dr. Ediansyah

Direktur

PENGALAMAN RS AN-NISA TANGERANG

Pengelolaan Dana JKN SecaraEfektif dan Efisien Untuk

Menjamin Mutu PelayananKesehatan

2014 : RUMAH SAKIT AN-NISA TANGERANGKELAS C, 100 TT

RUMAH SAKIT AN-NISA TANGERANGKELAS C, 160 TT

DATA KUNJUNGAN

120

6090

700

140

600

0

100

200

300

400

500

600

700

800

Rawat Jalan/hari Rawat Inap/hari Operasi/bulan

awal 2014

akhir 2016

KOMPOSISI PASIEN TAHUN 2016

NON BPJS

BPJS 82,43%

17,57%

KOMPOSISI PENDAPATAN TAHUN 2016

NON BPJS, 19.56

BPJS, 80.44

SIMULASI LABA RUGI RSPENDAPATAN : 10 M

HARGA POKOK PENJUALAN : 1,2 M (12%)--------------------------------------------------------------------------------LABA KOTOR : 8,8 M

JASA MEDIS : 2,5 M (25%)GAJI KARYAWAN : 1,8 M (18%)

BIAYA OPERASIONAL : 0,8 M (8%)

EBITDA : 3,7 M ------------------------------------------------------------------------------

BUNGA BANK : 0,1 M (1%)

DEPRESIASI : 0,5 M (5%)-----------------------------------------------------------------------------

PENDAPATAN SEBELUM PAJAK : 3,1 M PAJAK :

-----------------------------------------------------------------------------

LABA BERSIH : (15% - 20%)

EBIT : 3,2 M

-----------------------------------------------------------------------------

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. 1.000.000Margin(30%) : Rp. 300.000

Tarif INA CBG :Rp. 1.200.000

Sisa Rp. 200.000 (20%)

PRICE = UNIT COST + MARGIN

Tarif RS : Rp. 1.000.000 Tarif INA CBG : 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 Prices Costs

Rivalry Profitability Costs

Substitutes

HEALTHCARE MEGATRENDRobert M Wachter MD, Professor and Chair of Department of Medicine, University of California, San Francisco

2. Paper Industry to Digital Industry

1. Relentless Pressure to Deliver • The highest quality• Safest• Most satisfying care• The lowest possible cost

Value =Benefit----------------

Cost

1•Business Strategy

2•Growing Complexity

3•Leadeship & Change Management

4•Cost control & Quality control

5• Information Technology

Challanges in Implementing INA -CBG

1. Business Strategy

Strategic question1. 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

A

B

C/D

FKTP

RS AN-NISA

Product/Service:• Spesialisasi lengkap,• Penunjang medis lengkapMarket

Peserta JKN-KIS

Competitor:RS Kelas C

RS AN-NISA: How to Compete

1. Tidak ada diskriminasi pelayanan untuk pasien BPJS dannon BPJS

2. Fleksibilitas jam pelayanan rawat jalan (08.00 WIB –20.00 WIB)

3. Tidak ada kuota tempat tidur untuk pelayanan rawatinap 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

Dokter

Manajemen

Pemilik

GROWING COMPLEXITY (INTERNAL )

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.”

Rumah Sakit

Kem

Kes

BPJS

Pasien

GROWING COMPLEXITY (EKSTERNAL)

• Tarif INA-CBG• Verifikasi Claim• Rujukan Berjenjang

Kompleksitas

Memiliki keterkaitan dan salingberhubungan antara satu pihak denganpihak 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

Fix

ed c

ost ($

)

Cost p

er

un

it o

f o

utp

ut ($

)

Total Fixed Costs Curve

Output (in unit)

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

declines as

activity increases.

Variable Costs Curve

Total variable

costs increase as

activity increases.

1 2 3 4 5 6 7 8 9 10 11

Cost pe

r unit (

$)

1 2 3 4 5 6 7 8 9 10 11

Cost per unit

is constant as

activity increases.

Tota

l C

ost ($

)

Output (in Unit) Output (in Unit)

Volume in Units

Co

sts

an

d R

even

ue

in D

oll

ars

Break-even

PointProfit

Loss

Cost-Volume-Profit

Contoh

FIX COST KAMAR OPERASI : 100 JUTAJUMLAH OPERASI PER BULAN : 100

RATA RATA FIX COST PER OPERASI : 1 JUTA

FIX COST KAMAR OPERASI : 100 JUTAJUMLAH OPERASI PER BULAN : 500

RATA RATA FIX COST PER OPERASI : 200 RIBU

POLIKLINIK ANAK No Jam Dokter

1 08.00 – 09.00 Dr. Denok

2 09.00 – 10.00 Dr. Denok

3 10.00 – 11.00 Dr. Denok

4 11.00 – 12.00 Dr. Denok

5 12.00 – 13.00 Dr. Ari Mulyani

6 13.00 – 14.00 Dr. Ari Mulyani

7 14.00 – 15.00 Dr. Amin Husni

8 15.00 – 16.00 Dr. Amin Husni

9 16.00 – 17.00 Dr. Amin Husni

10 17.00 – 18.00 Dr. Arif Nasution

11 18.00 – 19.00 Dr. Arif Nasution

12 19.00 – 20.00 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 denganseluruh 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