belum semua faskes menginput koding dengan benar

• Penentuan Batasan Fragmentasi pelayanan terutama prosedur (prosedur berulang)

• Dispute dan masalah dalam penentuan severity Level

• Perbedaan tarif antar faskes yang tidak di imbangi penentuan kompetensi faskes

• Meskipun koding dan resume sudah sesuai sering terjadi penundaan Klaim

HULU • Puskesmas • Klinik

MASYARAKAT FAKTOR RESIKO - SMOKER - DIABETES MELITUS - DISLIPIDEMIA - HIPERTENSI - FAMILY HISTORY

• Budaya hidup sehat • Senam jantung

• Anti rokok • Makanan Sehat

HILIR • RS KELAS D • RS KELAS C • RS KELAS B • RS KELAS A • RS Khusus

Kredensialing, Klaim, Koding

Kemenkes

Formularium Nasional

PNPK Kardiovaskular

High Technology Assessment

Kompendium Alkes Nasional

Tarif INACBG’s

Akreditasi KARS

Panduan Praktek Klinik

Clinical Pathway

Permenkes No. 30 tentang Klasifikasi RS

PERKI

KKI

IDI

BPJS KT/Spes/Subspes LKPP

Available at: www.inaheart.org

THANK YOU

data penyakit jantung, pembiayaan dan strategi perki ......7 i-1-40-ii prosedur kardiovaskular...

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