Materi Ur RS Permata Bunda

UTILIZATION REVIEW
RS PERMATA BUNDA
TRI WULAN I TAHUN 2014
drg. Afrizayanti
KEPALA BPJS KESEHATAN CABANG UTAMA SEMARANG
www.bpjs-kesehatan.go.id
PERMENKES NOMOR 71 TAHUN 2013 Ps 39 ayat 2
BPJS Kesehatan wajib menerapkan Utilization

Review secara berkala dan berkesinambungan
dan memberikan umpan balik hasil Utilization
review kepada Fasilitas Kesehatan serta
melaporkan hasil Utilization Review kepada
menteri dan DJSN
RAWAT JALAN TINGKAT LANJUTAN
TREND KASUS RJTL
600
500
400
300
200
100
-
Jan-14 Feb-14 Mar-14
PERBANDINGAN TREND KASUS RJTL RS SWASTA TYPE C
1,400
1,200
1,000
800
Jan-14
Feb-14
600
400
200
-
RS Permata RS RS PW dr RS PW RS Permata RSI Weleri RS Pelita RS Panti RS PKU
Bunda Roemani Cipto Citarum Medika Anugerah Rahayu Muh Gubug
TREND BIAYA RJTL
90,000,000
80,000,000
70,000,000
60,000,000
50,000,000
40,000,000
30,000,000
20,000,000
10,000,000
-
PERBANDINGAN TREND BIAYA RJTL RS SWASTA TYPE C
300,000,000
250,000,000
200,000,000
150,000,000 Jan-14
Feb-14
100,000,000
50,000,000
-
RS RS RS PW dr RS PW RS RSI Weleri RS Pelita RS Panti RS PKU
Permata Roemani Cipto Citarum Permata Anugerah Rahayu Muh
Bunda Medika Gubug
TREND UC RJTL
160,500
160,000
159,500
159,000
158,500
158,000
157,500
157,000
156,500
156,000
155,500
PERBANDINGAN TREND UC RJTL RS SWASTA TYPE C
300,000
250,000
200,000
150,000 Jan-14
Feb-14
100,000
50,000
-
RS RS RS PW dr RS PW RS RSI Weleri RS Pelita RS Panti RS PKU
Permata Roemani Cipto Citarum Permata Anugerah Rahayu Muh
Bunda Medika Gubug
10 DESKRIPSI INA CBG s RJTL TERBANYAK
NO KODE INACBG's DESKRIPSI JUMLAH
1
Q-5-44-0 AMBULATORY VISIT FOR OTHER MAJOR CHRONIC DISEASES 1142
2
Z-3-27-0 WOUND CARE 100
3
L-3-12-0 MILDLY COMPLEX RADIOGRAPHS 12
4
L-2-42-0 OTHER RESPIRATORY SYSTEM OPERATIONS 12
5
J-3-17-0 OTHER CONTRAST IMAGING STUDIES 6
RAWAT INAP TINGKAT LANJUTAN
TREND KASUS RITL
450
400
350
300
250
200
150
100
50
-
PERBANDINGAN TREND KASUS RITL RS SWASTA TYPE C
350
300
250
200
Jan-14
150 Feb-14
100
50
-
RS Permata RS RS PW dr RS PW RS Permata RSI Weleri RS Pelita RS Panti RS PKU
Bunda Roemani Cipto Citarum Medika Anugerah Rahayu Muh
Gubug
TREND BIAYA RITL
1,400,000,000
1,200,000,000
1,000,000,000
800,000,000
600,000,000
400,000,000
200,000,000
-
PERBANDINGAN TREND BIAYA RITL RS SWASTA TYPE C
1,400,000,000
1,200,000,000
1,000,000,000
800,000,000
Jan-14
600,000,000 Feb-14
400,000,000
200,000,000
-
RS RS RS PW dr RS PW RS RSI RS Pelita RS Panti RS PKU
Permata Roemani Cipto Citarum Permata Weleri Anugerah Rahayu Muh
Bunda Medika Gubug
TREND UC RITL
3,400,000
3,350,000
3,300,000
3,250,000
3,200,000
3,150,000
PERBANDINGAN TREND UC RITL RS SWASTA TYPE C
6,000,000
5,000,000
4,000,000
3,000,000 Jan-14
Feb-14
2,000,000
1,000,000
-
RS RS RS PW dr RS PW RS RSI RS Pelita RS Panti RS PKU
Permata Roemani Cipto Citarum Permata Weleri Anugerah Rahayu Muh
Bunda Medika Gubug
TREND ALOS RITL
3.90
3.80
3.70
3.60
3.50
3.40
3.30
3.20
PERBANDINGAN TREND ALOS RITL RS SWASTA TYPE C
5.00
4.50
4.00
3.50
3.00
2.50 Jan-14
2.00 Feb-14
1.50
1.00
0.50
0.00
RS Pelita RS RS PW dr RS PW RS RSI Weleri RS RS Panti RS PKU
Anugerah Roemani Cipto Citarum Permata Permata Rahayu Muh
Medika Bunda Gubug
10 DESKRIPSI INA CBGs TERBANYAK RITL
KODE JUMLA
NO INACBG's DESKRIPSI H
1 O-6-10-I CESAREAN SECTON 486
2 E-4-10-I DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES 162
3 W-1-11-I INTRAUTERINE CERVICAL OPERATIONS and OTHER DILATION & CURETTAGE 162
EPIGLOTTITISUPPER RESPIRATORY TRACT INFECTION LARYNGOTRACHEITIS &
4 U-4-13-I OTITIS MEDIA 51
5 H-4-12-I OTHER EYE DISEASES 22
6 I-4-17-II HYPERTENSION 18
7 M-1-50-I OPERATION OF SOFT TISSUES 18
8 L-1-50-I BREAST OPERATIONS 18
9 K-4-11-I GASTRITIS & PEPTIC ULCER 18
10 W-4-16-I PREPARTUM DISEASES 7

RASIO RITL TERHADAP RJTL
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
-
PERBANDINGAN TREND RASIO RITL TERHADAP RJTL RS
SWASTA TYPE C
90.00
80.00
70.00
60.00
50.00
Jan-14
40.00
Feb-14
30.00
20.00
10.00
-
RS RS PW dr RS PW RS RSI Weleri RS RS Panti RS PKU RS Pelita
Roemani Cipto Citarum Permata Permata Rahayu Muh Anugerah
Medika Bunda Gubug
PERBANDINGAN PROPORSI TINGKAT SEVERITAS
TERHADAP KASUS RAWAT INAP BUPEL JANUARI 2014
90.00
80.00
70.00
RS PW Cipto
60.00 RS PW Citarum
RS Roemani
50.00
RSI Weleri
40.00 RS Pelita Anugerah

RS Permata Bunda
30.00 RS Panti Rahayu
RS PKU Muh Gubug
20.00
10.00
-
SEV 1 SEV 2 SEV 3
PERBANDINGAN PROPORSI TINGKAT SEVERITAS
TERHADAP KASUS RAWAT INAP BUPEL FEBRUARI 2014
90.00
80.00
70.00
RS PW Cipto
60.00 RS PW Citarum
RS Roemani
50.00
RSI Weleri
40.00 RS Pelita Anugerah

RS Permata Bunda
30.00 RS Panti Rahayu
RS PKU Muh Gubug
20.00
10.00
-
SEV 1 SEV 2 SEV 3
10 BESAR KASUS HARI RAWAT TERLAMA BUPEL
JANUARI 2014
HARI KODE INA JUMLAH
NO DESKRIPSI INA CBGs
RAWAT CBGs KASUS
1 13 V-1-10-II 1 PROSTATECTOMY
2 10 I-4-12-II 1 HEART FAILURE
9 V-1-10-I PROSTATECTOMY
3 9 P-8-11-III 2 NEONATE BIRTHWT 1000 1499 GRAMS WITHOUT COMPLEX OPERATION
8 A-4-13-III VIRAL AND OTHER NON BACTERIAL INFECTIONS
4 8 A-4-13-II 2 VIRAL AND OTHER NON BACTERIAL INFECTIONS
7 E-4-10-III DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES
7 K-1-40-II OTHER OPERATION OF DIGESTIVE SYSTEM
7 G-4-15-I NON SPECIFICIED CVA WITHOUT INFARCT
5 7 E-4-10-I 5 DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES
6 I-4-10-III ACUTE MYOCARDIAL INFARCTION
6 M-4-18-II OTHER DISORDER OF BONES & JOINTS
6 K-4-17-I GASTROENTERITIS & ABDOMINAL PAIN
6 6 W-4-16-I 6 PREPARTUM DISEASES
5 V-1-10-II PROSTATECTOMY
5 E-4-10-III DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES
5 A-4-13-I VIRAL AND OTHER NON BACTERIAL INFECTIONS
5 G-4-22-II SEIZURE
5 N-1-30-I BLADDER & LOWER URINARY TRACT OPERATION
5 I-4-12-I HEART FAILURE
5 I-4-17-I HYPERTENSION
5 O-6-10-I CESAREAN SECTON
7 5 O-6-10-I 9 CESAREAN SECTON
4 E-4-10-I DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES
4 I-4-16-II ATHEROSCLEROSIS
4 G-4-15-II NON SPECIFICIED CVA WITHOUT INFARCT
4 N-4-13-I URINARY CALCULI
8 4 I-4-12-I 9 HEART FAILURE
3 G-4-14-I CEREBROVASCULAR ACCIDENT WITH INFARCTION
3 N-4-15-I RENAL & URINARY TRACT SIGNS & SYMPTOMS
3 K-4-11-I GASTRITIS & PEPTIC ULCER
3 O-6-13-I VAGINAL DELIVERY
3 N-1-30-II BLADDER & LOWER URINARY TRACT OPERATION
VAGINAL DELIVERY WITH FALLOPIAN TUBE DISTRUCTION &/OR DILATION &
2 O-6-11-I CURETTAGE
2 W-1-11-I INTRAUTERINE CERVICAL OPERATIONS and OTHER DILATION & CURETTAGE
2 A-4-10-I SEPTICEMIA
2 A-4-14-I OTHER BACTERIAL & PARASITIC INFECTIONS
10 2 O-6-13-I 11 VAGINAL DELIVERY
FEBRUARI 2014
RAWAT CBGs KASUS
1 13 V-1-10-II 1 PROSTATECTOMY
2 10 I-4-12-II 1 HEART FAILURE
3 9 P-8-11-III 2 NEONATE BIRTHWT 1000 1499 GRAMS WITHOUT COMPLEX OPERATION
8 A-4-13-III VIRAL AND OTHER NON BACTERIAL INFECTIONS
4 8 A-4-13-II 2 VIRAL AND OTHER NON BACTERIAL INFECTIONS
5 7 E-4-10-I 3 DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES
EPIGLOTTITISUPPER RESPIRATORY TRACT INFECTION LARYNGOTRACHEITIS & OTITIS
6 U-4-13-I MEDIA
6 N-4-16-II OTHER RENAL & URINARY TRACT DISEASES
6 M-4-18-II OTHER DISORDER OF BONES & JOINTS
6 6 W-4-16-I 6 PREPARTUM DISEASES
4 N-4-13-I URINARY CALCULI
8 4 I-4-12-I 4 HEART FAILURE
2 A-4-10-I SEPTICEMIA
2 A-4-14-I OTHER BACTERIAL & PARASITIC INFECTIONS

INTRAUTERINE CERVICAL OPERATIONS and OTHER DILATION &
2 W-1-11-I CURETTAGE
10 2 O-6-13-I 5 VAGINAL DELIVERY

MARET 2014
RAWAT CBGs KASUS
1 15 E-4-10-II 1 DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES
4 12 K-1-13-I 1 APPENDIX OPERATION
5 2
10 E-4-10-II DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES
6 9 G-4-17-I 1 CRANIAL & PERIPHERAL NERVE DISEASES
8 J-4-16-I SIMPLE PNEUMONIA & PERTUSIS
7 2
8 J-4-16-II SIMPLE PNEUMONIA & PERTUSIS
7 I-4-19-III CARDIAC ARRHYTHMIA & CONDUCTION DISEASES
7 I-4-12-I HEART FAILURE
7 I-4-15-II PERIPHERAL & OTHER VASCULAR DISEASES
8 7 D-4-13-I 8 ANAEMIA EXCLUDING SICKLE CELL ANEMIA WITH CRISIS
7 B-4-13-I OTHER LIVER DISEASES
7 K-4-11-II GASTRITIS & PEPTIC ULCER
VAGINAL DELIVERY WITH FALLOPIAN TUBE DISTRUCTION &/OR
7 O-6-11-II
DILATION & CURETTAGE
9 6 D-4-13-I 3 ANAEMIA EXCLUDING SICKLE CELL ANEMIA WITH CRISIS
6 N-4-10-I RENAL & URINARY TRACT NEOPLASM & KIDNEY FAILURE
5 E-4-12-I INBORN ERRORS OF METABOLISM
5 G-4-17-I CRANIAL & PERIPHERAL NERVE DISEASES
10 BESAR KASUS SATU HARI PERAWATAN BUPEL
JANUARI 2014
LAMA HARI KODE INA
RAWAT CBGs
1 1 I-4-20-I ANGINA PECTORIS & CHEST PAIN
2 1 I-4-17-I HYPERTENSION
3 1 I-4-12-I HEART FAILURE
4 1 O-6-13-I VAGINAL DELIVERY
5 1 W-1-11-I INTRAUTERINE CERVICAL OPERATIONS and OTHER DILATION & CURETTAGE
8 1 W-1-30-I VAGINA CERVIX & VULVA OPERATION
14 1 O-6-11-II
CURETTAGE
20 1 C-4-14-I OTHER NEOPLASM INCLUDING SECONDARY NEOPLASM
FEBRUARI 2014
LAMA HARI KODE INA
RAWAT CBGs
1 1 I-4-20-I ANGINA PECTORIS & CHEST PAIN
2 1 I-4-17-I HYPERTENSION
3 1 I-4-12-I HEART FAILURE
5 1 W-1-11-I INTRAUTERINE CERVICAL OPERATIONS and OTHER DILATION & CURETTAGE
14
1 O-6-11-II CURETTAGE
20 1 C-4-14-I OTHER NEOPLASM INCLUDING SECONDARY NEOPLASM
MARET 2014
NO LAMA HARI RAWAT KODE INA CBGs DESKRIPSI INA CBGs
1
1 I-4-12-III HEART FAILURE
2
3
1 G-4-13-I NON TRAUMATIC INTRACRANIAL HEMORRHAGE
4
5
6
7
8
9
10
11
12
1 N-4-10-II RENAL & URINARY TRACT NEOPLASM & KIDNEY FAILURE
13
14
JUMLAH KUNJUNGAN PASIEN RAWAT INAP LEBIH DARI
1 KALI DALAM SEBULAN JANUARI – FEBRUARI 2014
Tidak ada kunjungan pasien rawat inap lebih dari 1 kali

dalam sebulan pada bulan Januari- Februari 2014
JUMLAH KUNJUNGAN PASIEN RAWAT INAP LEBIH DARI
1 KALI DALAM SEBULAN MARET 2014
KODE INA JUMLAH

NO KARTU CBGs DESKRIPSI INA CBGs KUNJUNGAN
0000073685597 J-4-15-II RESPIRATORY INFECTIONS & INFLAMMATIONS 2
0000073990225 B-4-13-I OTHER LIVER DISEASES 2
0000578873867 W-1-01-I PELVIC EVISCERATION HYSTERECTECTOMY & VULVECTOMY 2
0001022820682 N-4-12-I RENAL & URINARY TRACT INFECTIONS 2
PROSENTASE KUNJUNGAN ULANG PESERTA DENGAN DIAGNOSA YANG SAMA DALAM

KURUN WAKTU 30 HARI BULAN MARET 2014 SEBESAR 1,05 %
TERIMA KASIH

Materi Ur RS Permata Bunda

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UTILIZATION REVIEW

BPJS Kesehatan wajib menerapkan Utilization

1 O-6-10-I CESAREAN SECTON 486

2 E-4-10-I DIABETES AND NUTRITIONAL & OTHER METABOLIC DISEASES 162

5 H-4-12-I OTHER EYE DISEASES 22

7 M-1-50-I OPERATION OF SOFT TISSUES 18

8 L-1-50-I BREAST OPERATIONS 18

9 K-4-11-I GASTRITIS & PEPTIC ULCER 18

10 W-4-16-I PREPARTUM DISEASES 7

40.00 RS Pelita Anugerah

40.00 RS Pelita Anugerah

9 3 O-6-10-I 2 CESAREAN SECTON

2 O-6-13-I VAGINAL DELIVERY

2 A-4-14-I OTHER BACTERIAL & PARASITIC INFECTIONS

10 2 O-6-13-I 5 VAGINAL DELIVERY

Tidak ada kunjungan pasien rawat inap lebih dari 1 kali

KODE INA JUMLAH

0000073685597 J-4-15-II RESPIRATORY INFECTIONS & INFLAMMATIONS 2

0000073990225 B-4-13-I OTHER LIVER DISEASES 2

0000578873867 W-1-01-I PELVIC EVISCERATION HYSTERECTECTOMY & VULVECTOMY 2

0001022820682 N-4-12-I RENAL & URINARY TRACT INFECTIONS 2

PROSENTASE KUNJUNGAN ULANG PESERTA DENGAN DIAGNOSA YANG SAMA DALAM

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