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 apparatus, an information processing method, and an information processing program.

BACKGROUND ART

[0002] In the above technical field, patent documents disclose techniques for checking whether medical fee claims are appropriately made at medical institutions.

PRIOR ART DOCUMENTS

PATENT DOCUMENTS

[0003]

PATENT DOCUMENT 1

SUMMARY OF THE INVENTION

PROBLEMS TO BE SOLVED BY THE INVENTION

[0004] However, the technique described in the above document is merely a mechanism for checking the appropriateness of remuneration for specific medical fee items performed at medical institutions, and does not aim to maximize the profits of medical institutions or long-term care facilities.

[0005] An object of the present invention is to provide a technique that solves the above-described problems.

MEANS FOR SOLVING THE PROBLEMS

[0006] To achieve the above object, an apparatus according to the present invention comprises: Regarding medical procedures that may be performed in a medical facility, Medical fee items established by the Ministry of Health, Labour and Welfare, The medical fee items corresponding to the above medical fee items are determined by the Ministry of Health, Labour and Welfare. medical fee points and, Corresponding to the aforementioned medical fee items, related to the facility configuration of a medical facility The Ministry of Health, Labour and Welfare has established facility standards and, , Related a storage unit storing therein, The memory stored in the memory unit facility standards and facility configuration data of a specific medical facility and patient number data related to predetermined illness data at the said specific medical facility.Based on the above, the aforementioned specific medical facility The theoretical value of medical fee points for the facility configuration is calculated, and the change will result in the aforementioned theoretical value of medical fee points increasing. facility Configuration improvement measures a presentation unit that presents, is an information processing apparatus equipped with

[0007] To achieve the above object, a method according to the present invention is A method of information processing performed by a computer, For medical practices that may be performed at medical facilities, medical fee items specified by the Ministry of Health, Labour and Welfare, medical fee points specified by the Ministry of Health, Labour and Welfare corresponding to the aforementioned medical fee items, facility standards specified by the Ministry of Health, Labour and Welfare regarding the facility configuration of medical facilities, corresponding to the aforementioned medical fee items, referencing a storage unit that stores these in association with each other, Based on the facility standards stored in the aforementioned storage unit, the facility configuration data of a specific medical facility, and the patient count data related to predetermined injury and illness data at the specific medical facility, the theoretical value of medical fee points in the facility configuration of the specific medical facility is calculated, and the information processing method includes a presentation step in which a display control unit presents improvement measures for the facility configuration that increase the aforementioned theoretical value of medical fee points through modification.

[0008] To achieve the above object, an information processing program according to the present invention is Regarding medical procedures that may be performed in a medical facility, Medical fee items established by the Ministry of Health, Labour and Welfare, The medical fee points determined by the Ministry of Health, Labour and Welfare for the aforementioned medical fee items, Regarding the facility composition of medical facilities corresponding to the aforementioned medical fee items, the facility standards established by the Ministry of Health, Labour and Welfare, Referencing the memory unit that stores the associated information, This information processing program causes a computer to perform a suggestion step that calculates a theoretical value of medical fee points for the facility configuration of a specific medical facility based on facility standards stored in the memory unit, facility configuration data of a specific medical facility, and patient number data related to predetermined disease data at the specific medical facility, and suggests improvement measures for the facility configuration that would increase the theoretical value of medical fee points through changes. Effects of the Invention

[0009] According to the present invention, the profit of a medical institution or a long-term care facility can be maximized. Brief Description of the Drawings

[0010] [Figure 1]It is a block diagram showing the configuration of the information processing apparatus according to the first embodiment. [Figure 2] It is a diagram for explaining medical service fees. [Figure 3A] It is a block diagram showing the configuration of the information processing apparatus according to the second embodiment. [Figure 3B] It is a block diagram showing the configuration of the display control unit according to the second embodiment. [Figure 3C] It is a diagram showing a data configuration according to the second embodiment. [Figure 4] It is a diagram showing the configuration of the storage unit of the information processing apparatus according to the second embodiment. [Figure 5] It is a diagram showing the configuration of the storage unit of the information processing apparatus according to the second embodiment. [Figure 6A] It is a diagram showing a display example of the information processing apparatus according to the second embodiment. [Figure 6B] It is a diagram showing a display example of the information processing apparatus according to the second embodiment. [Figure 6C] It is a diagram showing a display example of the information processing apparatus according to the second embodiment. [Figure 7A] It is a flowchart showing the processing flow of the information processing apparatus according to the second embodiment. [Figure 7B] It is a flowchart showing the flow of theoretical value calculation processing of the information processing apparatus according to the second embodiment. [Figure 8] It is a flowchart showing the flow of facility standard determination processing of the information processing apparatus according to the second embodiment. [Figure 9] It is a diagram for explaining an example of the theoretical value calculation method of the information processing apparatus according to the second embodiment. [Figure 10] It is a block diagram showing the configuration of the information processing apparatus according to the third embodiment. [Figure 11] It is a diagram showing the configuration of a conversion table according to the third embodiment. [Figure 12] It is a flowchart showing the flow of theoretical value calculation processing of the information processing apparatus according to the third embodiment. [Figure 13A] It is a block diagram showing the configuration of the information processing apparatus according to the fourth embodiment. [Figure 13B] This is a block diagram showing the configuration of the display control unit according to the fourth embodiment. [Figure 14] This is a flowchart showing the processing flow of the information processing device according to the fourth embodiment. [Figure 15] This is a block diagram showing the configuration of the information processing device according to the fifth embodiment. [Modes for carrying out the invention]

[0011] Embodiments of the present invention will be described in detail below with reference to the drawings. However, the components described in the following embodiments are merely illustrative and are not intended to limit the technical scope of the present invention to them alone.

[0012] In this specification, "facility configuration" includes at least one of the following: number of hospital beds, number of medical staff, rehabilitation center configuration, presence or absence of specialized space configuration, and type of medical equipment. However, "facility configuration" is not limited to these and includes all configurations related to "facility standards" that affect medical fee points. Furthermore, "facility environmental data" refers to "external factors" that affect the facility configuration of medical institutions and nursing care facilities, including the population of the medical service area (where the facility is located), the composition of nearby medical institutions, and the roles that medical institutions and nursing care facilities should play, in contrast to "internal factors" within medical institutions and nursing care facilities that affect the facility configuration of hospitals. Furthermore, "medical service area" is a regional unit that is established in stages to provide medical services ranging from routine medical care to general inpatient care and specialized medical care, while comprehensively considering geographical conditions, transportation conditions, the level of satisfaction of daily life needs, administrative areas, etc., in order to efficiently provide appropriate medical services. For example, a "primary medical service area" is an area established to meet the demand for health services such as daily health consultations and health management, and the medical demand for diagnosis and treatment of common diseases, and is generally based on the unit of a municipality. Furthermore, a "secondary medical area" is an area defined in Article 30-4, Paragraph 2, Item 12 of the Medical Care Act, and is an area established beyond municipal boundaries to respond to general inpatient medical needs and to implement comprehensive initiatives that coordinate health, medical care, and welfare. Furthermore, a "tertiary medical area" is an area defined in Article 30-4, Paragraph 2, Item 13 of the Medical Care Act, and is an area established to respond to medical needs requiring special diagnosis and treatment, and is based on the entire prefecture.

[0013] [First Embodiment] An information processing device 100 as a first embodiment of the present invention will be described with reference to Figure 1. The information processing device 100 is a device for evaluating the remuneration for medical procedures performed at a medical institution or nursing care facility and for suggesting changes to the facility configuration.

[0014] As shown in Figure 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, in association with each of several possible medical procedures performed at a medical institution or nursing care facility 110, disease data 111, medical fee items 112, medical fee points 113, facility standards 114 for the facility to claim medical fee points, and calculation requirements 115 for the patient to claim medical fee points. The calculation unit 102 refers to the storage unit 101, inputs facility configuration data 116, 117 related to the facility standards and several disease data 120, calculates a first theoretical value 121 for medical fee points in the current facility configuration, and calculates a second theoretical value 122 for medical fee points when the facility configuration is changed. The display control unit 103 presents a change in facility configuration 132 when the increment from the first theoretical value to the second theoretical value is greater than a predetermined value 131.

[0015] With the above configuration, it becomes easier for medical institutions or nursing care facilities to change their facility configuration in order to maximize profits.

[0016] [Second Embodiment] Next, an information processing device according to the second embodiment of the present invention will be described using Figure 2 and subsequent figures.

[0017] (Regarding medical fees) Before explaining the configuration of the information processing device, we will explain the remuneration calculated for actions performed at medical institutions or nursing care facilities.

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

[0019] Medical fees are determined by considering the evaluation of technology and services as well as the price evaluation of goods (for pharmaceuticals, the price is determined by the drug price standard). The medical fee schedule evaluates individual technologies and services by assigning points (1 point = 10 yen) (as stated in the official notice). There are different types of fee schedules: medical, dental, and dispensing. Hospital revenue is calculated as "number of patients" x "unit price," but the unit price is controlled by the medical fee schedule.

[0020] Medical fees are classified into approximately 1,700 categories, and the number of drug price listings is approximately 14,000 (drug price: insurance reimbursement price of pharmaceuticals). The medical 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," "follow-up consultation fee," "basic inpatient fee," "additional charges for basic inpatient fee," "specific inpatient fee," and "basic fee for short-stay surgery, etc." Special medical fees are classified into "medical management, etc.," "home medical care," "examinations," "imaging diagnosis," "medication," "injections," "rehabilitation," "specialized psychiatric therapy," "procedures," "surgery," "anesthesia," "radiation therapy," and "pathological diagnosis."

[0022] The specific points that can be claimed for each category of activity are determined in detail by official notices and notifications, which specify facility standards and calculation requirements.

[0023] The calculation requirements are those listed along with the points in the aforementioned "Medical Fee Schedule."

[0024] Facility standards refer to the personnel and equipment that medical institutions must meet when calculating medical fees. These standards are determined by a separate notification from the medical fee schedule issued by the Minister of Health, Labour and Welfare, and detailed procedures are outlined in separate notices.

[0025] As shown in Figure 2, in order to calculate medical fees, it is necessary to first meet the facility standards 201 that correspond to the medical fee item 200. If the facility standards are not met, medical fees cannot be claimed without even considering the calculation requirements. Specifically, facility standards 201 include personnel standards 211 and equipment standards 212. Only after meeting the facility standards can the calculation requirements 202 be considered. Calculation requirements 202 include basic requirements 221 and exclusion requirements 222.

[0026] For example, the initial consultation fee at a medical institution covered by health insurance is generally 288 points, but if the initial consultation is conducted using information and communication equipment at a medical institution covered by health insurance that has notified the Regional Health Bureau Director, etc., that it meets the facility standards separately set by the Minister of Health, Labour and Welfare, then 251 points will be charged.

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

[0028] If the patient being treated is under 6 years old, an additional 75 points will be added as an infant surcharge. Furthermore, if the initial consultation is conducted outside of regular hours, on holidays, or late at night, an additional 85 points, 250 points, or 480 points (200 points, 365 points, or 695 points, respectively, for infants under 6 years old) will be added to the prescribed fee as an after-hours surcharge, holiday surcharge, or late-night surcharge. However, in the case of insurance medical institutions established solely to ensure emergency medical care at night, if the initial consultation is conducted at night during hours separately determined by the Minister of Health, Labour and Welfare, an additional 230 points (345 points, for infants under 6 years old) will be added to the prescribed fee. Furthermore, in the case of insurance medical institutions that specialize in pediatrics, if the initial consultation is conducted for an infant under 6 years old at night during hours separately determined by the Minister of Health, Labour and Welfare, on holidays, or late at night (limited to hours within the medical institution's stated consultation hours), an additional 200 points, 365 points, or 695 points will be added to the prescribed fee.

[0029] Medical fees are billed at a rate of 1 point x 10 yen. As described above, the calculation method for these fees is defined in extremely detailed and complex terms, and is revised approximately every two years.

[0030] (Excerpt from the 2020 medical fee score table) Furthermore, for example, when providing rehabilitation for cerebrovascular diseases, facility standards are stipulated in official notices and notifications as follows, but the level of detail differs for each, making it difficult to make a judgment.

[0031] (Facility standards for rehabilitation fees for cerebrovascular diseases, etc., as stipulated by public notice) (i) There must be a dedicated full-time physician assigned to each of the following services: cardiovascular rehabilitation, cerebrovascular rehabilitation, disuse syndrome rehabilitation, musculoskeletal rehabilitation, or respiratory rehabilitation.

[0032] (b) There must be an appropriate number of full-time nurses, physical therapists, occupational therapists, or speech-language pathologists assigned to each of the following services: cardiovascular rehabilitation, cerebrovascular rehabilitation, disuse syndrome rehabilitation, musculoskeletal rehabilitation, or respiratory rehabilitation.

[0033] (h) Having sufficient facilities for providing cardiovascular rehabilitation, cerebrovascular rehabilitation, disuse syndrome rehabilitation, musculoskeletal rehabilitation, or respiratory rehabilitation.

[0034] (ii) The facility must be equipped with the necessary equipment and instruments for providing rehabilitation services for cardiovascular diseases, cerebrovascular diseases, disuse syndrome, musculoskeletal disorders, or respiratory disorders.

[0035] In response to this, in "Attachment 1: Facility Standards for Special Medical Fees" of the notification from the Ministry of Health, Labour and Welfare titled "Regarding the Handling of Facility Standards for Special Medical Fees and Procedures for Notification Thereof," the facility standards are more specifically defined as follows (excerpt):

[0036] "Cerebrovascular Disease Rehabilitation Fee (I)" 1. Facility standards for rehabilitation fees (I) for cerebrovascular diseases, etc. (1) The medical institution must have at least two full-time physicians on staff. However, at least one of them must have at least three years of clinical experience in rehabilitation medicine for cerebrovascular diseases, etc., or have attended (or taught) training courses or workshops related to rehabilitation medicine for cerebrovascular diseases, etc. Furthermore, if two or more full-time part-time physicians who work at least three days a week and whose scheduled working hours are at least 22 hours per week are combined and these part-time physicians are assigned to the same time slots as the full-time physicians, their actual working hours can be converted to full-time equivalents and included in the number of full-time physicians. However, when calculating the full-time equivalents of these part-time physicians for a full-time physician who has at least three years of clinical experience in rehabilitation medicine for cerebrovascular diseases, etc., or has attended (or taught) training courses or workshops related to rehabilitation medicine for cerebrovascular diseases, etc., it is limited to part-time physicians who have said experience or attendance history (or teaching history).

[0037] (2) All of the following conditions A through D must be met.

[0038] a. 5 or more full-time physical therapists dedicated to the relevant service must be employed. Provided, however, that concurrent service with a full-time physical therapist in wards that calculate the ADL Maintenance and Improvement System Addition, Recovery Phase Rehabilitation Ward Inpatient Fee, and Community Comprehensive Care Ward Inpatient Fee, as well as wards with hospital rooms that calculate the Community Comprehensive Care Inpatient Medical Management Fee, is not permitted; but concurrent service with a full-time physical therapist for Disuse Syndrome Rehabilitation Fee (I), (II) or (III), Musculoskeletal Rehabilitation Fee (I), (II) or (III), Respiratory Rehabilitation Fee (I) or (II), Disabled Children (Persons) Rehabilitation Fee, and Cancer Patient Rehabilitation Fee is permitted.

[0039] b. 3 or more full-time occupational therapists dedicated to the relevant service must be employed. Provided, however, that concurrent service with a full-time occupational therapist in wards that calculate the ADL Maintenance and Improvement System Addition, Recovery Phase Rehabilitation Ward Inpatient Fee, and Community Comprehensive Care Ward Inpatient Fee, as well as wards with hospital rooms that calculate the Community Comprehensive Care Inpatient Medical Management Fee, is not permitted; but concurrent service with a full-time occupational therapist for Disuse Syndrome Rehabilitation Fee (I), (II) or (III), Musculoskeletal Rehabilitation Fee (I), (II) or (III), Respiratory Rehabilitation Fee (I) or (II), Disabled Children (Persons) Rehabilitation Fee, and Cancer Patient Rehabilitation Fee is permitted.

[0040] c. When implementing speech-language therapy, 1 or more full-time speech-language hearing therapists dedicated to the relevant service must be employed. Note that concurrent service is permitted, unless otherwise specified for other items that require a dedicated full-time speech-language hearing therapist among the items in Section 1 of Part 7 Rehabilitation.

[0041] There must be at least 10 full-time staff members in total from A to C. However, if the time spent on disease-specific rehabilitation (excluding cardiovascular rehabilitation), rehabilitation for disabled children / adults, and cancer patient rehabilitation at the said medical institution is less than the prescribed working hours set by the medical institution, staff members may engage in other duties outside of the rehabilitation time. Furthermore, if two or more full-time part-time physical therapists, part-time occupational therapists, or part-time speech-language pathologists who work at least three days a week and whose prescribed working hours are 22 hours or more per week are combined, and these part-time physical therapists, occupational therapists, or speech-language pathologists are assigned to the same time slots as full-time physical therapists, occupational therapists, or speech-language pathologists, their actual working hours can be converted to full-time equivalents and included in the number of full-time physical therapists, occupational therapists, or speech-language pathologists, respectively. However, only a maximum of four physical therapists, two occupational therapists, and one speech-language pathologist can be included in the calculation of the number of full-time equivalent physical therapists, occupational therapists, or speech-language pathologists from the total number of full-time staff.

[0042] If the following requirements (a) or (b) are met, and there are no patients for whom the dedicated staff members described in (a) through (c) should be providing disease-specific rehabilitation, then even during the hours when cerebrovascular disease rehabilitation is being conducted, the dedicated staff members may engage in outpatient rehabilitation provided by the said medical institution.

[0043] (i) All physical therapists, occupational therapists, and speech-language pathologists other than those dedicated to disease-specific rehabilitation as per the facility standards for disease-specific rehabilitation fees are engaged in rehabilitation under the long-term care insurance system or other work other than disease-specific rehabilitation.

[0044] (b) All physical therapists, occupational therapists, and speech-language pathologists assigned to the medical institution must be full-time staff members according to the facility standards for any of the disease-specific rehabilitation fees.

[0045] (3) The facility must have a dedicated functional training room (at least 160 square meters, measured internally) capable of adequately conducting treatment and training. The dedicated functional training room may be used for other purposes during times when the therapy is not being conducted. Furthermore, the term "dedicated" for the functional training room refers to the time when disease-specific rehabilitation, rehabilitation for disabled children / adults, or cancer patient rehabilitation is being conducted, and it is permissible to conduct disease-specific rehabilitation, rehabilitation for disabled children / adults, or cancer patient rehabilitation simultaneously in the same functional training room. However, if cardiovascular rehabilitation is conducted during the same time period, the respective facility standards must be met. In addition, if speech-language therapy is being conducted, the facility must have at least one separate dedicated individual therapy room (at least 8 square meters, measured internally) with consideration for shielding, etc.

[0046] (4) The following facilities and equipment / devices necessary for performing the said therapy are provided. These devices and devices may be used by users of the designated outpatient rehabilitation service provider when the insurance medical institution provides designated outpatient rehabilitation and there is no impediment to the provision of rehabilitation.

[0047] Walking aids, training mats, treatment tables, weights such as sandbags, various measuring instruments (goniometers, grip strength meters, etc.), blood pressure monitors, parallel bars, inclined tables, posture correction mirrors, various wheelchairs, various walking aids, various orthotic devices (long and short leg orthoses, etc.), household equipment, various equipment for daily living activities, etc. However, if speech-language therapy is performed, hearing test equipment, voice recording and playback devices, video recording systems, etc. may be provided. If necessary, rehabilitation medical equipment to assist with flexion and extension of the paralyzed joints and increase the amount of exercise should be provided.

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

[0049] A. At least one full-time physician is employed. However, if two or more full-time part-time physicians are employed on a regular basis for at least three days a week and whose scheduled working hours are at least 22 hours per week, and these part-time physicians are assigned to the same time slots as the full-time physician, then this criterion may be deemed to be met.

[0050] (i) There must be three or more full-time speech-language pathologists on staff. Furthermore, if two or more full-time part-time speech-language pathologists who work at least three days a week and whose scheduled working hours are 22 hours or more per week are combined and these part-time speech-language pathologists are assigned to the same time slots as the full-time speech-language pathologists, their actual working hours can be converted to full-time equivalents and included in the number of full-time speech-language pathologists. However, only up to two of the full-time speech-language pathologists can be converted to full-time equivalents and included in the number of full-time speech-language pathologists.

[0051] (c) Having a dedicated individual therapy room (8 square meters or more, measured by internal dimensions) with consideration for shielding and other measures.

[0052] (e) The facility must be equipped with the necessary instruments and equipment for speech-language therapy, such as hearing test equipment, voice recording and playback devices, and video recording systems.

[0053] (6) As of March 31, 2014, medical institutions that have already filed a notification for the rehabilitation fee shall be deemed to have met the requirements of (3) and (5) until they carry out an expansion or complete renovation of the functional training room, etc.

[0054] (7) Records related to rehabilitation (physician's instructions, implementation time, training content, person in charge, etc.) shall be centrally stored for each patient and always accessible to healthcare professionals.

[0055] (8) Conferences are held regularly with participation from the various professionals in charge.

[0056] (9) Physical therapists, occupational therapists, and speech-language pathologists other than those who are exclusively engaged in the services described in (2) A through C may engage in outpatient rehabilitation provided by the 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 following are the calculation requirements and additional fee requirements for rehabilitation fees for cerebrovascular diseases, etc.: "Cerebrovascular disease rehabilitation fee (I) (1 unit) 245 points" Rehabilitation fee for cerebrovascular diseases, etc. (II) (1 unit) 200 points Rehabilitation fee for cerebrovascular diseases, etc. (III) (1 unit) 100 points Note 1: In medical institutions that have notified the Regional Health Bureau Director, etc., that they meet the facility standards separately determined by the Minister of Health, Labour and Welfare, when rehabilitation as individual therapy is provided to patients separately determined by the Minister of Health, Labour and Welfare, the prescribed points shall be calculated according to the categories related to the said standards, up to a maximum of 180 days from the date of onset, surgery, acute exacerbation, or initial diagnosis. However, in cases where it is medically determined that improvement in the condition can be expected by continuing treatment for patients separately determined by the Minister of Health, Labour and Welfare, or in other cases separately determined by the Minister of Health, Labour and Welfare, the prescribed points may be calculated for more than 180 days.

[0058] Note 2 When rehabilitation is performed for a patient separately specified by the Minister of Health, Labour and Welfare as provided in the main text of Note 1 who is hospitalized, or a patient other than a hospitalized patient (limited to a stroke patient who has been discharged from the relevant insurance medical institution or discharged from another insurance medical institution (limited to patients for whom the regional collaborative care plan add-on listed in Note 4 of Classification No. A246 has been calculated)), 30 points per unit shall be added to the predetermined points as the early rehabilitation add-on, for a maximum of 30 days each from the onset, surgery, or acute exacerbation.

[0059] Note 3 When rehabilitation is performed at an insurance medical institution that has notified the Regional Bureau of Health and Welfare Director, etc. as conforming to the facility standards separately specified by the Minister of Health, Labour and Welfare, for a patient separately specified by the Minister of Health, Labour and Welfare as provided in the main text of Note 1 who is hospitalized, or a patient other than a hospitalized patient (limited to a stroke patient who has been discharged from the relevant insurance medical institution or discharged from another insurance medical institution (limited to patients for whom the regional collaborative care plan add-on listed in Note 4 of Classification No. A246 has been calculated)), 45 points per unit shall be further added to the predetermined points as the initial add-on, for a maximum of 14 days each from the onset, surgery, or acute exacerbation.

[0060] Note 4 Notwithstanding the provisions of the main text of Note 1, when rehabilitation is performed for a patient separately specified by the Minister of Health, Labour and Welfare as provided in the main text of Note 1 who is not a long-term care insured person, etc., and rehabilitation is necessary and performed for more than 180 days from the onset, surgery, acute exacerbation, or the date of initial diagnosis, the calculation may be made for up to 13 units per month.

[0061] Note 5 Notwithstanding the provisions of the main text of Note 1, for patients designated separately by the Minister of Health, Labour and Welfare as specified in the main text of Note 1, who are insured persons requiring long-term care and are hospitalized, if rehabilitation is provided for more than 180 days from the date of onset, surgery, acute exacerbation, or initial diagnosis, the following points may be calculated up to 13 units per month, in accordance with the classification of facility standards specified in Note 1: a) Rehabilitation fee for cerebrovascular diseases, etc. (I) (1 unit) 147 points b) Rehabilitation fee for cerebrovascular diseases, etc. (II) (1 unit) 120 points c) Rehabilitation fee for cerebrovascular diseases, etc. (III) (1 unit) 60 points Note 6: For patients specified separately by the Minister of Health, Labour and Welfare as stipulated in the main text of Note 1 (limited to insured persons requiring long-term care, etc.), if rehabilitation is continued after 60 days have passed since the onset of the illness, surgery, acute exacerbation, or initial diagnosis, and if the goal-setting support and management fee listed in H003-4 has not been calculated within the past three months, the fee shall be calculated at 90% of the prescribed points.

[0062] Note 7: In the case of an insured medical institution that has notified the Director of the Regional Health Bureau, etc., that it conforms to the facility standards separately determined by the Minister of Health, Labour and Welfare, and that continuously submits data on the status of medical fee claims and the content of medical treatment to the Ministry of Health, Labour and Welfare, and provides rehabilitation to patients other than inpatients as separately determined 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 shall be added to the prescribed fee, limited to once a month.

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

[0064] Appendix 9-5: Patients eligible for rehabilitation fees for cerebrovascular diseases, etc. 1. Patients with cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, or other acutely occurring cerebrovascular diseases or patients after surgery for such diseases. 2. Patients with brain tumors, brain abscesses, spinal cord injuries, spinal cord tumors, or other acutely occurring central nervous system diseases or patients after surgery for such diseases. 3. Patients with polyneuritis, multiple sclerosis, peripheral neuropathy, or other neurological diseases. 4. Patients with Parkinson's disease, spinocerebellar degeneration, or other chronic neuromuscular diseases. 5. Patients with aphasia, agnosia and apraxia, and higher brain dysfunction. 6. Patients with hearing loss or hearing and speech impairments due to 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 tumors of the tongue, etc. 9. Patients requiring rehabilitation who have experienced a certain degree of decline in basic motor skills, applied motor skills, speech and hearing abilities, and daily living abilities (excluding patients who qualify for cardiovascular rehabilitation fees, disuse syndrome rehabilitation fees, musculoskeletal rehabilitation fees, respiratory rehabilitation fees, rehabilitation fees for disabled children / adults, or cancer patient rehabilitation fees).

[0065] (Notification Regarding Implementation Guidelines Following Partial Revision of Medical Fee Calculation Methods) In addition to the above calculation requirements, there is also a notification of the following guidelines: "H001 Cerebrovascular Disease Rehabilitation Fee (1) The cerebrovascular disease rehabilitation fee is calculated at insurance medical institutions that have notified the Regional Health Bureau Director that they meet the facility standards separately determined by the Minister of Health, Labour and Welfare. It is calculated when various exercise therapies, practical walking training, daily living activity training, physical therapy, occupational therapy aimed at restoring applied motor skills and social adaptation skills are combined and performed according to the individual case in order to promote independence in various activities of practical daily living through the recovery of basic motor skills, etc., or when training related to language function or hearing function is performed for patients with speech and hearing impairments. If only physical therapy such as massage or thermotherapy is performed, it is calculated according to the provisions of Chapter 2, Special Medical Fees, Part 9, Procedures."

[0066] (2) Patients eligible for the cerebrovascular disease rehabilitation fee are those listed in Appendix 9-5 of the facility standards for special medical fees, etc., who fall under any of the following categories and whom a physician deems to require cerebrovascular disease rehabilitation. A. Patients with acutely occurring cerebrovascular disease or those who have undergone surgery for it include cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, encephalitis, acute encephalopathy (hypoxic encephalopathy, etc.), meningitis, etc. B. Patients with acutely occurring central nervous system disease or those who have undergone surgery for it include brain abscess, spinal cord injury, spinal cord tumor, post-craniotomy such as brain tumor resection, status epilepticus, etc. C. Neurological diseases include polyneuritis (Guillain-Barré syndrome, etc.), multiple sclerosis, peripheral neuropathy (facial nerve paralysis, etc.). E. Chronic neuromuscular diseases include Parkinson's disease, spinocerebellar degeneration, motor neuron disease (amyotrophic lateral sclerosis), hereditary motor sensory neuropathy, peripheral neuropathy, dermatomyositis, polymyositis, etc. O. Patients with aphasia, agnosia and apraxia, and higher brain dysfunction K. Patients with hearing and language impairments due to hearing loss or cochlear implant surgery, etc. refers to patients with voice disorders, dysarthria, language development disorders, hearing and language impairments due to hearing loss, or hearing and language impairments due to cochlear implant surgery, etc. Ki. Patients with dysarthria due to congenital abnormalities of the jaw and oral cavity Ku. Patients with dysarthria due to surgery for malignant tumors of the tongue, etc. Ke. Conditions requiring rehabilitation that result in a decline in basic motor skills, applied motor skills, language and hearing skills, and daily living skills of a certain degree or more refer to patients with congenital developmental disorders such as cerebral palsy, etc., whose FIM score is 115 or less and BI score is 85 or less at the start of treatment.

[0067] (3) The prescribed fee for rehabilitation for cerebrovascular diseases, etc., includes manual muscle testing and other tests associated with rehabilitation.

[0068] (4) The fee for rehabilitation for cerebrovascular diseases, etc., shall be calculated for rehabilitation performed under the guidance and supervision of a physician and supervised by a physical therapist, occupational therapist, or speech-language pathologist. Furthermore, even if a dedicated physician directly conducts the training, the fee may be calculated in the same way as when a physical therapist, occupational therapist, or speech-language pathologist conducts it.

[0069] (5) Rehabilitation for which the fee for cerebrovascular disease rehabilitation should be charged shall be provided when it is deemed necessary for one practitioner to provide focused, individualized training to one patient, and the rehabilitation shall be conducted on a one-to-one basis between a physical therapist, occupational therapist, or speech-language pathologist and the patient. The number of units for such rehabilitation shall be 18 units per day per practitioner as a standard, up to a maximum of 108 units per week. However, there shall be a maximum of 24 units per day. Furthermore, the number of units shall be the sum of the units for other disease-specific rehabilitation and group communication therapy. In this case, if the practitioner provides cardiovascular rehabilitation, the calculation shall be based on considering 20 minutes of actual time spent on cardiovascular rehabilitation as 1 unit.

[0070] (6) In a medical institution that has filed a notification for cerebrovascular disease rehabilitation fee (II) (limited to those with two or more full-time physical therapists dedicated to the field) or a medical institution that has filed a notification for cerebrovascular disease rehabilitation fee (III) (limited to those with a full-time physical therapist dedicated to the field), if training is provided by a person other than a physical therapist, occupational therapist, or speech-language pathologist, such as an anma massage therapist who has taken an exercise therapy functional training skills course and regularly completes appropriate training, the prescribed points for cerebrovascular disease rehabilitation fee (III) can be calculated only if a physician or physical therapist gives instructions in advance and receives a report on the therapy afterward, and all of the conditions in (1) to (5) are met.

[0071] (7) In facilities that have filed a notification for cerebrovascular disease rehabilitation fee (II) or (III), when physical therapy is performed by personnel other than physical therapists, such as nurses, massage therapists, etc., the physical therapist shall accurately grasp the content of the motor function training of patients receiving training under the guidance and supervision of a physician.

[0072] (8) When a physical therapist or occupational therapist, etc., assesses the patient's trunk function and sitting ability, and selects and adjusts cushions and accessories for pressure distribution and support, in order to ensure proper posture and prevent pressure ulcers in a wheelchair or seating device, the service can also be billed. However, the service cannot be billed if the patient is simply made to sit in a wheelchair for the purpose of getting out of bed.

[0073] (9) The standard number of days for calculation as stipulated in "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 otherwise.

[0074] (10) For patients exceeding the standard number of days for which treatment is provided, the prescribed points for cerebrovascular disease rehabilitation fees can be calculated up to 13 units per month, as stipulated in "Note 4" and "Note 5". In this case, for patients other than those hospitalized, it is necessary to appropriately evaluate whether they are eligible for rehabilitation under long-term care insurance and to provide the necessary support to receive rehabilitation services under long-term care insurance based on the patient's wishes. Furthermore, for hospitalized patients who are insured persons requiring long-term care as stipulated in Article 62 of the Long-Term Care Insurance Act, the points stipulated in "Note 5" shall be calculated according to their respective categories. However, for patients listed in Appendix 9-8 of the Facility Standards for Special Medical Treatment Fees, etc., in the cases listed in Appendix 9-9, even if the standard number of days for which treatment is provided is exceeded, the fees can be calculated in the same way as for periods within the standard number of days for which treatment is provided. The points to note are as follows. A. The phrase "other patients specified in Appendix 9-4 to Appendix 9-7 who are medically deemed to require continued rehabilitation" as stipulated in Appendix 9-8, Item 1 of the Facility Standards for Special Medical Fees refers to patients specified in Appendix 9-4 to Appendix 9-7 who are medically deemed to be able to expect improvement in their condition by continuing rehabilitation. B. The phrase "persons with illnesses resulting from physical and mental changes that occur with aging" as stipulated in Appendix 9-8 of the Facility Standards for Special Medical Fees refers to persons aged 40 or older who are in need of long-term care or support, and whose physical or mental disability causing their need for long-term care or support is due to a specific disease as defined in Article 7, Paragraph 3, Item 2 of the Long-Term Care Insurance Act.

[0075] (11) The additional fee stipulated in "Note 2" is an evaluation of the implementation of rehabilitation from the early stages after the onset, surgery, or acute exacerbation of cerebrovascular disease, etc. at the facility, and can be claimed when one or more units of individual therapy are provided to inpatients or non-inpatients (limited to stroke patients who have been discharged from the medical institution or another medical institution (limited to patients for whom the regional collaborative care plan additional fee under classification number "A246" Note 4 was claimed)). Furthermore, for inpatients, it can also be claimed when the therapy is performed in a ward other than the training room (including at the bedside). However, for patients listed in items 3, 4, 6, and 7 of Appendix 9-5 of the facility standards for special medical fees, the additional fee stipulated in "Note 2" cannot be claimed, except for those who have undergone surgery or experienced acute exacerbation.

[0076] (12) The additional fee stipulated in "Note 3" is an evaluation of the implementation of earlier rehabilitation after the onset, surgery, or acute exacerbation of cerebrovascular disease, etc., at the facility in question, and can be calculated separately from the additional fee stipulated in "Note 2". Furthermore, the patients eligible for this additional fee are inpatients or patients other than inpatients (limited to stroke patients who have been discharged from the medical institution in question or from another medical institution (limited to patients for whom the regional collaborative care plan additional fee under classification number "A246" Note 4 has been calculated)). In addition, for patients listed in items 3, 4, 6, and 7 of Appendix 9-5 of the facility standards for special medical fees, the additional fee stipulated in "Note 3" cannot be calculated, except for those who have undergone surgery or experienced acute exacerbation.

[0077] (13) When claiming the additional fee specified in "Note 2" or "Note 3" for patients other than hospitalized patients (limited to stroke patients who have been discharged from another medical institution), the fact that the patient is eligible for the regional collaborative care plan additional fee specified in Note 4 of classification number "A246" must be noted in the remarks column of the medical fee statement.

[0078] (14) For patients who continue rehabilitation beyond the standard number of days specified in "Note 4" and "Note 5", if the standard number of days is exceeded in the middle of the month, the disease-specific rehabilitation performed from the day onward onward onward onward must be 13 units or less.

[0079] (15) The “prescribed points” in “Note 6” refers to the points calculated by applying “Notes 1” through “Note 5”.

[0080] (16) The handling of the additional fee for submitting rehabilitation data as stipulated in "Note 7" is the same as in (12) of the cardiovascular rehabilitation fee for category number "H000".

[0081] (Summary of facility standards and calculation requirements) As described above, each medical fee item (~fee) has a defined base score, detailed facility standards, detailed calculation requirements, and corresponding additional requirements and additional points. Listing all the detailed medical fee and additional items would amount to several thousand in total. Additional items do not exist independently but are linked to one or more medical fee items. Not all medical fee items are necessarily linked to additional items. Each medical fee item (~fee) and additional item has its own independently defined facility standards and calculation requirements, but these are not compiled into a single document, requiring comparison of various notifications and multiple notices. Reimbursement can be claimed for patients who meet all of these facility standards and calculation requirements. However, not all medical fee items have clearly defined facility standards and calculation requirements. In particular, items involving clinical judgment often do not have clearly defined facility standards and calculation requirements.

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

[0083] 1. Patients with complex upper and lower limb injuries, quadriplegia due to spinal cord injury, or other acutely onset musculoskeletal disorders or patients who have undergone surgery for such conditions. 2. Patients who have a certain degree or greater decline in motor function and daily living ability due to degenerative joint diseases, inflammatory joint diseases, or other chronic musculoskeletal disorders. Furthermore, patients eligible for musculoskeletal rehabilitation fees are those listed in Appendix 9-6 of the facility standards for special medical fees, who fall under any of the following categories, and whom a physician individually deems to require musculoskeletal rehabilitation.

[0084] A. Patients with acutely developing musculoskeletal disorders or those who have undergone surgery for such disorders include those with complex injuries to the upper and lower limbs (complex injuries to three or more types of bones, muscles, tendons, ligaments, nerves, and blood vessels), quadriplegia due to spinal cord injury (one or more limbs), trauma or fractures of the trunk, upper and lower limbs, amputation or disarticulation (prosthetic limbs), malignant tumors of the musculoskeletal system, etc.

[0085] (i) Patients who have a certain degree or greater decline in motor function and daily living ability due to chronic musculoskeletal disorders include those with degenerative joint diseases, inflammatory joint diseases, joint contractures due to burn scars, musculoskeletal instability, diabetic foot complications, etc.

[0086] However, there is a discrepancy between the above expression and the name of the illness written on the medical claim form, making it difficult to determine whether or not a patient qualifies for the above-mentioned musculoskeletal rehabilitation fee simply by looking at the medical claim form.

[0087] Given the above circumstances, accurately calculating medical fees for services performed at medical institutions and nursing care facilities is extremely difficult. In particular, the additional fee items are detailed and diverse, making it easy for calculation errors to occur.

[0088] Verifying the actual performance of a medical fee item for the target population (the base number) is extremely time-consuming. Furthermore, it is difficult to develop an action plan for what should be done (because it is calculated based on factors such as personnel, equipment, and the patient's condition).

[0089] <Configuration of the information processing device> Under the circumstances described above, the information processing device 300 according to this embodiment will be explained using Figure 3A and subsequent figures. Figure 3A is a diagram illustrating 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 services performed at medical institutions or nursing care facilities and for maximizing them. The information processing device 300 is equipped with a facility configuration improvement suggestion function (suggesting an increase in medical fees by adding or 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 memory unit 301 stores, in association with each of the multiple medical procedures that may be performed at the medical institution or nursing care facility 310, disease data, medical fee items, medical fee points, facility standards, and calculation requirements. Facility standards are the criteria required for a facility to claim medical fee points, and calculation requirements are the conditions for a patient to claim medical fee points. Each medical fee item is further associated with additional items, additional points, additional facility standards, and additional calculation requirements. This memory 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 cases where an external server located outside of Japan functions as the memory 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 as stipulated in the Ministry of Health, Labour and Welfare's "Medical Fee Schedule," and a second memory unit 319 for storing facility standards and calculation requirements that are not clearly stipulated in the Ministry of Health, Labour and Welfare's "Medical Fee Schedule."

[0093] The disease and injury data stored in the memory unit 301 may include, for example, ICD (International Statistical Classification of Diseases and Related Health Problems) codes established by the WHO (World Health Organization) or disease name codes established by the Ministry of Health, Labour and Welfare.

[0094] The memory unit 301 stores all facility standards 400 for each medical fee item (~fee), as shown in Figure 4, for example. The memory unit 301 may store disease classification codes in a format that is incorporated into the calculation requirements (corresponding to disease names listed in the "Medical Fee Schedule"), or it may store them separately from the calculation requirements, as shown in Figure 5. As disease classification codes corresponding to "musculoskeletal diseases" listed in the "Medical Fee Schedule," codes representing, for example, "spinal cord injury," "rheumatoid arthritis," and "ligament loss" are stored. Medical fee items may be flagged to allow for determination of whether or not they require a physician's clinical judgment.

[0095] The contents of memory unit 301 have been thoroughly reviewed by multiple experts. For example, calculation requirements that are described as "similar to XX" in the "Medical Fee Schedule" are specifically registered. Items that are not listed in the "Medical Fee Schedule" but require clinical judgment are added as calculation requirements.

[0096] Furthermore, the memory unit 301 stores hospital information, linked to the hospital ID, including the number of beds, the number of doctors, the number of nurses, the types and number of medical devices, and the work status. This information per hospital is necessary for determining facility standards and calculation requirements.

[0097] The memory unit 301 may also store the following information in addition to the information mentioned above: ·UKE file: disease name, date of birth, gender, medical department, medication, medical procedures, score data ·H file: date of birth, severity, nursing care needs data ·EF file: date of birth, gender, ward, medical department, disease name, medication, medical procedures data ·FF1 file: patient basic information, ward, medical department, life history, admission / discharge route, medical condition, care level, outcome data ·Bed function report: bed function, medical department, number of patients, route, staff, number of main procedures, etc. for medical institutions nationwide ·Other publicly available data: prefectural medical information (unified standard), patient survey, demographics, national facility standards list, medical facility survey, hospital report, diagnosis-related group (DPC) data, long-term care service facility / business survey, etc. ·Other hospital-specific data: electronic medical record data, medical affairs 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 uses multiple disease and injury data 320 obtained from a medical institution or nursing care facility 310 to refer to the storage unit 301, derives medical fee items 312, facility standards 313, calculation requirements 314, and fee points 315, and calculates the total theoretical value 321 of the medical fee points that can be calculated based on the current facility configuration data 316. Specifically, if the hospital and patient meet the facility standards 313 and calculation requirements 314 corresponding to the disease and injury data 320, the associated fee points 315 are used as the theoretical value (maximum claimable points) for that disease and injury data. The theoretical values ​​corresponding to multiple disease and injury data 320 are accumulated to derive the total theoretical value 321. The calculation unit 302 calculates the sum of theoretical values ​​for each classification to which the medical fee items belong. The calculation unit 302 also considers additional items and additional points when calculating the theoretical value.

[0099] Furthermore, the calculation unit 302 refers to the storage unit 301 using multiple injury and illness data 320 obtained from a medical institution or nursing care facility 310, derives the medical fee items 312, facility standards 313, calculation requirements 314, and fee points 315, and calculates the total theoretical value 322 of the medical fee points that can be calculated based on the facility configuration data 317 in case of changes.

[0100] Figure 3C shows the current facility configuration data 316, the facility configuration data 317 after the change, and the calculation table 323. It is desirable to set the facility configuration data 317 after the change not unconditionally, but rather starting with facility configurations where the change from the current facility configuration data 316 is small and results in an increase in medical fee points.

[0101] The display control unit 303 calculates the increase from the 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 care facility 310, to the total theoretical value 322 of medical fee points calculated based on the facility configuration data 317 after the change. If the increase is greater than a predetermined value 331, the display control unit 303 displays the change in facility configuration. In addition to presenting the proposed change in facility configuration, the display control unit 303 may also display the actual medical fee points in the current facility configuration data 316 and improvement measures to bring the medical fee points in the current facility configuration data 316 towards the theoretical value.

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

[0103] (Example of display screen on the display unit) Figures 6A to 6C show examples of display screens shown on the display unit by the display control unit 303. The display screen may, for example, present a change in the facility configuration. Alternatively, it may show the actual value of medical fee points in the current facility configuration and the theoretical value of the change where the increase is greater than a predetermined value. Alternatively, it may show the profit in the current facility configuration and the profit in the changed facility configuration.

[0104] Figure 6A is an example of a display screen that shows the actual medical fee points for the current facility configuration data 316, improvement measures to reach the theoretical value of medical fee points for the current facility configuration data 316, and proposed changes to the facility configuration.

[0105] As shown in the example screen 610 in Figure 6A, the calculated amount at the hospital and the theoretical value based on the current facility configuration are displayed for each medical procedure. For example, the hospital has billed 1,027,500 yen for the specific disease treatment management fee, but the theoretical value calculated by the calculation unit 302 is 1,335,000 yen, and the calculation 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 shows that there is a 22% underbilling. Similarly, the actual billed amount and the theoretical value are displayed for cerebrovascular rehabilitation, musculoskeletal rehabilitation, etc. The display control unit 303 may also 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 care facility 310. The "Status" column automatically calculates and displays the percentage of patients with certain diseases and the number of patients undergoing rehabilitation, making it possible to suggest measures that can be taken to improve the calculation rate without changing the facility's structure.

[0106] The "Theoretical Value of Facility Change" column displays the theoretical value of medical fee points based on facility configuration changes that would yield the greatest improvement, and the "Action Plan" column displays the details of facility configuration changes that would yield the greatest improvement. For example, for "Cerebrovascular Rehabilitation," the plan states, "Assuming one unit is performed per patient per day, increasing the number of PTs by one and OTs by two will make 100% of the fees reimbursement possible. In addition, the establishment of a speech-language pathology room is necessary to raise the standards." For "Feeding Function Therapy," the plan states, "The evaluation function of VE / VF needs to be improved. To do this, speech-language pathologists, technicians capable of taking images, and radiologists are necessary. The number of reimbursed cases can also be increased through the intervention of ward nurses."

[0107] Figure 6B is a display screen showing the breakdown of cases where medical fees increase due to a change in medical function. As shown in Figure 6B, changing long-term care beds to community-based integrated care beds requires an increase in the number of nurses compared to when they were long-term care beds (other factors include reducing the length of hospital stay and admitting patients with specific diseases), but the unit price also increases, resulting in increased revenue.

[0108] Figure 6B shows the facility configuration before and after the change, and displays a comment proposing the change in facility configuration stating, "We need to increase the staff by 3 nurses and 3 assistants. We need to increase the number of patients admitted and discharged by 2 per month. Furthermore, adding one more assistant will make it possible to obtain additional fees for the XX department."

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

[0110] Figure 6C shows the facility configuration before and after the change, and displays comments indicating the improvement effects of the change, such as "Operational capacity increased by XX%, and the average cost of medical services increased by XX yen."

[0111] <Processing flow of information processing equipment> Figure 7A is a flowchart illustrating the processing flow of the information processing device 300. This flowchart shows how the CPU, which constitutes the information processing device 300, executes using RAM to realize the components shown in Figure 3A.

[0112] In step S711, the information processing device 300 acquires the current facility configuration data 316. Then, in step S713, it performs 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 modified facility configuration data 317. Then, in step S717, it performs a modified theoretical value calculation process using the modified 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 calculate the theoretical change value for the further modified 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 the theoretical change value is not calculated, in step S725, the information processing device 300 presents the facility configuration data with the largest theoretical change value among those stored in step S721 as the proposed change.

[0115] (Theoretical value calculation process) Figure 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 Figure 7A.

[0116] In step S731, the information processing device 300 acquires injury and illness data. In step S733, the information processing device 300 queries the storage unit 301 using the injury and illness data. In other words, it picks out the medical fee items stored in the storage unit 301 that are linked to the injury and illness data.

[0117] In step S735, the information processing device 300 compares the facility standards and facility information for the selected medical fee items to further narrow down the medical fee items that meet the facility standards. At this time, medical fee items that involve the physician's clinical judgment may be excluded from the calculation of theoretical values. This is because caution is sometimes necessary when determining the theoretical value of medical fee items that involve the physician's clinical judgment. On the other hand, if medical fee items that involve the physician's clinical judgment are already included in the claims data, the theoretical value may be calculated by adding the additional points for the additional items linked to those medical fee items that involve the physician's clinical judgment. In step S737, the information processing device 300 further narrows down the medical items based on the calculation requirements.

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

[0119] (Facility standard determination process) Figure 8 is a flowchart illustrating the flow of the facility standard determination process performed by the calculation unit 302.

[0120] In step S801, the facility standards corresponding to the medical fee items are read from the storage unit 301. In step S803, the hospital's facility structure data is compared with the read facility standards. If the standards are not met, the process may proceed to step S805, where improvement measures are proposed.

[0121] If the hospital's facility structure meets the standards, the process proceeds to step S807, where the staffing structure (number of doctors, number of certified physicians, number of nurses, number of physical therapists, etc.) is compared with the hospital's staffing data and the facility standards read from the memory unit 301 to make a determination. If the standards are not met, the process proceeds to step S805, where improvement measures may be proposed.

[0122] If the criteria are met, proceed to step S809, where the medical device is evaluated by comparing the hospital's equipment configuration data with the retrieved facility criteria. If the criteria are not met, proceed 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 process for calculation requirements) Figure 9 shows the flow of the process for determining the calculation requirements.

[0125] In this example, it is assumed that the calculation requirements stipulate a calculation period of 901 days and a calculation period of 902 for each medical fee item.

[0126] Here, the calculation period is defined by the maximum number of calculations per day (1 in this case) and the maximum number of calculation days (150 days from the onset in this case). In addition, there is a limit of 13 calculations per month if the period exceeds 150 days. The medical fee standards are not limited to those set by the Ministry of Health, Labour and Welfare, and independent standards (maximum 3 times per week, after onset, number of days excluded from calculation: 14) may be established.

[0127] Let's assume that, for example, claim data 903-905 has been obtained as injury data. In other words, it is a femoral fracture with an onset date of June 15th. The actual billed points are 555 points for June and 3700 points for July. Against this, the musculoskeletal rehabilitation fee (I) is calculated as the sum of 2960 points for the 16 days from the onset to the end of June and 5735 points for the 31 days in July, which is the theoretical value.

[0128] As described above, this embodiment automatically selects the "items" that the hospital can calculate based on the current facility configuration data 316 and the modified facility configuration data 317, by referring to pre-registered facility standards and calculation standards, and automatically calculates the "theoretical maximum value" of those items. Then, it presents the facility configuration that should be changed based on the calculated theoretical value that is the largest.

[0129] In summary, according to this embodiment, it is possible to construct a medical fee database / platform and present measures to improve the facility configuration that will increase the revenue of the hospital.

[0130] [Third Embodiment] Next, an information processing device according to the third embodiment of the present invention will be described. The information processing device according to this embodiment differs from the second embodiment in that it presents changes to the facility configuration that take into further consideration the facility's environmental data. For example, as shown in "Joint guidance fee at discharge" in Figure 6A, it presents, "It is necessary to increase the number of collaborating medical institutions in the vicinity by about three. XX Hospital, XX Home, and XX Nursing Care Facility are located nearby." The other configurations and operations are the same as in the second embodiment, so the same reference numerals are used for the same configurations and operations and their detailed explanations are omitted.

[0131] <Configuration of the information processing device> Figure 10 is a block diagram showing the configuration of the information processing device 1000 according to this embodiment. In Figure 10, the same reference numerals are used for components similar to those in Figure 3A, and redundant explanations are omitted.

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

[0133] In Figure 10, an example is shown in which the environmental data of the facility acquired by the conversion unit 1004 is converted into corresponding virtual injury and illness data. However, as shown 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 the theoretical value of the facility configuration modified by the prediction model (AI / machine learning). Alternatively, the conversion unit 1004 may be configured as the prediction model (AI / machine learning). (Conversion Table) Figure 11 shows the configuration of the conversion table 1041 according to this embodiment. The conversion table 1041 is used when the conversion unit 1004 converts the facility's environmental data into corresponding virtual injury and illness data.

[0134] The conversion table 1041 contains environmental data for the facility, including data that influences the number of patients, which serves as the basis for changes to the facility's configuration, both now and in the future. This data includes demographic data of the facility's area, patient / physician numbers in the medical service area, information on nearby hospitals, and regional development plans. It stores hypothetical disease data converted based on this environmental data for the facility.

[0135] (Theoretical value calculation process) Figure 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 Figure 12, steps similar to those in Figure 7B are given the same step numbers, and redundant explanations are omitted.

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

[0137] According to this embodiment, it is possible to present measures for improving the facility configuration that take into account environmental data from outside medical institutions and nursing care facilities.

[0138] In hospital management, there is a fundamental structural principle that profitability will suffer if the medical services provided by the hospital do not match the medical needs of the community. For example, a hospital located next to a university hospital that provides cutting-edge medical care may not have the same demand for the same advanced medical care, resulting in a decrease in patient numbers. In such an environment, the role that the hospital should play may be to act as a support hospital for advanced medical care, accepting patients from the university hospital and serving as a rehabilitation hospital to support their return home. To illustrate further, if the demographics of the region to which the hospital belongs, disease statistics per 100 people, and information on medical institutions in the region are analyzed and calculated using AI (machine learning) or algorithms, it may be determined that the hospital should not continue its traditional surgical services, but rather specialize in and provide "ophthalmology and urology" to meet the needs of local patients. As a result, medical fees will increase, and hospital profits will be maximized.

[0139] Thus, in this embodiment, it is possible to aim not only for optimization of the current patient composition but also for optimization of the patient composition as a whole. In other words, the hospital can determine the type of patients it desires and create a facility configuration that maximizes revenue, or it can consider what kind of patients are in the medical service area and whether it would be better to attract certain patients from neighboring hospitals. Furthermore, it is possible to control long-term care beds on a community-based basis, or to consider the idea of ​​sending long-term care patients out of the hospital, for example, by having ophthalmology patients go to a neighboring hospital depending on the hospital's infrastructure and environment.

[0140] [Fourth Embodiment] Next, an information processing apparatus according to the fourth embodiment of the present invention will be described. Compared to the second and third embodiments described above, the information processing apparatus according to this embodiment differs in that it presents a facility configuration change that further considers the cost of changing the facility configuration. Other configurations and operations are the same as in the second or third embodiment, so the same reference numerals are used for the same configurations and operations and their detailed descriptions are omitted.

[0141] <Configuration of the information processing device> Figure 13A is a block diagram showing the configuration of the information processing device 1300 according to this embodiment. In Figure 13A, the same reference numerals are used for components that are the same as those in Figure 3A or Figure 10, and redundant explanations are omitted.

[0142] The information processing device 1300 includes a display control unit 1303. The display control unit 1303 acquires facility configuration data 317 in the event of a change, calculates the cost of changing the facility configuration, and calculates the net profit by subtracting that cost from the increase in revenue due to the change in facility configuration. If the calculated profit is greater than a predetermined value 1331, it then presents the facility configuration change.

[0143] (Display Control Unit) Figure 13B is a block diagram showing the configuration of the display control unit 1303 according to this embodiment. In Figure 13A, the same reference numerals are used for components similar to those in Figure 3B, and redundant explanations are omitted.

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

[0145] <Processing flow of information processing equipment> Figure 14 is a flowchart showing the processing flow of the information processing device 1300 according to this embodiment. In Figure 14, steps similar to those in Figure 7A are given the same step numbers, and redundant explanations are omitted.

[0146] In step S1418, the information processing device 1300 calculates the difference by subtracting the current total theoretical value of 321 from the total theoretical value of 322 for the changes. Next, in step S1419, it calculates the profit increase by subtracting the facility change costs from the revenue increase due to the difference. Then, in step S1420, it determines whether the profit increase (= difference revenue increase - change costs) > predetermined value 1331. If the profit increase ≤ predetermined value 1331, it returns to step S715 and repeats the process. If the profit increase > predetermined value 1331, in step S1421, it stores the changed facility configuration data and the changed profit. In step S1425, the information processing device 1300 presents the changed facility configuration data that yields the largest profit.

[0147] The cost burden for changes to the facility configuration includes both temporary costs such as medical equipment and devices, and ongoing costs such as personnel expenses. These costs should be taken into consideration when calculating the cost burden to be deducted from revenue. Furthermore, depreciation may be considered when calculating the cost burden for medical equipment and devices.

[0148] According to this embodiment, it is possible to present a solution for improving the facility configuration that takes into account the cost burden of changing the facility configuration.

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

[0150] <Configuration of the information processing device> Figure 15 is a block diagram showing the configuration of the information processing device 1500 according to this embodiment. In Figure 15, the same reference numerals are used for components that are the same as those in Figure 1, and redundant explanations are omitted.

[0151] The information processing device 1500 comprises 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 the dependent variable and disease data and facility configuration data as explanatory variables. The prediction unit 1502 corresponds to the calculation unit 102 in Figure 1 and takes multiple disease data as input to predict a first theoretical value 1521 and a second theoretical value 1522 using the learning model 1510. The display control unit 1503 presents a change in facility configuration 1532 if the increment from the first theoretical value 1521 to the second theoretical value 1522 is greater than a predetermined value 1531. In the case of the third embodiment, facility environment data is added as an explanatory variable and the learning model is generated.

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

[0153] [Other embodiments] Although the present invention has been described above with reference to embodiments, the present invention is not limited to the above embodiments. Various modifications to the structure and details of the present invention can be made, as can be understood by those skilled in the art within the technical scope of the present invention. Furthermore, any system or apparatus that combines the separate features included in each embodiment is also within the technical scope of the present invention.

[0154] Furthermore, the present invention may be applied to a system composed of multiple devices or to a single device. Moreover, the present invention is also applicable when an information processing program that realizes the functions of the embodiment is supplied to a system or device and executed by a built-in processor. The technical scope of the present invention includes programs installed on a computer to realize the functions of the present invention on a computer, or a medium storing such a program, a server that downloads such a program, and a processor that executes such a program. In particular, at least a non-transitory computer-readable medium storing a program that causes a computer to execute the processing steps included in the embodiments described above is included in the technical scope of the present invention.

Claims

1. Regarding medical procedures that may be performed in a medical facility, Medical fee items established by the Ministry of Health, Labour and Welfare, The medical fee points determined by the Ministry of Health, Labour and Welfare for the aforementioned medical fee items, Regarding the facility composition of medical facilities corresponding to the aforementioned medical fee items, the facility standards established by the Ministry of Health, Labour and Welfare, A memory unit that stores them in association, A presentation unit calculates a theoretical value of the medical fee points for the facility configuration of a specific medical facility based on the facility standards stored in the memory unit, facility configuration data of a specific medical facility, and patient number data related to predetermined disease data at the specific medical facility, and presents improvement measures for the facility configuration that will increase the theoretical value of the medical fee points through changes. Equipped with an information processing device.

2. 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 personnel, the configuration of a rehabilitation center, the presence or absence of specialized space configurations, and the types of medical equipment.

3. The system further includes a profit calculation unit that calculates profit by subtracting the costs incurred when changing the facility configuration of the specific medical facility from the increase in revenue obtained by increasing the aforementioned medical fee points. The information processing device according to claim 1, which, when the aforementioned profit is greater than a predetermined value, presents a change in the facility configuration of the specific medical facility.

4. A computer-based information processing method, Regarding medical procedures that may be performed in a medical facility, Medical fee items established by the Ministry of Health, Labour and Welfare, The medical fee points determined by the Ministry of Health, Labour and Welfare for the aforementioned medical fee items, Regarding the facility composition of medical facilities corresponding to the aforementioned medical fee items, the facility standards established by the Ministry of Health, Labour and Welfare, Referencing the memory unit that stores the associated information, An information processing method including a presentation step in which the display control unit calculates a theoretical value of medical fee points for the facility configuration of a specific medical facility based on facility standards stored in the memory unit, facility configuration data of a specific medical facility, and patient number data related to predetermined disease data at the specific medical facility, and presents improvement measures for the facility configuration that would increase the theoretical value of medical fee points through changes.

5. Regarding medical procedures that may be performed in a medical facility, Medical fee items established by the Ministry of Health, Labour and Welfare, The medical fee points determined by the Ministry of Health, Labour and Welfare for the aforementioned medical fee items, Regarding the facility composition of medical facilities corresponding to the aforementioned medical fee items, the facility standards established by the Ministry of Health, Labour and Welfare, Referencing the memory unit that stores the associated information, An information processing program that causes a computer to perform a suggestion step of calculating a theoretical value of medical fee points for the facility configuration of a specific medical facility based on facility standards stored in the memory unit, facility configuration data of a specific medical facility, and patient number data related to predetermined disease data at the specific medical facility, and suggesting improvement measures for the facility configuration that would increase the theoretical value of medical fee points through changes.

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