2020 Volume 21 Issue 1 Pages 20-24
2014年度診療報酬改定で新設されたADL維持向上等体制加算の病院経営への影響を明らかにすることを目的に、加算点数実態調査と分析をおこなった。対象は、2015年12月からの1年間に、病棟専従理学療法士を配置した病棟（専従病棟）1,558例と、後に病棟専従配置を検討しているシミュレーション病棟（SIM 病棟）1,140例である。入院延べ日数からADL維持向上等体制加算除外日数を引いて加算点数を算出し、疾患別リハビリテーション点数と合わせて患者カルテから後方視的に比較検討した。専従病棟とSIM病棟でそれぞれ、入院延べ日数、12,996日と12,076日が算出され、15日以上の入院日数2,084日と2,842日、疾患別リハビリテーション日数1,356日と595日、病棟専従理学療法士非勤務日数1,772日と1,926日が算出された。加算日数は、7,784日と6,713日が算出され、加算単独の年間点数は622,720点と537,040点、疾患別リハビリテーション点数は、135,080点と72,860点であった。総合計点数は、専従病棟757,800点、SIM病棟609,900点で、専従病棟が147,900点多かった。ADL維持向上等体制加算に準ずる病棟専従理学療法士の配置は、リハビリテーション関連点数の増加を認め、専従理学療法士の人数や非勤務日数、リハビリテーション運用が同様な病院では、経済的に優位な点が認められる。
The additional medical coverage to maintain or improve activities of daily living started in 2014. This coverage is paid for physical therapist working full time in ward. The acute phase hospital introducing this coverage was as low as 4.9%, and in many hospitals, decline in revenue is stated as a reason not to introduce it. Little has been reported evaluating this coverage from an economic point of view. The purpose of this study is to examine the impact of this coverage on hospital management. This is a retrospective study at Showa general hospital. Study subjects were patients who stayed between December 2015 and November 2016 in the ward in which a physical therapist worked full time, and patients who stayed in the ward evaluating the need for placement of a physical therapist. The collected record contains number of days stayed. The number of patients in the ward where physical therapist worked full time was 1,558, while simulation group had 1,140. The total score of the additional coverage and fee-for-service rehabilitation was 147,900 higher for dedicated group than for simulation group. The implementation of additional medical coverage to maintain or improve activities of daily living leads to early initiation of rehabilitation, and it is expected to be effective for improving medical quality and contributing to hospital management.
