Objective: Through further research and analysis of DRG grouping principle and settlement management methods, this paper explores a localized settlement management scheme suitable for the characteristics of specialized medical institutions. Methods: Through the horizontal and vertical comparison of some performance indicators during the operation of DRG, this paper analyzes the restrictive factors and differences of specialized hospitals under DRG payment mode. Results: Children's Hospital, traditional Chinese medicine hospital and other specialized hospitals, due to the influence of patient composition, charge pricing and treatment principle, scheme differences and other factors, under the DRG payment system, the overall profit and loss is difficult to balance, and the professional characteristics can not be fully reflected in the grouping scheme. Conclusion: We should establish a performance incentive mechanism and efficient coordination mechanism in line with the characteristics of specialty, further stimulate the enthusiasm of specialty medical institutions to participate in DRG payment reform, promote them to improve the level of data quality and continuously optimize the performance distribution mechanism.