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RIWAYAT HIDUP

• Nama : dr. Ediansyah,MARS,MM

• TTL : Pemangkat (KALBAR)


12 Maret 1974

• Pekerjaan : Direktur RS AN-NISA Tangerang


(2010-sekarang)
• Pendidikan
• Dokter : UGM (Th 2000)
• MARS : UI (Th 2008)
• MM : Prasetiya Mulya (Th 2015)

• Organisasi
• PERSI, ARSSI dan MUKISI
• Wakil Ketua PERSI Banten periode 2015-2018

TANTANGAN RUMAH SAKIT DI
ERA JKN-KIS
(Cost Control, Quality Control, Productivity)

PENGALAMAN RS AN-NISA TANGERANG

Ediansyah
Direktur
2014 : RUMAH SAKIT AN-NISA TANGERANG
KELAS C, 100 TT
RUMAH SAKIT AN-NISA TANGERANG
KELAS C, 160 TT
DATA KUNJUNGAN
800
700
700
600
600

500

400 awal 2014


akhir 2016
300

200
120 140
90
100 60

0
Rawat Jalan/hari Rawat Inap/hari Operasi/bulan
SIMULASI LABA RUGI RS
PENDAPATAN : 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
DEPRESIASI : 0,5 M (5%)
-----------------------------------------------------------------------------
EBIT : 3,2 M
BUNGA BANK : 0,1 M (1%)
-----------------------------------------------------------------------------
PENDAPATAN SEBELUM PAJAK : 3,1 M
PAJAK :
-----------------------------------------------------------------------------
LABA BERSIH : (15% - 20%)
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. 1.000.000 Tarif INA CBG :Rp. 1.200.000


Margin (30%) : Rp. 300.000

Sisa Rp. 200.000 (20%)


Cash flows:
Making profits will help, but only if those profits can be quickly converted into cash

Operating activities Investing activities Financing activities


• Long-term borrowing
• Sale of goods and services • Sale of fixed assets
• Short-term borrowing

CASH

Financing activities
Operating activities Investing activities • Repayment of long
• Purchase of supplies • Capital expenditures /short term debt
• Long term financial • Interest payment
• Administrative expenses
investment • Divident payment
• Tax expense
INVENTORY Harga sesuai e catalog

DOKTER Kolaborasi

CASEMIX Merubah kertas menjadi duit


Perubahan Lingkungan Bisnis
HEALTHCARE MEGATREND
Robert M Wachter MD, Professor and Chair of Department of Medicine, University of California,
San Francisco

1. Relentless Pressure to Deliver


• The highest quality Benefit
• Safest Value = ----------------
Cost
• Most satisfying care
• The lowest possible cost

2. Paper Industry to Digital Industry Empowered Patient


Cost + Profit = Price Price – Cost = Profit

Price
Price
Loss
Rupiah

Rupiah
Profit (fix price)
Profit

Cost Cost

Volume Volume

Fee For Service Payment Package Payment (INA – CBG)


Risiko Bisnis
• Risiko Bisnis adalah apabila kita mendapat tekanan
kenaikan cost, tetapi tidak bisa menaikkan tarif.

• Pengelola rumah sakit harus mampu mengelola


risiko (cost) supaya rumah sakit dapat bertahan dan
berkembang
“ The greatest danger in times of turbulance
is not the turbulance;
It is to act with yesterday’s logic”

(Peter F.Drucker)
Adaptability: Kemampuan perusahaan melakukan respon efektif terhadap
perubahan lingkungan (Pasar, Teknologi dan Regulasi)

Alignment: Kemampuan perusahaan mengendalikan semua elemen organisasi agar


selaras dan berfokus pada tujuan perusahaan
Challanges in Implementing INA -CBG

1
• Business Strategy

2
• Growing Complexity

3
• Leadeship & Change Management

4
• Cost control & Quality control

5
• Information Technology
1. Business Strategy
Strategic question
1. 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

Product/Service:
• Spesialisasi lengkap,
Market A • Penunjang medis lengkap
Peserta JKN-KIS

B
RS AN-NISA
Competitor:
C/D RS Kelas C

FKTP
RS AN-NISA: How to Compete
1. Tidak ada diskriminasi pelayanan untuk pasien BPJS dan
non BPJS

2. Fleksibilitas jam pelayanan rawat jalan (08.00 WIB –


20.00 WIB)

3. Tidak ada kuota tempat tidur untuk pelayanan rawat


inap pasien BPJS

4. Tidak ada urun biaya

5. Mendapat Benefit non medis: Gift, antar pulang gratis,


foto copy gratis.
(Porter,1980)
1. Value chain
2. Value network
3. Value shop
2. Managing Growing
Complexity
GROWING COMPLEXITY (INTERNAL )

Pemilik
Manaje
men

Dokter

Berapa % Jasa medis?


Berapa % Obat?
Berapa % Penunjang?

Bagaimana Mengelola Tarif Paket ?


GROWING COMPLEXITY (EKSTERNAL)

Rumah Sakit

Kem
Pasien
Kes

BPJS • Tarif INA-CBG


• Verifikasi Claim
• Rujukan Berjenjang
Kompleksitas
• Memiliki keterkaitan dan saling berhubungan antara
satu pihak dan pihak lainnya. (tidak bisa hidup
sendiri)

KOLABORASI
• Function Based Cross Function
STRUKTUR ORGANISASI
DIREKTUR

TIM CASEMIX

Kepera Penunj Keu,Akt SDM &


Medis Resiko
watan ang & IT Umum

IGD

Rajal

Ranap

Khusus
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.”
3. Leadership & Change
Management
Leadership

Boss or Leader
Control or Trust
Delegate or Collaborate
Steered or Engaged
Rules or Freedom
Think & Talk or Trial & Test
Hierarchy or Network
Protection or Transparency
Power or Respect
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.
TOTAL COST = FIXED COST + VARIABEL COST
Total Fixed Costs Curve

Cost per unit of output ($)


Fixed cost ($)

1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Output (in unit) Output (in unit)

Total fixed costs Cost per unit


remain constant as declines as
activity increases. activity increases.
Variable Costs Curve

Total Cost ($)

Cost per unit ($)


1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Output (in Unit) Output (in Unit)

Total variable Cost per unit


costs increase as is constant as
activity increases. activity increases.
Cost-Volume-Profit

Costs and Revenue

Break-even Profit
Point
in Dollars

Loss

Volume in Units
Contoh
FIX COST KAMAR OPERASI : 100 JUTA
JUMLAH OPERASI PER BULAN : 100

RATA RATA FIX COST PER OPERASI : 1 JUTA

FIX COST KAMAR OPERASI : 100 JUTA


JUMLAH OPERASI PER BULAN : 500

RATA RATA FIX COST PER OPERASI : 200 RIBU


No Jam Dokter
POLIKLINIK ANAK
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
Menyusun Clinical Pathways
Optimal sequence and timing of interventions by physicians, nurses
and other disciplines
for a particular diagnosis or procedure,
designed to minimize delays and resources utilization and to maximize
the quality of care
Coffey,1992
The Experiences of CP implementation in
Johns Hopkins Hospital
1. Improve Quality of Care
2. Reduce Cost
3. Reduce Length of stay
Developing CP
1. Determine appropriateness of the case
2. Select team
3. Gather information
4. Evaluate current practice
5. Compare current management to information gathered
6. Team meeting
7. Create draft
8. Review of changes
9. Provided final draft
10. Finalise CP
11. Implement
12. Monitor effectiveness
13. Audit ang evaluate
14. Improve Sumber: UNU-IIGH
Suitable Cases for Clinical Pathway
• High volume case types
• Common conditions
• Predictable course and outcomes
• Potential for improvement in length of stay
• Clear clinical protocols and guidelines
• Committed doctors/nurses/allied health providers
• Change agents / drive force
• Accountability of staff
• Realistics and practical to apply
• Integrated and holistic approach
Sumber: UNU-IIGH
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
STRATEGI KE DEPAN ? People
Inovasi
Learning Organisation Kreativitas

Knowledge Management

Keunggulan Bersaing

Produktivitas
Efisiensi

Syarat untuk bertahan hidup


Productivity Management Creativity Management

Managing Growth/
costs Innovation

Quality Creativity
control Methods

Assets Corporate
utilization Brand

Operational Future
Efficiency Strategy
Blue ocean
TERIMA KASIH