Information processing device, information processing method and information processing program

Abstract

To provide an information processing device capable of maximizing benefits of medical institutions or care facilities.SOLUTION: An information processing device includes: a storage part for associating and storing each of a plurality of medical practices that may be performed in medical institutions or care facilities, with injury / disease data, medical fee items, medical fee points, facility criteria for facilities for requesting medical fee points, and calculation requirements for a patient for requesting medical fee points; a calculation part referring to the storage part to input facility configuration data relating to the facility criteria and the plurality of injury / disease data, calculating a first theoretical value of the medical fee points in a current facility configuration and calculating a second theoretical value of the medical fee points when the facility configuration is changed; and a display control part, when an increment from the first theoretical value to the second theoretical value is larger than a first prescribed value, presenting the change in the facility configuration.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The present invention relates to an information processing device, an information processing method, and an information processing program. [Background technology]

[0002] In the above technical field, patent documents disclose a technique for checking whether medical institutions are properly claiming for medical fees. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] JP 2003-108662 A Summary of the Invention [Problem to be solved by the invention]

[0004] However, the technology described in the above document was merely a mechanism for checking the appropriateness of remuneration for specific medical treatment fee items provided by medical institutions, and did not aim to maximize the profits of medical institutions or nursing facilities.

[0005] An object of the present invention is to provide a technique for solving the above-mentioned problems. [Means for solving the problem]

[0006] In order to achieve the above object, the device according to the present invention comprises: a storage unit that stores, for each of a plurality of medical procedures that may be performed at a medical institution or a nursing facility, injury / disease data, medical fee items, medical fee points, facility standards for the facility for claiming the medical fee points, and calculation requirements for the patient for claiming the medical fee points, in association with each other; a calculation unit that refers to the storage unit, inputs facility configuration data related to the facility standard and a plurality of injury / illness data, calculates a first theoretical value of medical fee points for the current facility configuration, and calculates a second theoretical value of medical fee points when the facility configuration is changed; a display control unit that presents a change in the facility configuration when an increment from the first theoretical value to the second theoretical value is greater than a first predetermined value; The information processing device is provided with:

[0007] In order to achieve the above object, the method according to the present invention comprises: a calculation step of referring to a memory unit that stores, in association with each other, injury / illness data, medical fee items, medical fee points, facility standards for facilities for claiming the medical fee points, and calculation requirements for patients for claiming the medical fee points for each of a plurality of medical procedures that may be performed at a medical institution or nursing facility, inputting facility configuration data related to the facility standards and a plurality of injury / illness data to calculate a first theoretical value of medical fee points for the current facility configuration, and calculating a second theoretical value of medical fee points if the facility configuration is changed; a display control step of presenting a change in the facility configuration when an increment from the first theoretical value to the second theoretical value is greater than a first predetermined value; The present invention relates to an information processing method.

[0008] In order to achieve the above object, the program according to the present invention comprises: a calculation step of referring to a memory unit that stores, in association with each other, injury / illness data, medical fee items, medical fee points, facility standards for facilities for claiming the medical fee points, and calculation requirements for patients for claiming the medical fee points for each of a plurality of medical procedures that may be performed at a medical institution or nursing facility, inputting facility configuration data related to the facility standards and a plurality of injury / illness data to calculate a first theoretical value of medical fee points for the current facility configuration, and calculating a second theoretical value of medical fee points if the facility configuration is changed; a display control step of presenting a change in the facility configuration when an increment from the first theoretical value to the second theoretical value is greater than a first predetermined value; It is an information processing program that causes a computer to execute the above. Effect of the Invention

[0009] According to the present invention, it is possible to maximize the profits of medical institutions or nursing facilities. [Brief description of the drawings]

[0010] [Figure 1] 1 is a block diagram showing a configuration of an information processing device according to a first embodiment. [Diagram 2] FIG. 1 is a diagram explaining medical fees. [Figure 3A] FIG. 11 is a block diagram showing a configuration of an information processing device according to a second embodiment. [Figure 3B] FIG. 11 is a block diagram showing a configuration of a display control unit according to a second embodiment. [Figure 3C] FIG. 11 is a diagram showing a data configuration according to the second embodiment. [Figure 4] FIG. 11 is a diagram illustrating a configuration of a storage unit of an information processing device according to a second embodiment. [Diagram 5] FIG. 11 is a diagram illustrating a configuration of a storage unit of an information processing device according to a second embodiment. [Figure 6A] FIG. 11 is a diagram showing a display example of an information processing device according to the second embodiment. [Figure 6B] FIG. 11 is a diagram showing a display example of an information processing device according to the second embodiment. [Figure 6C] FIG. 11 is a diagram showing a display example of an information processing device according to the second embodiment. [Figure 7A] 13 is a flowchart showing a flow of processing in an information processing device according to a second embodiment. [Figure 7B] 13 is a flowchart showing the flow of theoretical value calculation processing in the information processing device according to the second embodiment. [Figure 8] 13 is a flowchart showing the flow of facility criterion determination processing by an information processing device according to a second embodiment. [Figure 9] 13A to 13C are diagrams illustrating an example of a method for calculating a theoretical value in the information processing device according to the second embodiment. [Figure 10] FIG. 13 is a block diagram showing a configuration of an information processing device according to a third embodiment. [Figure 11] FIG. 13 is a diagram showing the configuration of a conversion table according to the third embodiment. [Figure 12] 13 is a flowchart showing the flow of theoretical value calculation processing in the information processing device according to the third embodiment. [Figure 13A] FIG. 13 is a block diagram showing a configuration of an information processing device according to a fourth embodiment. [Figure 13B] FIG. 13 is a block diagram showing the configuration of a display control unit according to a fourth embodiment. [Figure 14] 13 is a flowchart showing a flow of processing in an information processing device according to a fourth embodiment. [Figure 15] FIG. 13 is a block diagram showing a configuration of an information processing device according to a fifth embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0011] Hereinafter, an embodiment of the present invention will be described in detail with reference to the drawings. However, the components described in the following embodiment are merely examples, and are not intended to limit the technical scope of the present invention.

[0012] In addition, the "facility configuration" used in this specification includes at least one of the following: the number of hospital beds, the number of medical staff, the configuration of a rehabilitation center, the presence or absence of a specialized space configuration, and the type of medical equipment. In addition, the "facility configuration" is not limited to this, but includes all configurations related to the "facility standards" that affect the medical fee points. In addition, the "facility environment data" refers to the "external factors" that affect the facility configuration of medical institutions and nursing facilities, including the population of the medical area (where the area is), the configuration of nearby medical institutions, and the role that medical institutions and nursing facilities should play, in contrast to the "internal factors" within the medical institutions and nursing facilities that affect the facility configuration of the hospital. In addition, the "medical area" is a regional unit that is set in stages to provide medical services ranging from daily medical care to general hospitalization medical care and special medical care, while comprehensively considering geographical conditions, traffic conditions, the fulfillment status of daily life demand, administrative areas, etc., in order to efficiently provide appropriate medical services. For example, a "primary medical area" is an area set to meet the demand for health services such as daily health consultations and health management, and the medical demand for diagnosis and treatment of general diseases, and is generally set on a city, town, or village basis. In addition, a "secondary medical care area" is an area stipulated in Article 30-4, Paragraph 2, Item 12 of the Medical Care Act, which is an area established beyond municipal boundaries to respond to general inpatient medical needs and to undertake comprehensive efforts in cooperation with health, medical care, and welfare. In addition, a "tertiary medical care area" is an area stipulated in Article 30-4, Paragraph 2, Item 13 of the Medical Care Act, which is an area established to respond to medical needs that require special diagnosis and treatment, and which covers the entire prefecture.

[0013] [First embodiment] An information processing device 100 according to a first embodiment of the present invention will be described with reference to Fig. 1. The information processing device 100 is a device for evaluating fees for medical procedures performed in a medical institution or a care facility and presenting changes to the facility configuration.

[0014] As shown in FIG. 1, the information processing device 100 includes a storage unit 101, a calculation unit 102, and a display control unit 103. The storage unit 101 stores injury / illness data 111, medical fee items 112, medical fee points 113, facility criteria 114 for facilities for claiming medical fee points, and calculation requirements 115 for patients for claiming medical fee points, in association with each of a plurality of medical procedures that may be performed at a medical institution or a nursing facility 110. The calculation unit 102 refers to the storage unit 101, inputs facility configuration data 116 and 117 related to the facility criteria and a plurality of injury / illness data 120, calculates a first theoretical value 121 of medical fee points in the current facility configuration, and calculates a second theoretical value 122 of medical fee points when the facility configuration is changed. The display control unit 103 presents a change 132 in the facility configuration when the increment from the first theoretical value to the second theoretical value is greater than a predetermined value 131.

[0015] According to the above configuration, it becomes easy for a medical institution or a care facility to change the facility configuration in order to maximize profits.

[0016] [Second embodiment] Next, an information processing device according to a second embodiment of the present invention will be described with reference to FIG.

[0017] (Regarding medical fees) Before describing the configuration of the information processing device, a description will be given of the remuneration calculated for the actions taken in a medical institution or a care facility.

[0018] In this embodiment, the so-called medical fee stipulated in the "Medical Treatment Fee Schedule" established by the Ministry of Health, Labor and Welfare of Japan will be described, but the present invention is not limited thereto. Medical fee is the remuneration that insurance medical institutions and insurance pharmacies receive from insurers as compensation for insurance medical services. It is decided by the Minister of Health, Labor and Welfare (Minister of Health, Labor and Welfare Public Notification) based on discussions at the Central Social Insurance Medical Council (Chuikyo).

[0019] Medical fees are determined by taking into consideration the evaluation of technology and services and the price of goods (prices for pharmaceuticals are set according to the drug price standard), and in the medical fee schedule, each technology and service is scored (1 point is 10 yen) for evaluation (listed in the notice). There are three types of point schedule: medical, dental, and pharmacy. Hospital income is calculated by multiplying the number of patients by the unit price, but the unit price is controlled by medical fees.

[0020] Medical treatment fees are classified into approximately 1,700 categories, and the number of drug price-listed items is approximately 14,000 (drug price: insurance reimbursement price of pharmaceuticals). The medical treatment fee schedule is broadly divided into "basic medical fees," "special medical fees," and "medical fees for residents of nursing care facilities for the elderly."

[0021] Basic medical fees are classified into "initial consultation fee," "re-examination fee," "basic hospitalization fee," "basic hospitalization fee surcharge," "specific hospitalization fee," and "basic fee for short-term stay surgery, etc." Special medical fees are classified into "medical management, etc.", "home medical care," "examination," "imaging diagnosis," "medication," "injections," "rehabilitation," "specialized psychiatric therapy," "treatment," "surgery," "anesthesia," "radiotherapy," and "pathological diagnosis."

[0022] The facility standards and calculation requirements for what points can be claimed for activities included in each category are specified in detail by notices and notifications.

[0023] The calculation requirements are those requirements that are listed along with points in the above-mentioned "Medical Treatment Fee Schedule."

[0024] The facility standards are the personnel and equipment that an insured medical institution must meet when calculating medical fees. They are set by a separate notification from the Minister of Health, Labour and Welfare, and detailed handling is also provided in notifications.

[0025] As shown in FIG. 2, when calculating medical fees, it is first necessary to satisfy facility standards 201 defined for the medical fee item 200. If the facility standards are not satisfied, medical fee points cannot be claimed without even considering the calculation requirements. Specifically, facility standards 201 include personnel standards 211 and equipment standards 212. Only after the facility standards are satisfied can the calculation requirements 202 be considered. Calculation requirements 202 include basic requirements 221 and excluded requirements 222.

[0026] For example, the initial consultation fee when an initial consultation is made at an insured medical institution is generally 288 points, but if the initial consultation is made using information and communications devices at an insured medical institution that has notified the director of a local health bureau that it complies with the facility standards set by the Minister of Health, Labour and Welfare, 251 points will be calculated.

[0027] Furthermore, for the medical fee items 200, in addition to the calculation requirements 202, additional items 210 (and additional points) are specified.

[0028] If the patient being treated is under 6 years old, 75 points will be added as an infant surcharge. If the first consultation is made outside of business hours, on a holiday, or late at night, 85 points, 250 points, or 480 points will be added to the specified points as an out-of-hours surcharge, holiday surcharge, or late-night surcharge, respectively (200 points, 365 points, or 695 points, respectively, for infants under 6 years old). However, for health insurance medical institutions established solely to ensure emergency medical care at night, if the first consultation is made at night during hours separately determined by the Minister of Health, Labor, and Welfare, 230 points will be added to the specified points (345 points for infants under 6 years old). For health insurance medical institutions that advertise themselves as pediatricians, if the first consultation is made at night during hours separately determined by the Minister of Health, Labor, and Welfare, on a holiday, or late at night (limited to the hours within the business hours displayed by the health insurance medical institution), 200 points, 365 points, or 695 points will be added to the specified points, respectively.

[0029] Medical fee points are charged at 1 point x 10 yen. As mentioned above, the calculation method for fee points is set in very detailed and difficult terms, and is revised approximately every two years.

[0030] (Excerpt from the 2020 medical fee score table) Furthermore, for example, when providing rehabilitation to patients with cerebrovascular disease, facility standards are set out by public notice and notification as follows, but since the granularity of each standard varies, it is difficult to make a judgment.

[0031] (Standards for facilities regarding rehabilitation fees for cerebrovascular diseases, etc., as stipulated by notification) (i) There are appropriate full-time dedicated doctors in charge of the following rehabilitation services: cardiovascular disease rehabilitation, cerebrovascular disease rehabilitation, disuse syndrome rehabilitation, musculoskeletal rehabilitation, or respiratory rehabilitation.

[0032] (b) There are an appropriate number of full-time nurses, physical therapists, occupational therapists or speech-language-hearing therapists in charge of cardiac and large vascular disease rehabilitation, cerebrovascular disease rehabilitation, disuse syndrome rehabilitation, musculoskeletal rehabilitation or respiratory rehabilitation.

[0033] (c) Having sufficient facilities to provide rehabilitation services for cardiovascular disease, cerebrovascular disease, etc., disuse syndrome, musculoskeletal rehabilitation, or respiratory rehabilitation.

[0034] (ii) The facility is equipped with the necessary equipment and instruments for the provision of rehabilitation services for cardiovascular disease, cerebrovascular disease, etc., disuse syndrome, musculoskeletal rehabilitation, or respiratory rehabilitation services.

[0035] In response to this, in the notification from the Ministry of Health, Labour and Welfare entitled "Regarding facility standards for special medical fees and procedures for their notification," in "Appendix 1: Facility Standards for Special Medical Fees," the facility standards are clearly defined more specifically as follows (excerpt):

[0036] Article 40: Rehabilitation Fees for Cerebrovascular Diseases, etc. (I) 1. Facility standards for rehabilitation fees for cerebrovascular diseases, etc. (I) (1) The insured medical institution must have two or more full-time doctors working there. However, one of them must have three or more years of clinical experience in rehabilitation medicine for cerebrovascular disease, etc., or a history of attending (or serving as a lecturer in) training sessions and seminars on rehabilitation medicine for cerebrovascular disease, etc. In addition, if two or more full-time part-time doctors who regularly work three or more days a week and whose scheduled working hours are 22 or more hours a week are combined and these part-time doctors are assigned during the same working hours as the full-time doctors, the actual working hours of the part-time doctors can be converted into full-time hours and included in the number of full-time doctors. However, when converting full-time doctors who have three or more years of clinical experience in rehabilitation medicine for cerebrovascular disease, etc., or a history of attending (or serving as a lecturer in) training sessions and seminars on rehabilitation medicine for cerebrovascular disease, etc., into full-time hours, this is limited to the part-time doctors who have the experience or history of attending (or serving as a lecturer in) training sessions and seminars on rehabilitation medicine for cerebrovascular disease, etc.

[0037] (2) All of the following items A through D are met.

[0038] A. There must be five or more full-time physical therapists working in the facility. However, they may not serve concurrently with full-time physical therapists in wards that charge the ADL maintenance and improvement system surcharge, the rehabilitation ward admission fee for recovery, and the comprehensive community care ward admission fee, or in wards that have rooms that charge the comprehensive community care inpatient medical management fee, but they may serve concurrently with full-time physical therapists in disuse syndrome rehabilitation fees (I), (II), or (III), musculoskeletal rehabilitation fees (I), (II), or (III), respiratory rehabilitation fees (I), or (II), rehabilitation fees for disabled children (adults), and rehabilitation fees for cancer patients.

[0039] A. There must be three or more full-time occupational therapists working for the facility. However, they may not serve concurrently with full-time occupational therapists in wards that charge the ADL maintenance and improvement system surcharge, the rehabilitation ward admission fee for recovery, and the comprehensive community care ward admission fee, and in wards that have rooms that charge the comprehensive community care inpatient medical management fee, but they may serve concurrently with full-time occupational therapists in disuse syndrome rehabilitation fees (I), (II), or (III), musculoskeletal rehabilitation fees (I), (II), or (III), respiratory rehabilitation fees (I), or (II), rehabilitation fees for disabled children (adults), and rehabilitation fees for cancer patients.

[0040] In the case of speech-language-hearing therapy, there must be at least one full-time speech-language-hearing therapist on staff. However, except as otherwise provided for in each item of Section 1 of Part 7 Rehabilitation, which requires a full-time speech-language-hearing therapist, it is possible for them to hold concurrent positions.

[0041] A. A total of 10 or more full-time employees from A to C must be employed. If the time spent on disease-specific rehabilitation (excluding cardiovascular disease rehabilitation), rehabilitation for disabled children (adults), and rehabilitation for cancer patients at the health insurance medical institution does not meet the prescribed working hours set by the health insurance medical institution, employees may be allowed to engage in other work outside of the time spent on rehabilitation. If a combination of two or more full-time part-time physical therapists, occupational therapists, or speech-language-hearing therapists who regularly work three or more days a week and whose prescribed working hours are 22 hours or more per week are arranged during the same working hours as full-time physical therapists, occupational therapists, or speech-language-hearing therapists, respectively, the actual working hours of these part-time physical therapists, occupational therapists, or speech-language-hearing therapists may be converted to full-time hours and included in the number of full-time physical therapists, occupational therapists, or speech-language-hearing therapists, respectively. However, the number of full-time physical therapists, full-time occupational therapists, or full-time speech-language-hearing therapists that can be counted as full-time is limited to four full-time physical therapists, two full-time occupational therapists, and one full-time speech-language-hearing therapist.

[0042] If the following requirements (i) or (ii) are met, and there are no patients to whom the full-time staff members listed in (a) through (c) are to provide disease-specific rehabilitation, the full-time staff members may engage in day rehabilitation provided by the insured medical institution, even during the hours when rehabilitation for cerebrovascular disease, etc. is being carried out.

[0043] (i) All physical therapists, occupational therapists, and speech-language-hearing pathologists other than full-time employees as defined in the facility standards for disease-specific rehabilitation fees are engaged in work other than long-term care insurance rehabilitation or other disease-specific rehabilitation.

[0044] (b) All physical therapists, occupational therapists, and speech-language-hearing pathologists employed at the insurance medical institution are full-time employees according to the facility standards for any disease-specific rehabilitation fee.

[0045] (3) The facility must have a dedicated functional training room (at least 160 square meters measured according to the internal method) that is large enough to carry out treatment and training. The dedicated functional training room may be used for other purposes outside of the hours when the therapy in question is being carried out. Furthermore, a dedicated functional training room is "dedicated" during the hours when disease-specific rehabilitation, rehabilitation for disabled children (adults), or rehabilitation for cancer patients is being carried out, and it is acceptable for disease-specific rehabilitation, rehabilitation for disabled children (adults), or rehabilitation for cancer patients to be carried out simultaneously in the same functional training room. However, when cardiovascular disease rehabilitation is being carried out during the same hours, the respective facility standards must be met. Furthermore, when speech-language-hearing therapy is being carried out, at least one dedicated individual therapy room (8 square meters or more measured according to the internal method) that takes into consideration shielding, etc. must be provided.

[0046] (4) The following facilities and equipment / tools necessary for carrying out the therapy must be provided. These equipment / tools may be used by users of the designated rehabilitation facility when the health insurance medical institution provides designated rehabilitation services and when doing so does not impede the provision of rehabilitation services.

[0047] Walking aids, training mats, treatment tables, weights such as sandbags, various measuring instruments (angle meters, grip strength meters, etc.), blood pressure monitors, parallel bars, tilt tables, posture correction mirrors, various wheelchairs, various walking aids, various braces (long and short leg braces, etc.), household equipment, various equipment for activities of daily living, etc. However, if speech-language hearing therapy is performed, hearing test equipment, audio recording and playback devices, video recording systems, etc. If necessary, rehabilitation medical equipment to assist flexion and extension of the joint on the paralyzed side and increase the amount of movement must be provided.

[0048] (5) In cases where only speech-language-hearing therapy is provided, if all of the following criteria (a) to (d) are met, notwithstanding the above criteria, the criteria for cerebrovascular disease, etc. rehabilitation fee (I) are met.

[0049] A. There must be at least one full-time doctor on the job. However, if there are two or more full-time part-time doctors who regularly work at least three days a week and whose scheduled working hours are at least 22 hours a week, and these part-time doctors are assigned during the same hours as the full-time doctors, the said standard may be considered to be met.

[0050] A. There are three or more full-time speech-language-hearing therapists. However, if two or more full-time part-time speech-language-hearing therapists who regularly work three or more days a week and whose scheduled working hours are 22 or more hours a week are combined and these part-time speech-language-hearing therapists are assigned during the same working hours as the full-time speech-language-hearing therapists, the actual working hours of these part-time speech-language-hearing therapists can be converted to full-time hours and included in the number of full-time speech-language-hearing therapists. However, only two of the full-time staff can be converted to full-time hours and included in the number of full-time speech-language-hearing therapists.

[0051] C) Having a dedicated individual therapy room (8 square meters or more as measured according to internal dimensions) with consideration given to shielding, etc.

[0052] E. The facility is equipped with the necessary equipment for speech-language-hearing therapy, such as hearing testing equipment, audio recording and playback devices, and video recording systems.

[0053] (6) With regard to health insurance medical institutions that have actually filed the relevant rehabilitation fee report as of March 31, 2014, they shall be deemed to be satisfying the provisions of (3) and (5) of the Internal Law until they carry out an expansion or complete reconstruction of the relevant functional training rooms, etc.

[0054] (7) Records concerning rehabilitation (such as doctor's instructions, implementation time, training content, and person in charge) must be kept centrally for each patient and must be available for viewing by medical professionals at all times.

[0055] (8) Regular conferences are held in which relevant professionals from various professions participate.

[0056] (9) Physical therapists, occupational therapists, and speech-language-hearing pathologists other than the full-time employees listed in (2) (a) through (c) above are to be able to engage in outpatient rehabilitation provided by the health insurance medical institution, except during the hours when they are engaged in disease-specific rehabilitation.

[0057] (Requirements for calculating rehabilitation fees for cerebrovascular diseases, etc.) On the other hand, the calculation requirements and additional requirements for the rehabilitation fee for cerebrovascular disease, etc. are stipulated as follows: "Rehabilitation fee for cerebrovascular disease, etc. (I) (1 unit) 245 points" Rehabilitation fee for cerebrovascular disease, etc. (II) (1 unit) 200 points Rehabilitation fee for cerebrovascular disease, etc. (III) (1 unit) 100 points Note 1: In cases where an insured medical institution that has notified the Director-General of a Regional Bureau of Health and Welfare as conforming to the facility standards separately stipulated by the Minister of Health, Labour and Welfare provides rehabilitation, which is an individual therapy, to a patient separately stipulated by the Minister of Health, Labour and Welfare, the prescribed points shall be calculated according to the classification related to the said standards, up to a maximum of 180 days from the date of onset, surgery, acute exacerbation, or first diagnosis. However, for patients separately stipulated by the Minister of Health, Labour and Welfare, in cases where it is medically determined that continued treatment is expected to improve their condition, or in other cases separately stipulated by the Minister of Health, Labour and Welfare, the prescribed points may be calculated for more than 180 days.

[0058] Note 2: Note 1: When rehabilitation is provided to patients who are hospitalized or other patients as specified by the Minister of Health, Labour and Welfare separately as provided for in the main text (limited to stroke patients who have been discharged from the relevant health insurance medical institution or those who have been discharged from another health insurance medical institution (limited to patients for whom the regional collaboration medical plan surcharge listed in Note 4 of classification number A246 has been calculated)), 30 points per unit will be added to the specified points as an early rehabilitation surcharge, for a maximum of 30 days from the onset, surgery or acute exacerbation, respectively.

[0059] Note 3: In cases where an insurance medical institution that has notified the Director-General of a Regional Bureau of Health and Welfare, etc., as complying with the facility standards separately specified by the Minister of Health, Labour and Welfare as provided for in the main text of Note 1 provides rehabilitation to patients who are hospitalized or other patients who are not hospitalized and who are specified by the Minister of Health, Labour and Welfare separately, as provided for in the main text of Note 1 (limited to stroke patients who have been discharged from the insurance medical institution or who have been discharged from another insurance medical institution (limited to patients for whom the Regional Collaboration Medical Plan Surcharge listed in Note 4 of Classification Number A246 has been calculated)), an additional 45 points per unit will be added to the specified points as an initial surcharge, for a maximum of 14 days from the onset, surgery, or acute exacerbation of the condition, respectively.

[0060] Note 4 Notwithstanding the provisions of the main text of Note 1, for patients specified by the Minister of Health, Labour and Welfare as specified in the main text of Note 1, other than insured persons requiring long-term care, etc., who undergo rehabilitation beyond 180 days from the date of onset, surgery, acute exacerbation, or initial diagnosis, only 13 units per month may be billed.

[0061] Note 5 Notwithstanding the provisions of Note 1, for patients who are separately designated by the Minister of Health, Labour and Welfare as provided for in the main text of Note 1 and who are insured persons requiring long-term care and are hospitalized, if necessary, and rehabilitation is provided for more than 180 days from the date of onset, surgery, acute exacerbation, or first diagnosis, the following points may be calculated in accordance with the classification of facility standards provided for in Note 1, limited to 13 units per month. A. Rehabilitation fee for cerebrovascular disease, etc. (I) (1 unit): 147 points B. Rehabilitation fee for cerebrovascular disease, etc. (II) (1 unit): 120 points C. Rehabilitation fee for cerebrovascular disease, etc. (III) (1 unit): 60 points Note 6 Note 1: In the case of continuing rehabilitation for patients (limited to insured persons requiring long-term care, etc.) separately specified by the Minister of Health, Labour and Welfare as stipulated in the main text 60 days have passed since the onset, surgery, acute exacerbation, or initial diagnosis, respectively, and if the goal setting support and management fee set forth in H003-4 has not been calculated within the past three months, it shall be calculated at the points equivalent to 90 / 100 of the prescribed points.

[0062] Note 7: In the case where an insurance medical institution that has notified the Director-General of a Regional Bureau of Health and Welfare, etc., as complying with the facility standards separately set forth by the Minister of Health, Labour and Welfare is continuously submitting data on the status of medical fee claims and the contents of medical treatment at said insurance medical institution to the Ministry of Health, Labour and Welfare, and provides rehabilitation to patients other than hospitalized patients as separately specified by the Minister of Health, Labour and Welfare as stipulated in the main text of Note 1, a rehabilitation data submission surcharge of 50 points will be added to the specified points, limited to once a month.

[0063] (Basic requirements: Eligible patients) The requirements for patients are set out as follows. "Appendix 9-5" sets out the facility standards, and the Ministry of Health, Labour and Welfare basically specifies the patient's illness name, etc. as part of the facility standards, and notifies the finer details as points to note for the calculation method. However, for the sake of clarity, this specification treats it as part of the calculation requirements.

[0064] Attached Table 9-5: Patients eligible for rehabilitation fees for cerebrovascular disease, etc. 1. Patients with cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, and other acute cerebrovascular diseases or patients who have undergone surgery for such diseases. 2. Patients with brain tumors, brain abscesses, spinal cord injuries, spinal cord tumors, and other acute central nervous diseases or patients who have undergone surgery for such diseases. 3. Patients with multiple neuritis, multiple sclerosis, peripheral neuropathy, and other neurological diseases. 4. Patients with Parkinson's disease, spinocerebellar degeneration, and other chronic neuromuscular diseases. 5. Patients with aphasia, agnosia, apraxia, and higher brain dysfunction. 6. Patients with hearing and language disorders due to hearing loss, cochlear implant surgery, etc. 7. Patients with speech disorders due to congenital abnormalities of the jaw and oral cavity. 8. Patients with speech disorders due to surgery for malignant tongue tumors, etc. 9. Patients who require rehabilitation and who have a certain level of decline in basic and applied motor skills, speech and hearing skills, and daily living skills (excluding patients who qualify for the cardiovascular disease rehabilitation fee, disuse syndrome rehabilitation fee, musculoskeletal rehabilitation fee, respiratory rehabilitation fee, disabled children (adults) rehabilitation fee, or cancer patient rehabilitation fee)

[0065] (Notice regarding implementation points to note in relation to the partial revision of the calculation method for medical fees) In addition to the above calculation requirements, the following points have also been notified. "H001 Rehabilitation fee for cerebrovascular disease, etc. (1) Rehabilitation fee for cerebrovascular disease, etc. is calculated at insurance medical institutions that have notified the Director of the Regional Bureau of Health and Welfare as conforming to the facility standards separately set by the Minister of Health, Labor and Welfare, and is calculated when various types of exercise therapy, practical walking training, daily living activity training, physical therapy, occupational therapy aimed at the recovery of applied movement ability and social adaptability, etc. are combined and performed according to individual cases in order to promote independence in practical activities in daily life through the recovery of basic movement ability, etc., or when training related to language function or hearing function is performed for patients with speech and hearing impairments. In addition, when only physical therapy such as massage or heat therapy is performed, it is calculated according to the item on treatment in Chapter 2 Special Medical Fees Part 9.

[0066] (2) Patients eligible for the rehabilitation fee for cerebrovascular disease, etc. are those listed in Schedule 9-5 of the Facility Standards for Special Medical Fees, who fall under any of the following and who a doctor recognizes as needing rehabilitation for cerebrovascular disease, etc. A. Patients with acute cerebrovascular disease or after surgery include those with cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, brain trauma, encephalitis, acute encephalopathy (hypoxic encephalopathy, etc.), meningitis, etc. B. Patients with acute central nervous system disease or after surgery include those with brain abscess, spinal cord injury, spinal cord tumor, post-craniotomy such as brain tumor removal, status epilepticus, etc. C. Neurological disease includes polyneuritis (Guillain-Barré syndrome, etc.), multiple sclerosis, peripheral neuropathy (facial nerve paralysis, etc.), etc. D: Chronic neuromuscular diseases include Parkinson's disease, spinocerebellar degeneration, motor neuron disease (amyotrophic lateral sclerosis), hereditary motor and sensory neuropathy, peripheral neuropathy, dermatomyositis, polymyositis, etc. E: Patients with aphasia, agnosia, apraxia, and higher brain dysfunction F: Patients with hearing and language impairments due to hearing loss or cochlear implant surgery, etc. include patients with voice disorder, speech disorder, language development disorder, hearing and language impairments due to hearing loss, or hearing and language impairments due to cochlear implant surgery, etc. G: Patients with speech disorders due to congenital abnormalities of the jaw and oral cavity H: Patients with speech disorders due to surgery for malignant tongue tumors, etc. K: Patients who require rehabilitation and have a certain level of decline in basic motor ability, applied motor ability, speech and hearing ability, and daily living ability include patients with congenital developmental disorders due to cerebral palsy, etc., with FIM 115 or less and BI 85 or less at the start of treatment.

[0067] (3) The specified points for the rehabilitation fee for cerebrovascular disease, etc. include manual muscle testing and other tests incidental to rehabilitation.

[0068] (4) Rehabilitation fees for cerebrovascular disease, etc. shall be calculated for those services provided under the supervision of a physician and under the supervision of a physical therapist, occupational therapist, or speech-language-hearing therapist. Even if a full-time physician directly provides the training, the fees may be calculated in the same way as if a physical therapist, occupational therapist, or speech-language-hearing therapist had provided the training.

[0069] (5) Rehabilitation for which the fee for rehabilitation for cerebrovascular disease, etc. is to be calculated is when it is deemed necessary for one practitioner to provide intensive individual training for one patient, and is to be performed one-on-one between a physical therapist, occupational therapist, or speech-language-hearing therapist and the patient. The number of units of rehabilitation to be performed shall be 18 units per day per practitioner as standard, up to a maximum of 108 units per week, with a maximum of 24 units per day. The number of units to be performed shall be the combined number of units of other disease-specific rehabilitation and group communication therapy. In this case, if the practitioner performs cardiovascular disease rehabilitation, the calculation shall be made with each 20 minutes of actual time spent in cardiovascular disease rehabilitation considered to be one unit.

[0070] (6) In a health insurance institution that has filed a notice of rehabilitation fee for cerebrovascular disease, etc. (II) (limited to those with two or more full-time physical therapists on the staff) or a health insurance institution that has filed a notice of rehabilitation fee for cerebrovascular disease, etc. (III) (limited to those with a full-time physical therapist on the staff), if, in addition to physical therapists, occupational therapists or speech-language-hearing pathologists, training is provided by massage therapists or other personnel who have attended a functional training skills course for exercise therapy and regularly complete appropriate training courses, the specified points for rehabilitation fee for cerebrovascular disease, etc. (III) may be calculated only when the following conditions are met: a doctor or physical therapist gives instructions in advance and subsequently receives a report on the therapy; and any of (1) to (5) above is satisfied.

[0071] (7) In a facility that has filed a notification for cerebrovascular disease rehabilitation fee (II) or (III), where physical therapy is provided by personnel other than physical therapists, such as nurses, masseurs, and shiatsu therapists, the physical therapists must, under the guidance and supervision of a physician, accurately understand the content of the motor function training of the patients receiving the training.

[0072] (8) For patients who have difficulty maintaining a posture in a wheelchair and therefore have a reduced ability to perform activities of daily living such as eating, physical therapists or occupational therapists may also select or adjust cushions or accessories for pressure dispersion and support after evaluating the patient's trunk function and sitting function to maintain proper posture in the wheelchair or seating device and prevent bedsores. However, this cannot be billed if the patient is made to sit in a wheelchair simply for the purpose of getting out of bed.

[0073] (9) The standard number of days to be calculated under Note 1 shall be within 180 days from the date of onset, surgery, or acute exacerbation if the date is clear, or within 180 days from the date the disease was first diagnosed in other cases.

[0074] (10) For patients who exceed the standard calculation period, the designated points for rehabilitation fees for cerebrovascular disease, etc. can be calculated up to 13 units per month, as specified in "Notes 4" and "5". In addition, for patients other than hospitalized patients, the hospital must properly evaluate whether rehabilitation under the long-term care insurance applies, and provide the necessary support to receive rehabilitation services under the long-term care insurance based on the patient's wishes. In addition, for hospitalized patients who are insured persons requiring long-term care as specified in Article 62 of the Long-Term Care Insurance Act, the points specified in "Note 5" are calculated according to their respective classifications. However, for patients listed in Appendix 9-8 of the Facility Standards for Special Medical Fees and cases listed in Appendix 9-9, even if the standard calculation period is exceeded, the period can be calculated in the same way as for the period within the standard calculation period. Note that the points to note are as follows. "Other patients as specified in Schedule 9-4 to Schedule 9-7 who are medically recognized as needing continued rehabilitation" as specified in Schedule 9-8, item 1 of the facility standards for special medical fees refers to patients as specified in Schedule 9-4 to Schedule 9-7 who are medically recognized as being able to improve their condition through continued rehabilitation. "Persons with illnesses caused by physical and mental changes that occur with aging" as specified in Schedule 9-8, facility standards for special medical fees refers to persons aged 40 or older who are in a state of needing nursing care or support, and whose physical or mental disabilities that are the cause of their state of needing nursing care or support are caused by a specific disease as specified in Article 7, paragraph 3, item 2 of the Nursing Care Insurance Act.

[0075] (11) The surcharge specified in "Note 2" is an evaluation of the implementation of rehabilitation at the facility from the onset, surgery, or acute exacerbation of cerebrovascular disease, etc., and can be calculated when one or more units of individual therapy are provided to hospitalized patients or patients other than hospitalized patients (limited to stroke patients who have been discharged from the insurance medical institution or those who have been discharged from another insurance medical institution (limited to patients for whom the regional collaboration medical plan surcharge in classification number "A246" Note 4 has been calculated)). In addition, for hospitalized patients, it can also be calculated even if it is provided in a ward (including bedside) other than the training room. In addition, the surcharge specified in "Note 2" cannot be calculated for patients listed in Items 3, 4, 6, and 7 of Appendix 9-5 of the Facility Standards for Special Medical Fees, except for those who have undergone surgery or have an acute exacerbation.

[0076] (12) The surcharge specified in "Note 3" is an evaluation of the implementation of rehabilitation at an earlier stage after the onset, surgery, or acute exacerbation of cerebrovascular disease, etc., at the facility, and may be calculated separately from the surcharge specified in "Note 2". In addition, the patients eligible for this surcharge are hospitalized patients or patients other than hospitalized patients (limited to stroke patients who have been discharged from the insurance medical institution or those who have been discharged from another insurance medical institution (limited to patients for whom the regional cooperation medical plan surcharge in Note 4 of classification number "A246" has been calculated). In addition, for patients listed in Item 3, 4, 6, and 7 of Schedule 9-5 of the Facility Standards for Special Medical Fees, the surcharge specified in "Note 3" cannot be calculated, except for those who have undergone surgery or have an acute exacerbation.

[0077] (13) In the case where a patient other than an inpatient (limited to a stroke patient who has been discharged from another insured medical institution) is to be charged the surcharge specified in "Note 2" or "Note 3", the fact that the patient is to be charged the regional collaboration medical plan surcharge under classification number "A246" Note 4 must be stated in the summary column of the medical fee statement.

[0078] (14) For patients who continue rehabilitation beyond the standard number of days set forth in "Notes 4" and "Notes 5," if the standard number of days is exceeded during the middle of a month, the amount of disease-specific rehabilitation performed after the day on which the standard number of days is exceeded in that month must be 13 units or less.

[0079] (15) The "prescribed points" in "Note 6" are the points calculated by applying "Notes 1" through "Note 5."

[0080] (16) The treatment of the rehabilitation data submission surcharge stipulated in "Note 7" is the same as (12) of the classification number "H000" cardiovascular disease rehabilitation fee.

[0081] (Summary of facility standards and calculation requirements) As described above, for each medical fee item (~ fee), the basic points, detailed facility standards, detailed calculation requirements, corresponding surcharge requirements, and surcharge points are defined. If the detailed items of medical fees and surcharges were to be listed, the total would amount to several thousand. The surcharge items do not exist independently, but are linked to one of the medical fee items. Not all medical fee items are necessarily linked to surcharge items. The medical fee items (~ fee) and surcharge items each have their own facility standards and calculation requirements, but they are not compiled in a single document, and it is necessary to compare various notices and multiple notifications. Remuneration can be claimed from patients who meet all of these facility standards and calculation requirements. However, facility standards and calculation requirements are not clearly defined for all medical fee items. In particular, facility standards and calculation requirements are often not clearly defined for items that involve clinical judgment.

[0082] For example, Section 6 of Appendix 9 of the Facility Standards for Special Medical Fees, "Patients eligible for musculoskeletal rehabilitation fees" is defined as follows:

[0083] 1. Patients with multiple injuries of the upper and lower limbs, quadriplegia due to spinal cord injury, or other acute musculoskeletal disorders or those who have undergone surgery (2) Patients who have a certain degree of decline in motor function and ability to perform daily activities due to degenerative joint diseases, inflammatory joint diseases, or other chronic musculoskeletal diseases. In addition, patients who are eligible for musculoskeletal rehabilitation fees are those listed in Item 6 of Appendix 9 of the Facility Standards for Special Medical Fees, who meet any of the following criteria and who a doctor individually recognizes as being in need of musculoskeletal rehabilitation.

[0084] A. Patients with acute musculoskeletal disease or after surgery for such disease refer to those with complex injuries to the upper and lower limbs (complex injuries to three or more of the following: bone, muscle / tendon / ligament, nerve, and blood vessel), quadriplegia (one or more limbs) due to spinal cord injury, trauma and fractures of the trunk and upper and lower limbs, amputation and detachment (prosthetic limb), malignant tumors of the musculoskeletal system, etc.

[0085] "Patients who have a certain degree of decline in motor function and ability to perform daily activities due to chronic musculoskeletal diseases" refers to those with degenerative joint diseases, inflammatory joint diseases, joint contractures due to burn scars, musculoskeletal instability, diabetic foot diseases, etc.

[0086] However, there is a discrepancy between the above expression and the name of the illness or injury written on the receipt, and it is difficult to determine whether or not a patient is eligible for the above-mentioned musculoskeletal rehabilitation fee just by looking at the receipt.

[0087] Due to the above circumstances, it is extremely difficult to accurately calculate medical fees for procedures performed at medical institutions and nursing care facilities. In particular, because the additional items are detailed and diverse, it is easy for oversights to occur.

[0088] It takes a lot of time to verify the performance of the target population (population) of medical fee items. Furthermore, it is difficult to create an action plan on what to do (because it is calculated based on people, facilities, patient conditions, etc.).

[0089] <Configuration of information processing device> Under the above circumstances, the information processing device 300 according to this embodiment will be described with reference to FIG. 3A and subsequent figures. FIG. 3A is a diagram for explaining the configuration of the information processing device 300 according to this embodiment. The information processing device 300 is a medical fee database / platform for evaluating and analyzing medical fees for actions performed in medical institutions or nursing facilities and maximizing them. The information processing device 300 has a function for proposing improvements to facility configuration (proposing raising and increasing medical fees by adding and optimizing medical resources).

[0090] The information processing device 300 includes a storage unit 301 , a calculation unit 302 , and a display control unit 303 .

[0091] The storage unit 301 stores injury / illness data, medical fee items, medical fee points, facility standards, and calculation requirements in association with each of a plurality of medical procedures that may be performed at the medical institution or nursing facility 310. The facility standards are standards required of facilities for claiming medical fee points, and the calculation requirements are conditions related to patients for claiming medical fee points. Each medical fee item is further linked with additional items and additional points, additional facility standards, and additional calculation requirements. This storage unit 301 does not necessarily have to exist as hardware inside the information processing device 300. For example, the concept of the present invention also includes a case where an external server installed outside Japan functions as the storage unit 301 of the information processing device 300.

[0092] The memory unit 301 includes a first memory unit 318 for storing the fee points, facility standards, and calculation requirements defined in the Ministry of Health, Labor, and Welfare's "Medical Medical Fee Schedule," and a second memory unit 319 for storing facility standards and calculation requirements that are not clearly defined in the Ministry of Health, Labor, and Welfare's "Medical Medical Fee Schedule."

[0093] The injury / illness data stored in the storage unit 301 may include, for example, an ICD (International Statistical Classification of Diseases and Related Health Problems) code defined by the World Health Organization (WHO) or an injury / illness name code defined by the Ministry of Health, Labor and Welfare.

[0094] In the storage unit 301, all facility standards 400 are registered for each medical fee item (~ fee), and are stored, for example, as shown in FIG. 4. As shown in FIG. 5, the storage unit 301 may store disease classification codes in a format in which they are incorporated into the calculation requirements (associated with the names of injuries and illnesses listed in the "Medical Fee Schedule"), or may store them separately from the calculation requirements. As disease classification codes corresponding to "musculoskeletal diseases" listed in the "Medical Fee Schedule", codes representing, for example, "spinal injury", "rheumatoid arthritis", "ligament loss", etc. are stored. Regarding the medical fee items, flags may be attached so that it can be determined whether or not they require a doctor's clinical judgment.

[0095] The contents of the storage unit 301 are examined by multiple experts, and for example, calculation requirements described as "similar to XX" in the "Medical Treatment Fee Schedule" are specifically registered. Items that are not described in the "Medical Treatment Fee Schedule" but require clinical judgment are added as calculation requirements.

[0096] Furthermore, the memory unit 301 stores, as hospital information, information on personnel and equipment required for determining facility standards and calculation requirements, such as the number of hospital beds, number of doctors, number of nurses, types and number of medical equipment, and working status, linked to the hospital ID for each hospital.

[0097] In addition to the above information, the storage unit 301 may store the following information: UKE file: disease name, date of birth, sex, medical department, medicine, medical procedure, score data H file: date of birth, severity, nursing necessity data EF file: date of birth, sex, ward, medical department, disease name, medicine, medical procedure data FF1 file: patient basics, ward, medical department, life history, admission and discharge route, illness, care level, outcome data Bed function report: bed function, medical department, number of patients, route, staff, number of main procedures, etc. of medical institutions nationwide Other public data: prefectural medical information (unified standard), patient survey, demographics, list of national facility standards, medical facility survey, hospital report, diagnosis procedure classification (DPC) data, nursing care facility / business survey, etc. Other hospital-specific data: electronic medical record data, medical data, number of personnel, hospital structure, financial statements, labor management data, departmental statistics, etc.

[0098] The calculation unit 302 has a calculation table 323. The calculation unit 302 refers to the storage unit 301 using a plurality of injury / illness data 320 acquired from a medical institution or a care facility 310, derives medical examination fee items 312, facility standards 313, calculation requirements 314, and fee points 315, and calculates a total theoretical value 321 of the calculable medical fee points based on the current facility configuration data 316. Specifically, when a hospital and a patient satisfy the facility standards 313 and calculation requirements 314 corresponding to the injury / illness data 320, the associated fee points 315 is set as the theoretical value of the injury / illness data (maximum billable points). The theoretical values ​​corresponding to the plurality of injury / illness data 320 are integrated to derive the total theoretical value 321. The calculation unit 302 calculates the total theoretical value for each classification to which the medical fee items belong. The calculation unit 302 calculates the theoretical value taking into account the additional items and additional points.

[0099] In addition, the calculation unit 302 refers to the memory unit 301 using multiple injury / illness data 320 acquired from a medical institution or nursing facility 310, derives medical examination fee items 312, facility standards 313, calculation requirements 314, and fee points 315, and calculates a theoretical total value 322 of the calculable medical fee points based on the facility configuration data 317 in the event of a change.

[0100] 3C shows the current facility configuration data 316, the changed facility configuration data 317, and the calculation table 323. Note that the changed facility configuration data 317 is not set unconditionally, but is preferably set from a facility configuration that is changed little from the current facility configuration data 316 and increases the medical fee points.

[0101] The display control unit 303 calculates an increment from a total theoretical value 321 of medical fee points calculated based on the current facility configuration data 316 for past medical procedures performed at the medical institution or nursing facility 310 to a total theoretical value 322 of medical fee points calculated based on the facility configuration data 317 when changed. Then, if the increment is greater than a predetermined value 331, the display control unit 303 displays the change in the facility configuration. In addition to presenting the proposed change in the facility configuration, the display control unit 303 may display the actual value of medical fee points in the current facility configuration data 316 and an improvement measure for the theoretical value of medical fee points in the current facility configuration data 316.

[0102] 3B shows a block diagram of the display control unit 303. The display control unit 303 includes a difference calculation unit 351, a determination unit 352, a changed facility storage unit 353, and a presentation selection unit 354. The difference calculation unit 351 calculates the difference between a theoretical total value 321 of medical fee points calculated based on the current facility configuration data 316 and a theoretical total value 322 of medical fee points calculated based on the changed facility configuration data 317. The determination unit 352 compares the increment from the theoretical total value 321 of medical fee points calculated based on the current facility configuration data 316 to the theoretical total value 322 of medical fee points calculated based on the changed facility configuration data 317 with a predetermined value 331, and if the increment is greater than the predetermined value 331, stores the facility configuration data 317 corresponding to the theoretical total value 322 in the changed facility storage unit 353. The presentation selection unit 354 causes the display unit to present, as a proposed change to the facility configuration, the facility configuration data 317 having the largest total theoretical value 322 among those stored in the change facility storage unit 353.

[0103] (Example of display screen) 6A to 6C are examples of display screens displayed on the display unit by the display control unit 303. For example, the display screen presents changes to the facility configuration. Alternatively, the actual value of the medical fee points in the current facility configuration and a theoretical change value in which the increment is greater than a predetermined value are displayed. Alternatively, the profit in the current facility configuration and the profit in a changed facility configuration are displayed.

[0104] FIG. 6A is an example of a display screen that displays the actual medical fee points in the current facility configuration data 316, improvement measures toward the theoretical medical fee points in the current facility configuration data 316, and proposed changes to the facility configuration.

[0105] As shown in the example screen 610 of FIG. 6A, the hospital displays the calculated amount for each medical procedure against the theoretical value for the current facility configuration. For example, a specific disease medical care management fee of 1,027,500 yen is billed, but the theoretical value calculated by the calculation unit 302 is 1,335,000 yen, and the billing rate is displayed as 77.7%. This actual billed amount of 1,027,500 yen is high compared to the national average of 850,500 yen, but compared to the theoretical value of 1,335,000 yen, it indicates that there is a 22% billing omission. Similarly, the actual billed amount and the theoretical value are displayed against each other for cerebrovascular rehabilitation, musculoskeletal rehabilitation, etc. The display control unit 303 may display additional items corresponding to additional points that were not included in the medical fee points billed for past procedures performed at the medical institution or nursing facility 310. The "Status" column automatically calculates and displays the percentage of diseases and the number of patients undergoing rehabilitation, making it possible to suggest measures that can be taken to improve billing rates without changing the structure of the facility.

[0106] The "Theoretical Value of Facility Changes" column shows the theoretical value of medical fee points by changing the facility configuration to have the greatest improvement effect, and the "Action Plan" column shows the changes to the facility configuration that will have the greatest improvement effect. For example, in "cerebrovascular rehabilitation," the plan states, "Assuming one unit per patient per day, 100% billing is possible with an additional PT and 2 OTs. Also, in order to raise the standard, a speech-language-hearing room needs to be established," and in "feeding function therapy," the plan states, "VE / VF evaluation functions need to be improved. To do this, STs and radiographers and radiologists who can take radiographs are required. The number of billing cases can also be increased with the intervention of ward nurses."

[0107] Figure 6B is a display screen showing the breakdown of the increase in medical fee points when medical functions are converted, for example. As shown in Figure 6B, when a long-term care bed is converted into a community-based comprehensive care bed, the number of nurses must be increased compared to when it was a long-term care bed (other measures include reducing the length of hospital stay and admitting patients with specific diseases), but the unit price also increases, which ultimately leads to increased revenue.

[0108] Figure 6B shows the before and after changes to the facility configuration, and displays the proposed changes to the facility configuration: "We need to add three nurses and three assistants. Two more patients will be admitted and discharged per month. In addition, adding one assistant will make it possible to obtain an additional surcharge for the XX department."

[0109] FIG. 6C is a display screen showing the details of an increase in medical fee points when, for example, a psychiatric treatment ward is changed to a medical treatment ward.

[0110] Figure 6C shows the before and after images of the facility configuration change, along with comments on the improvements that will be made as a result of the change, such as "Information such as occupancy rates will increase by xx%, and medical treatment costs will increase by xx yen."

[0111] <Processing flow of information processing device> Fig. 7A is a flowchart illustrating the flow of processing by the information processing device 300. This flowchart is executed by the CPU constituting the information processing device 300 using the RAM, and realizes the components in Fig. 3A.

[0112] In step S711, the information processing device 300 acquires the current facility configuration data 316. Then, in step S713, the information processing device 300 executes a current theoretical value calculation process using the current facility configuration data 316. In step S715, the information processing device 300 acquires one of the changed facility configuration data 317. Then, in step S717, the information processing device 300 executes a changed theoretical value calculation process using the changed facility configuration data 317.

[0113] In step S719, the information processing device 300 determines whether the difference obtained by subtracting the current theoretical value from the changed theoretical value is greater than a predetermined value 331. If the difference is not greater than the predetermined value 331, the information processing device 300 returns to step S715 and repeats the process. If the difference is greater than the predetermined value 331, the information processing device 300 stores the changed facility configuration data 317 and the changed theoretical value in step S721.

[0114] In step S723, the information processing device 300 determines whether or not to further calculate a theoretical change value for the changed facility configuration data 317. Unless the change from the current facility configuration is too large, the process returns to step S715 and is repeated. If no further theoretical change value is to be calculated, in step S725, the information processing device 300 presents, as a change proposal, the facility configuration data stored in step S721 that has the largest theoretical change value.

[0115] (Theoretical value calculation process) FIG. 7B is a flowchart illustrating the flow of the theoretical value calculation process of the information processing device 300 corresponding to steps S713 and S717 in FIG. 7A.

[0116] The information processing device 300 acquires injury / illness data in step S731. In step S733, the information processing device 300 queries the storage unit 301 using the injury / illness data. That is, among the medical fee items stored in the storage unit 301, medical fee items linked to the injury / illness data are picked up.

[0117] In step S735, the information processing device 300 compares the facility criteria of the picked up medical fee items with the facility information, and further narrows down the medical fee items that meet the facility criteria. At this time, the medical fee items that involve the doctor's clinical judgment may be controlled to be excluded from the judgment target of the theoretical value. This is because there are cases where it is necessary to be careful in determining the theoretical value of the medical fee items that involve the doctor's clinical judgment. On the other hand, if the medical fee items that involve the doctor's clinical judgment are already included in the receipt data, the theoretical value may be calculated by adding the additional points to the additional items linked to the medical fee items that involve the doctor's clinical judgment. In step S737, the information processing device 300 further narrows down the medical fee items using the calculation requirements.

[0118] Next, in step S739, the information processing device 300 determines the facility criteria and calculation requirements for the additional fee items. Furthermore, in step S741, the total value of the medical fee points and the additional fee points is calculated as a theoretical value.

[0119] (Facility Standards Judgment Process) FIG. 8 is a flowchart illustrating the flow of the facility criterion determination process performed by the calculation unit 302.

[0120] In step S801, facility criteria corresponding to medical fee items are read from the storage unit 301. In step S803, the facility structure data of the hospital is compared with the read facility criteria, and if the criteria are not met, the process proceeds to step S805, where improvement measures may be proposed.

[0121] If the facility structure of the hospital meets the criteria, the process proceeds to step S807, where the personnel structure (number of doctors, number of certified doctors, number of nurses, number of physical therapists, etc.) is judged by comparing the hospital's personnel structure data with the facility criteria read out from the storage unit 301. If the criteria are not met, the process proceeds to step S805, where improvement measures may be proposed.

[0122] If the criteria are met, the process proceeds to step S809, where the medical equipment is judged by comparing the equipment configuration data of the hospital with the retrieved facility criteria. If the criteria are not met, the process proceeds to step S805, where improvement measures may be proposed.

[0123] If the criteria are met, the process proceeds to determining the calculation requirements corresponding to the medical fee item.

[0124] (Determination of calculation requirements) FIG. 9 is a diagram showing the flow of the process of determining the calculation requirements.

[0125] In this example, it is assumed that the number of calculation days 901 and the calculation number 902 are specified for each medical fee item as calculation requirements.

[0126] Here, the maximum number of times per day (here, 1 time) and the maximum number of days (here, 150 days from onset) are set as the number of days for calculation. In addition, the calculation number is set to an upper limit of 13 times per month if it exceeds 150 days. It is not limited to the medical fee standards established by the Ministry of Health, Labor and Welfare, and original standards (upper limit 3 times per week, number of days excluded from calculation after onset: 14) may be set.

[0127] Assume that, for example, receipt data 903 to 905 are acquired as injury / illness data. That is, the injury is a femur fracture, and the onset date is June 15th. The actual claim points are 555 points for June and 3700 points for July. In response to this, the total value of 2960 points for the 16 days from onset to the end of June and 5735 points for the 31 days of July is calculated as the theoretical value for musculoskeletal rehabilitation fee (I).

[0128] As described above, this embodiment automatically selects "items" that are billable by the hospital and automatically calculates the "theoretical maximum value" of the item by referring to the preregistered facility standards and calculation standards based on the current facility configuration data 316 and the changed facility configuration data 317. Then, the facility configuration with the largest calculated theoretical value is presented as one that should be changed.

[0129] As described above, according to this embodiment, a medical fee database / platform can be constructed, and improvement measures for facility configuration that will increase the hospital's income can be presented.

[0130] [Third embodiment] Next, an information processing device according to a third embodiment of the present invention will be described. The information processing device according to this embodiment is different from the second embodiment in that it presents changes to the facility configuration that further considers the environmental data of the facility. For example, as in the "Joint Guidance Fee at the Time of Discharge" in FIG. 6A, "You need to increase collaboration with surrounding medical institutions by about three. There is a XX clinic, a XX home, and a XX elderly care facility nearby." is presented. The other configurations and operations are the same as those in the second embodiment, so the same reference numerals are used for the same configurations and operations and detailed explanations thereof are omitted.

[0131] <Configuration of information processing device> Fig. 10 is a block diagram showing the configuration of an information processing device 1000 according to an embodiment. In Fig. 10, the same components as those in Fig. 3A are given the same reference numerals, and duplicated explanations will be omitted.

[0132] The information processing device 1000 includes a calculation unit 1002 and a conversion unit 1004. The conversion unit 1004 inputs environmental data of the facility and converts it into a plurality of injury / illness data. That is, the conversion unit 1004 has a conversion table 1041, converts the acquired environmental data of the facility into corresponding virtual injury / illness data, and adds it to the plurality of injury / illness data 320 input to the calculation unit 1002. The calculation unit 1002 calculates a theoretical value 1022 of medical fee points based on the facility configuration data 317 when changed, corresponding to the injury / illness data including the virtual injury / illness data from the conversion unit 1004 as the plurality of injury / illness data 320.

[0133] 10 shows an example in which the acquired environmental data of the facility is converted into corresponding virtual injury / illness data in the conversion unit 1004, but as indicated by the dashed line, the acquired environmental data of the facility may be input as a variable to the calculation unit 1002, and the calculation unit 1002 may calculate a theoretical value of the changed facility configuration using a prediction model (AI / machine learning). Alternatively, the conversion unit 1004 may be configured as a prediction model (AI / machine learning). (Conversion table) 11 is a diagram showing the configuration of the conversion table 1041 according to this embodiment. The conversion table 1041 is used when the conversion unit 1004 converts the environmental data of the facility into corresponding virtual injury / illness data.

[0134] The conversion table 1041 is data that influences the number of patients, which is the basis for changing the facility configuration, from the present to the future, as environmental data of the facility, such as demographics of the facility area, the number of patients / doctors in the medical area, information on hospitals near the facility, regional development plans, etc. Virtual injury and illness data converted based on such environmental data of the facility is stored.

[0135] (Theoretical value calculation process) Fig. 12 is a flowchart showing the flow of theoretical value calculation processes S713 and S717 of the information processing device 1000 according to this embodiment. In Fig. 12, the same steps as those in Fig. 7B are given the same step numbers, and duplicated explanations will be omitted.

[0136] In step S1211, the information processing device 1000 determines whether the process is step S713 or S717. If it is step S713, the process proceeds to step S731. On the other hand, if it is S717, the information processing device 1000 acquires environmental data of the facility in step S1213. Then, in step S1215, the information processing device 1000 converts the environmental data of the facility into virtual injury / illness data and adds it to the plurality of injury / illness data 320.

[0137] According to this embodiment, it is possible to present improvement measures for facility configuration that take into account environmental data outside a medical institution or a care facility.

[0138] In hospital management, there is a structural and fundamental principle that profits will be damaged if the medical care required in the region does not match the medical functions of the hospital. For example, even if a hospital next to a university hospital that provides cutting-edge medical care provides the same advanced medical care, there is no demand and the number of patients will decrease. In such an environment, the role that the hospital should play is to become a rear support hospital for advanced medical care, and in some cases, a rehabilitation hospital that accepts patients from the university hospital and supports their return to home. As a further example, it is assumed that, as a result of analyzing and calculating the demographics of the region to which the hospital belongs, statistical data on diseases per 100 people, and information on medical institutions in the region using AI (machine learning) or algorithms, the hospital will not continue with traditional surgery, but will instead advertise and provide "ophthalmology and urology," which is what local patients need most, and as a result, medical fees will increase and hospital profits will be maximized.

[0139] In this way, in this embodiment, it is possible to aim for optimization of the patient composition, not just the current patient composition. In other words, it is possible to consider facility composition for the hospital to determine the patients that are desirable for the hospital and maximize profits, or to consider what kind of patients are in the medical area and how to attract such patients from neighboring hospitals. In addition, it is possible to comprehensively control medical beds in the community and to move medical patients out, for example, to have ophthalmology patients go to neighboring hospitals depending on the hospital's infrastructure and environment.

[0140] [Fourth embodiment] Next, an information processing device according to a fourth embodiment of the present invention will be described. The information processing device according to this embodiment differs from the second and third embodiments in that it presents changes to the facility configuration that further take into account the cost of changing the facility configuration. Since the other configurations and operations are the same as those of the second and third embodiments, the same reference numerals are used for the same configurations and operations, and detailed descriptions thereof will be omitted.

[0141] <Configuration of information processing device> Fig. 13A is a block diagram showing the configuration of an information processing device 1300 according to this embodiment. In Fig. 13A, the same components as those in Fig. 3A or 10 are given the same reference numerals, and duplicated explanations will be omitted.

[0142] The information processing device 1300 has a display control unit 1303. The display control unit 1303 acquires the facility configuration data 317 in the case of the change, calculates the cost of changing the facility configuration, and calculates the net profit by subtracting the cost burden from the increase in income due to the change in the facility configuration. Then, if the calculated profit is greater than a predetermined value 1331, the change in the facility configuration is presented.

[0143] (Display control unit) Fig. 13B is a block diagram showing the configuration of a display control unit 1303 according to this embodiment. In Fig. 13A, the same components as those in Fig. 3B are given the same reference numerals, and duplicated explanations will be omitted.

[0144] The display control unit 1303 has a change cost calculation unit 1352, a profit increment calculation unit 1353, and a determination unit 1354. The change cost calculation unit 1352 calculates the cost of the change from the facility configuration data 317 when the change is made. The profit increment calculation unit 1353 calculates the profit by subtracting the cost of changing the facility configuration from the increase in income obtained from the increment. That is, it calculates the net profit by subtracting the cost of changing the facility configuration from the increase in income due to the difference (=total theoretical value 322-total theoretical value 321) output from the difference calculation unit 351. If the net profit is greater than the predetermined value 1331, the determination unit 1354 stores the changed facility configuration data, the theoretical value, and the net profit in the changed facility storage unit 353. Then, the presentation selection unit 354 presents the change to the facility configuration with the highest net profit.

[0145] <Processing flow of information processing device> Fig. 14 is a flowchart showing the flow of processing by the information processing device 1300 according to this embodiment. In Fig. 14, the same steps as those in Fig. 7A are given the same step numbers, and duplicated explanations will be omitted.

[0146] In step S1418, the information processing device 1300 calculates the difference by subtracting the current theoretical total value 321 from the change total theoretical value 322. Next, in step S1419, the cost of the facility change is subtracted from the increase in income due to the difference to calculate the profit increase. Then, in step S1420, it is determined whether the profit increase (=increase in income difference-change cost)>predetermined value 1331. If the profit increase≦predetermined value 1331, the process returns to step S715 and is repeated. If the profit increase>predetermined value 1331, in step S1421, the changed facility configuration data and the changed profit are stored. In step S1425, the information processing device 1300 presents the changed facility configuration data that will provide the largest profit.

[0147] The cost burden for changes in facility configuration includes one-time costs such as medical facilities and medical equipment, and ongoing costs such as personnel costs, and the cost burden to be deducted from income is calculated taking these into consideration. In addition, the cost burden for medical facilities and medical equipment may take into account depreciation at original cost.

[0148] According to this embodiment, it is possible to present improvement measures for facility configuration that take into account the costs of changing the facility configuration.

[0149] [Fifth embodiment] Next, an information processing device according to a fifth embodiment of the present invention will be described. The information processing device according to this embodiment differs from the second and fourth embodiments in that it presents changes to facility configurations using a learning model generated by machine learning. This embodiment is realized as a modification of the first to fourth embodiments. Other configurations and operations are similar to those of the second and third embodiments, so the same reference numerals are used for the same configurations and operations, and detailed descriptions thereof will be omitted.

[0150] <Configuration of information processing device> Fig. 15 is a block diagram showing the configuration of an information processing device 1500 according to this embodiment. In Fig. 15, the same components as those in Fig. 1 are given the same reference numerals, and duplicated explanations will be omitted.

[0151] The information processing device 1500 includes a storage unit 1501, a prediction unit 1502, and a display control unit 1503. The storage unit 1501 stores a learning model 1510 generated using medical fee items, facility standards, and calculation requirements, with medical fee points as a response variable, and injury / illness data and facility configuration data as explanatory variables. The prediction unit 1502 corresponds to the calculation unit 102 in FIG. 1, and inputs a plurality of injury / illness data, and predicts a first theoretical value 1521 and a second theoretical value 1522 using the learning model 1510. The display control unit 1503 presents a change 1532 in the facility configuration when the increment from the first theoretical value 1521 to the second theoretical value 1522 is greater than a predetermined value 1531. In addition, when corresponding to the third embodiment, the environmental data of the facility is added as an explanatory variable to generate the learning model.

[0152] According to this embodiment, it is possible to maximize the profits of medical institutions or nursing facilities more accurately and efficiently.

[0153] [Other embodiments] Although the present invention has been described above with reference to the embodiments, the present invention is not limited to the above embodiments. Various modifications that can be understood by those skilled in the art can be made to the configuration and details of the present invention within the technical scope of the present invention. In addition, systems or devices that combine the separate features included in each embodiment in any way are also included in the technical scope of the present invention.

[0154] The present invention may be applied to a system consisting of multiple devices, or to a single device. Furthermore, the present invention is also applicable to a case where an information processing program for implementing the functions of the embodiments is supplied to a system or device and executed by a built-in processor. In order to implement the functions of the present invention with a computer, a program installed on a computer, a medium storing the program, a server for downloading the program, and a processor for executing the program are also included in the technical scope of the present invention. In particular, at least a non-transitory computer readable medium storing a program for causing a computer to execute the processing steps included in the above-mentioned embodiments is included in the technical scope of the present invention.

Claims

1. A storage unit that stores facility standards related to the facility configuration of medical facilities in order to claim medical fee points; a presentation unit that presents other facility standards that the medical facility can satisfy based on the facility standards of the medical facility; An information processing device comprising:

2. The information processing device according to claim 1, further comprising a calculation unit that refers to the memory unit, inputs facility configuration data and injury / illness data related to the facility standards, and calculates a first theoretical value of medical fee points for the current facility configuration.

3. The storage unit stores facility standards of other medical facilities, The information processing device according to claim 1 , wherein the presenting unit presents other facility standards that the medical facility can meet, with reference to facility standards of the other medical facilities.

4. The information processing device according to claim 1 , wherein the facility configuration includes at least one of the number of hospital beds, the number of medical staff, the configuration of a rehabilitation center, the presence or absence of a specialized space, and the type of medical equipment.

5. a profit calculation unit that calculates profit by subtracting costs for changing the facility configuration from an increase in revenue obtained from the increase; The information processing device according to claim 1 , wherein a change in facility configuration is suggested when the profit is greater than a second predetermined value.

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