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Pemanfaatan ketiga indikator (casemix, CMI, dan HBR) secara berkala untuk mempertahankan mutu sembari menjaga efisiensi pelayanan RS di era JKN. Penelitian ini bertujuan untuk menganalisis dan strategi peningkatan capaian indikator casemix, casemix index dan hospital baserate RSU Bali Royal tahun 2019 - 2024.
Penelitian dilakukan di RSU Bali Royal selama bulan Mei - Juni 2025, menggunakan data primer wawancara mendalam dan focus group discussion dan sekunder yang didapatkan dari rekapitulasi elektronik klaim (e-klaim) Kemenkes, laporan keuangan, dan laporan rumah sakit. Penelitian ini menggunakan studi observasional pendekatan kualitatif untuk menganalisis capaian indikator Casemix, CMI dan HBR rawat inap dan rawat jalan.
Hasil penelitian menunjukkan bahwa terdapat unsur struktur (sumber daya manusia, material, mesin, anggaran, dan metode) dan unsur proses (manajemen pasien, manajemen koding, dan manajemen klaim) membuahkan unsur output (indikator casemix, casemix index, dan hospital baserate) Dinamika penambahan unsur struktur berdampak pada proses pelayanan pasien, efisiensi koding hingga 50%, dan keberhasilan klaim. Casemix rawat jalan tahun 2019 – 2024 diperoleh 11.393; 16.037; 32.763; 59.520; 111.193; dan 129.423. Casemix rawat inap kelas 1 tahun 2019 – 2024 diperoleh 907; 1.321; 2.657; 3.165; 3.829; dan 4.014. Casemix rawat inap kelas 2 tahun 2019-2024 diperoleh 818; 1.013; 1.800; 2.511; 3.052; dan 3.309. Casemix rawat inap keas 3 tahun 2019 – 2024 diperoleh 205; 539; 1.557; 2.023; 2.646; dan 3.038. Nilai CMI rawat jalan tahun 2019 – 2024 diperoleh 0,98; 1,11;1,16; 1,21; 1,35;dan 1,24. CMI rawat inap kelas 1 tahun 2019 – 2024 diperoleh 1,32; 1,60; 1,84; 1,57; 1,45; dan 1,37. CMI rawat inap kelas 2 tahun 2019 – 2024 diperoleh 1,17; 1,36; 1,58; 1,41; 1,33; dam 1,33. CMI rawat inap kelas 3 tahun 2019 – 2024 diperoleh 1,46; 1,82; 1,67; 1,54; 1,53; dan 1,45. HBR rawat jalan tahun 2019 – 2024 diperoleh 354.393; 333.231; 257.536; 243.675; 226.650; dan 238.494. HBR rawat inap kelas 1 tahun 2019 – 2024 diperoleh 5.257.416; 6.028.120; 5.477.120; 5.970.918; 6.542.667; dan 7.082.825. HBR rawat inap kelas 2 tahun 2019 – 2024 diperoleh 4.449.693; 5.628.665; 4.817.066; 4.993.043; 5.156.750; dan 5.563.012. HBR rawat inap kelas 3 tahun 2019 – 2024 diperoleh 3.616.138; 4.594.204; 3.746.071; 4.325.317; 4.584.260; dan 4.789.356. Nilai casemix dan casemix index mengalami peningkatan setiap tahunnya dengan capaian CMI di atas standar rumah sakit swasta kelas C regional 2. HBR rawat jalan pada tahun 2021-2024 dibawah HBR nasional, namun HBR rawat inap kelas 1, 2, dan 3 selalu berada di atas HBR nasional. Strategi yang dapat ditempuh untuk peningkatan casemix, casemix index, dan penurunan HBR adalah optimalisasi unsur struktur dengan perbaikan sumber daya manusia dan pengkajian metode, efisiensi mesin, material, dan anggaran, dan evaluasi pada unsur proses (manajemen pasien, koding, dan klaim).
ABSTRAK Keberhasilan universal health coverage di Indonesia sangat ditentukan oleh utilisasi sumber daya yang efisien di rumah sakit. Variasi biaya yang tinggi untuk perawatan tertentu menunjukkan indikasi bahwa rumah sakit belum cukup efisien dalam memanfaatkan sumber dayanya untuk menyediakan pelayanan. Length of stay (LOS) adalah salah satu faktor penting penentu biaya yang banyak digunakan sebagai indikator efisiensi rumah sakit dalam penggunaan sumber daya. LOS dan biaya perawatan dipengaruhi oleh banyak faktor, baik yang merupakan karakteristik pasien maupun faktor terkait manajemen di rumah sakit. Penelitian ini bertujuan untuk mengidentifikasi seberapa besar hubungan antara karakteristik pasien dengan variasi LOS dan biaya perawatan,dan mengetahui gambaran penerapan clinical pathway sebagai upaya kendali mutu dan biaya pada pasien JKN rawat inap di RSUP Fatmawati dari tahun 2015 – September 2017. Hasil penelitian menunjukkan bahwa variasi usia, jumlah diagnosis, jumlah prosedur dan kelas rawat hanya dapat menjelaskan sedikit variasi LOS dan biaya perawatan (R 2 <34%). Sementara itu clinical pathway sebagai salah satu pendekatan manajemen untuk kendali mutu dan biaya belum diterapkan secara optimal. Berbagai upaya kreatif perlu dilakukan manajemen antara lain implementasi care plan, difungsikannya kembali case manager, pengisian CP secara elektronik dan identifikasi inefisiensi dalam pelayanan menggunakan data unit cost rumah sakit. Kata kunci: Length of stay (LOS), biaya (costs), efisiensi, clinical pathway, CMG
ABSTRACT Efficient use of resources in hospitals will contribute to successful implementation of universal health coverage in Indonesia. Substantial variation in hospital costs for certain diagnosis or procedure is an indication of resource use inefficiency. Length of stay is a well-accepted measure of resource utilization and a key driver to hospital costs. Variation in LOS and costs can be influenced by patient demographic and clinical factors that are outside a hospital’s control, in the meanwhile there are also factors within the control of a hospital. This research focuses on five Casemix Main Groups and aims to identify how patient characteristic factors contribute to variation in LOS and costs, and to investigate qualitatively the implementation of Clinical Pathway as a management approach to control LOS as well as hospital costs for JKN patients at RSUP Fatmawati, a class-A teaching hospital in Jakarta, from 2015 to September 2017. The result indicates that the variance in LOS and cost is not significantly correlated to patient’s age, number of diagnoses, number of procedures and room types as independent variables. The hospital has numerous clinical pathways that have not been optimally implemented yet for LOS and cost control. This research provides information for hospital management team to improve LOS performance by implementing care planning, intensive case management and to use cost data for identification of inefficiency of certain types of care. Keywords: Length of stay (LOS), costs, efficiency, clinical pathway, CMG
Background: Nahdlatul Ulama Islamic Hospital (RSI NU) Demak is a private and nonprofit Islamic hospital, which is not only looking for profit (profitability) but also carrying out social values in its management. In order to balance the economic and social functions amid increasingly fierce competition between hospitals and the industrial revolution 4.0 era, a hospital performance measurement tool is needed. One of the evaluation approaches used to assess hospital performance is the Balanced Scorecard (BSC) method. Methods: This study uses a qualitative approach with a case study method to measure the performance of the RSI NU Demak and the implementation of NU values in hospital management as well as policy recommendations and programs for the RSI NU Demak in the period 2017-2020. Results and Discussion: The eight variables from a financial perspective showed a positive value of +1 only on the variable of increasing efficiency and variable Hospital Social Responsibility (HSR). Then, other variables such as income growth, the effectiveness of ROA, ROI, ROE decreased because the number of patient visits also decreased thus affecting hospital income. The total score for the financial perspective is -6. The customer perspective of RSI NU Demak is generally good enough with a total score of 5 out of 8 variables. The aspects that should be improved are the customer retention rate, improvements in the tangible aspects or physical evidence, the timeliness of specialist doctor services and the speed of handling patient complaints. The internal business process perspective of RSI NU Demak is good with a score of 15 out of 19 variables. The aspects that should be improved are the low BOR, BTO and AvLOS, and the absence of Standard Operating Procedures (SPO) related to Aswaja NU values. The learning and growth perspective of the RSI NU Demak is quite good with a score of 8 out of 12 variables. The common concerned problems include employee satisfaction variables such as the adequacy of allowances and support among employees in one team, employee turnover, the evaluation needs of the Hospital Information System Management at RSI NU Demak (Hos MIS) and the productivity level of the RSI NU Demak. Conclusion: The final score from the four perspectives is 0.34. It means that the performance of RSI NU Demak is said to be quite following the standard, but continuous improvement must be implemented as well
ABSTRAK Nama : Albert Hasibuan Program Studi : Kajian Administrasi Rumah Sakit Judul :Analisis Kinerja Tim Casemix RSU UKI Berdasarkan Malcolm Baldrige Criteria for Performance Excellence Tahun 2018 Pembimbing : dr. Adang Bachtiar MPH DSc Tim Casemix rumah sakit akan menjadi penggerak membantu melakukan sosialisasi, monitoring dan evaluasi implementasi INA-CBGs di rumah sakit. Pada awal mulainya menjalankan program JKN/BPJS rumah sakit ini mengalami peningkatan jumlah kunjungan pasien yang cukup signifikan, namun semakin ke depan terdapat penurunan jumlah pasien dan semakin tingginya beban biaya rumah sakit berkenaan dengan banyaknya klaim biaya yang tertunda/ditolak pembayarannya. Penelitian ini untuk melakukan penilaian kinerja Tim Casemix RSU UKI Berdasarkan Malcolm Baldrige Criteria for Performance Excellence untuk mendapatkan gambaran rencana perbaikan kinerja manajemen rumah sakit. Metode yang digunakan adalah metode penelitian kombinasi menggunakan Analisis data kuantitatif dan kualitatif, dimana peneliti melakukan pengumpulan data dengan menggunakan kuesioner diikuti dengan wawancara mendalam informan kunci, telaah dokumen, observasi, dan diskusi kelompok terarah. Hasil penelitian didapatkan Tim Casemix RSU UKI Jakarta memiliki aspek kesempatan untuk peningkatan (Opportunity For Improvement /OFI) di semua kriteria selain sistem kerja, dimana pada kriteria-kriteria tersebut penilaian masih di bawah 50% dari nilai kesempurnaan MBCfPE. Total skor kriteria Malcolm Baldrige pada Analisis Kinerja Tim Casemix berdasarkan Malcolm Baldrige Criteria for Performance Excellence RSU UKI Jakarta tahun 2018 adalah 376,31, yang artinya tim casemix mencapai predikat kinerja “Early Improvement” dengan tingkatan mutu “Average”. Kata kunci: Malcolm Baldrige; Rumah Sakit; Tim Casemix
ABSTRACT Name : Albert Hasibuan Study Program : Magister Of Hospital Administration Title : Performance Analysis of UKI Hospital Casemix Team based on Malcolm Baldrige Criteria for Performance Excellence on 2018 Counsellor : dr. Adang Bachtiar MPH DSc Hospital Casemix team will become a driving force helping to conduct socialization, monitoring and evaluation of the implementation of INA-CBGs in hospitals. At the beginning of start run programs JKN/BPJS hospital is experiencing an increase in the number of patient visits are significant enough, but getting to the front there is a decrease in the number of patients and the increasing costs of hospitals with regard to the number of claims pending/rejected charges that the payout. The research is to conduct a performance analysis of UKI Hospital Casemix Team based on Malcolm Baldrige Criteria for Performance Excellence to get an overview of performance improvement plan of hospital management. The method used is a combination of research methods using quantitative and qualitative data analysis, where the researchers doing data collection using the questionnaire followed by in-depth key informant interviews, document review, observation, and discussion groups. The Research Team obtained Casemix RSU UKI Jakarta has the opportunity for improvement (Opportunity For Improvement/OFI) on all criteria in addition to the working system, where in the criteria of assessment is still under 50% of the value MBCfPE perfection. A total score of Malcolm Baldrige on performance analysis of UKI Hospital Casemix Team based on Malcolm Baldrige Criteria for Performance Excellence Jakarta in 2018 is 376.31, meaning that the casemix team reached the predicate "Early Improvement" performance with the "Average" level of quality. Keywords: Malcolm Baldrige; The Hospital; Casemix Team
Penelitian ini menguji hubungan antara variabel indikator kinerja mutu pelayanan, kepedulian kepada masyarakat, dan kepedulian terhadap lingkungan dengan kepuasan pelanggan terhadap 14 rumah sakit vertikal di indonesia. Untuk melihat kinerja dan hubungan di antara indikator-indikator tersebut, digunakan analisis deskriptif dan uji korelasi regresi dengan bootstrapping. Selain itu, dilakukan pula pendekatan kualitatif melalui wawancara mendalam. Dari hasil penilaian kinerja, didapatkan sebagian dari sasaran strategik belum mencapai nilai optimum.
This study examines relationship between the variables of service quality performance indicators, public awareness and concern for the environment and customer satisfaction among 14 vertical hospitals in Indonesia. To see the performance and the relationship between these indicators, used descriptive analysis and correlation regression with bootstrapping. In addition, a qualitative approach through in-depth interviews was also applied. Performance evaluation resultes obtained from a portion of the strategic objectives have not yet reached the optimum value.
