Japanese Fee Schedule Revisions

Heisei28Revision of annual
Version as of March 4, 2016
Overview of medical fee revision

in FY28
(DPC system related part)
Medical Division, Health Bureau, Ministry of Health, Labour and
Welfare
1
1 Background to DPC/PDPS introduction
2 Revision of coefficients by medical institution
3 Revision of the diagnosis group classification score table
4 Revision of calculation rules
5. Review of requirements as a DPC target hospital
6 Review of the Discharged Patient Survey (DPC data)
2
DPC/PDPSBackground of introduction (1) Heisei 2 3 January 2

J a p a n Chuikyo General
1
 The DPC system (DPC/PDPS) was introduced for special function

hospitals based on a Cabinet decision in April 15. It is a comprehensive
payment system per day based on the diagnosis group classification that
targets the .
(Reference) Excerpted from the basic policy based on the provisions of Article 2, Paragraph 2 of the
Supplementary Provisions of the Act to Partially Revise the Health Insurance Act, etc. (Cabinet decision
on March 28, 15)
Regarding acute inpatient care, a comprehensive evaluation of special function hospitals will be carried out
from FY15. Mata,
While examining the impact, the characteristics and severity of the disease were reflected in an appropriate
[January 21, 23 General Meeting of the Japan-China Medical Association, Total-3-1 (excerpt)]
・Prior to the introduction of DPC/PDPS, a trial of a comprehensive payment system for
acute inpatient medical care equivalent to one hospitalization at 10 hospitals including
national hospitals from November 10 was implemented (until March 16).
・In the trial of the comprehensive payment system implemented before the introduction of
the system, even for the same disease, the length of hospitalization varies greatly
depending on the patient, and the comprehensive evaluation system per day has a smaller difference between the comprehensive range
score and the score actually taken for treatment compared to the comprehensive evaluation
system per hospitalization, even if the number of days of hospital stay varies, and there is
an incentive to reduce the daily unit price. As a result, the current DPC/PDPS, which calculates a
fixed amount of remuneration per day according to the number of days in the hospital, was
introduced.
3
Background to DPC/PDPS
Heisei 2 3 January 2 1
J a p a n Chuikyo General
* About DPC/PDPS
「DPC; Diagnosis Procedure Combination Diagnostic
Group Classification " Diagnosis
Procedure Treatment (Surgery,
Examination, etc.) Combination
Combination
「PDPS; Per-Diem Payment SystemDaily Blanket Payment System"

Per-Diem Daily
* Regarding the name "DPC",
(1) Daily fixed remuneration calculation system based on diagnosis group classification
(2) Diagnosis group classification as patient classification
Originally, DPC (Diagnosis Procedure Combination) is an abbreviation created in the
sense of (2), and the case of meaning (1) is mixed. In light of the suggestion that the
distinction between the two should be clarified, the abbreviation of the DPC system as a
payment system is DPC/PDPS (Diagnosis Procedure Combination) / Per-Diem Payment
System) on December 16, 22 It was sorted out at the DPC evaluation subcommittee
meeting on Sunday.
4
Changes in DPC target hospitals
• After the introduction of the system,DPC/PDPSThe target

hospitals will be gradually expanded, and28Expected on April
1,1,667hospital・約49Million bedsandAll in one
About General Beds55％It has come to be occupied.
Changes in the number of hospitals subject to DPC
Fiscal Year and Data Timing Number of Number of Heisei15年
hospitals general
hospital 82 wards 66,497 beds
beds
Target hospitals (April H15) 82 66,497
Hospitals (April H16) 144 89,330
Target hospitals (April H18) 359 176,395
Target hospitals (July H20) 713 286,088
Target hospitals (July H21) 1,278 430,224
Target hospitals (July H22) 1,388 455,148
Target hospitals (April H23) 1,447 468,362
Target hospitals (April H25) 1,496 474,981 Heisei28年
1,667 495,227
Target hospitals (April H28)
beds
(Estimate) 1,667 495,227
* General hospitals refer to hospitals other than hospitals with only psychiatric beds and tuberculosis beds (Medical Facility Survey).
5
6
Revision of adjustment factor (1)
(1) Review adjustment factorsResponse to
(1) The adjustment coefficients set for the smooth introduction of DPC/P D PS will be replaced in stages with the
basic coefficient and the functional evaluation coefficient II in two revisions, including this revision. In this revision, 7 5% of the
adjustment part is replaced with a functional evaluation coefficient II. The remaining adjustment part is
set as the "provisional adjustment factor"
to do.
〔Number of provisional coordinators at Medical institution A〕

=([Adjustment factor of medical institution A (*)] -[Basic coefficient of medical institution group to
which medical institution A belongs])×0.25
* "Adjustment factor" is based on the definition at the time of establishment of the system (Heisei 15)
(2) Transitional measures (mitigation of drastic changes) related to the coefficients for each medical institution of individual
medical institutions
○ In the revision of medical service fees in FY2 4 and FY26, from the viewpoint of mitigating drastic changes in medical service
fees due to the replacement of adjustment coefficients, etc., the estimated medical fee fluctuation
rate (including the volume part) due to the influence of fluctuations in the medical institution coefficient
of individual medical institutions ) did not fluctuate by more than about 2%.
○ Adjust the provisional adjustment coefficient so that the estimated rate of change in medical service fees (including the volume
portion) does not fluctuate by more than about 2% with respect to fluctuations in the coefficients for individual
medical institutions due to the replacement of the provisional adjustment coefficient (replacement of 50% → 75% of the adjustment). 。
7
Revision of adjustment factor (2)

Replacing adjustment factors
 The adjustment coefficients set for the smooth introduction of DPC/PDPS will be replaced in stages with
the basic coefficients and functional evaluation coefficients II in two revisions, including this revision, and will
continue to be replaced with the basic coefficients and functional evaluation coefficients II in this revision.
Adjustment H24 revision H26 revision H28 revision H30 (assumed)
25% 50% The

75%
A
Functional
Evaluation
B Factor II
A
A C
C B Func
C B tiona
C l
A B Eval
Interim
uatio
Base base
Foundation Foundation Heisei 28 Foundation Foundation
ClerkChangeClerkClerk
Number Number Number Number
From the adjustment coefficient, gradually approach the basic
ＡＢＣ Hospital Hospital ＡＢＣ Hospital Hospital

Hospital Hospital
ＡＢＣＡＢＣ A
Hospital Hospital Hospital ~
Hospital Hospital C
Hospital H
o
s
p
i
t
a
l
* Imagine 8 assuming Hospital A ~ Hospital C with the same functional evaluation coefficient II
Method of calculating medical fees in

Comprehensive evaluation part (hospital fee part)
Diagnosis group classification score表 Medical Institution Section数
Basic coefficient
＋
Functional evaluation
Daily points for × ＋ ×
Number of
each diagnostic
Functional Evaluation
＋
Interim Adjustment
Piecework evaluation part (doctor-fee remuneration part, not

inclusive, etc.)
Oper Additional basic
hospitalization fees, etc.
＋ ative calculated for each patient
anes Costs of drugs and
Prescribed w
9
Review of medical institutions

II. Selection
 II. Evaluation of internal medicine skills will be added to the performance
requirements for the selection of group hospitals (high-performance hospital groups).
• For each of the following [Performance Requirements 1] ~ [Performance Requirements 4], from the lowest value (excluding
outliers) of Group I (main hospital of the university hospital)
High-level medical institutions are classified as Group II.
【Performance requirement 1】: Density of treatment Average daily range volume score (corrected for all hospital patient composition;
Correction for external factors)
【Performance requirement 2】: Implementation of Number of clinical residents per licensed bed
physician training (Up to the second year after obtaining a license at a core clinical training hospital)
(3a): Surgical case Gaihoren Surgery Index per Case
Gaihoren (3b) : DPC calculated index per hospital bed

Tentative Plan
【Performance requirement 3】: Implementation of (3c) : Number of surgical cases
advanced medical technology (3A）： Percentage of cases
(Satisfy at least 5 out of 6 items)
Specific Internal (3B) : Number of cases per bed calculated by DPC
Medicine
(3C) : Number of target cases
【Performance requirement 4】: Implementation of Complexity index (after severe DPC correction)
medical care for critically ill patients
10
Revision of medical institutions and basic coefficients

[Basic coefficient of each hospital group (Heisei 28)]
={[Average value of the comprehensive range volume score of each hospital group*1*2]×[Revision rate*3]
/[Average value of inclusive score*4*5 based on DPC score table*2 for each hospital group ]
* 1Actual value based on the volume score table before revision (discharge patient survey).
However, the revision of the basic hospitalization fee and the comprehensive scope of the
revision will be reflected in the amendment.
*2Average value per admission for all hospitals and all inclusive patients (after revision) in the
relevant hospital group.
* 3 In the 28th revision, it will be (1-0.0103). The recalculation of special market expansion will be
reflected separately in the score table.
*4 The DPC score table is tabulated and scored excluding exceptional cases (outliers).
Furthermore, since the revision rate is also reflected in the basic coefficient, the weighted
average value of the basic coefficient for all hospitals exceeds 1.0.
DPC score before multiplication DPC Hospital Group I (University 81
Aggreg
1.1354
H it l M i H it l)
The number of DPChospitalⅢ群 ation in 1.0296
inclusive progres
sum s 1.0499
points.
11
Revision of Functional Evaluation Coefficient I (1)

What is Functional Evaluation
Regarding the functional evaluation coefficient I, "addition calculated for all inpatients at the relevant
medical institution" and "correction value of the basic hospitalization fee" in the piecework evaluation
1． Evaluate the difference in (Example).

basic hospitalization fees Basic charge for 7:1
The diagnosis group hospitalization in general wards
classification score table is Basic 7:1 hospitalization fee for
prepared based on the "basic charge for specialized hospitals
hospitalization of general wards 10:1", and the difference
between the basic charge for hospitalization of each hospital
Basic charge for 10:1
the "basic charge for admission
and
hospitalization at specialized
to general wards of 10:1" is
2． "Addition of basic (Example).
hospitalization charges, etc.", etc. Addition of comprehensive
Evaluate "additions calculated hospitalization system
by all inpatients who Physician clerical work
h i l l l DPC assistance system added
Medical record management
12
Functional evaluation factorⅠRated as
"Addition of basic
Major Changes (Overview)
A200 Addition of comprehensive
A204 Regional Medical Support Hospital
A204-2 Clinical Training Hospital Inpatient Care
A207 Medical record management system
A207-2 Physician clerical work assistance ⇒ Added to Special Function Hospitals
of the hospital A234 Medical Safety Measures Surcharge
evaluation A234-2 Infection prevention measures added
A244 Ward Pharmacy Service Implementation ⇒ Establishment of Ward Pharmacy Service
A245 Data submission addition
A230 Medical management at the time of
A230-2 Psychiatric Community Transition
A243 Addition of generic drug use system
⇒ Change from 25:1 to 30:1 at night,
A207-3 Addition of acute nursing assistance
and new addition of night nursing
Nursing A207-4 Nursing staff night placement surcharge ⇒ Subdivision into 12:1 addition 1.2 and 16:1
Medical value A213 Nursing placement addition
value ⇒ Establishment of a 75:1
A214 Nursing Assistance Addition
nighttime nursing assistance
Evaluation of A218 Regional addition ⇒ Establishment of a new Grade 7 site
value A218-2 Remote Island Addition
A224 Aseptic treatment room management
Evaluation of A225 addition
special
A229 Psychiatric isolation room management
hospital
A219 Addition of medical treatment
A220 Special Addition to the Treatment
A220-2 Special Addition to the Treatment
A221 Special Addition to the
Evaluation of
A221-2 Treatment Environment for
the
recupera A222 the Seriously Ill Special
A222-2 Addition to the improvement of the
A223 Addition of Clinic Recuperation Bed
A223-2 Addition to Improvement of Clinic Bed
13
Revision of Functional Evaluation Coefficient II (1)

New Clause of Functional Evaluation Coefficient II
 Evaluation is performed by 8 indices with the addition of the severity
index.
 Evaluation of the deviation rate of patient severity, which cannot be expressed in the diagnosis group classification score
t bl
activ Revised in Heisei

e
28
(1) Health insurance Review → (1) Health insurance
medical treatment index medical treatment index
(2) Efficiency Index As it is (2) Efficiency Index
(3) Complexity index As it is (3) Complexity index
(4) Coverage index Review → (4) Coverage index
(5) Emergency Medical As it is (5) Emergency Medical
Care Index Care Index
(6) Regional Health Care Review → (6) Regional Health
Index Care Index
(7) Generic drug index Review → (7) Generic drug index
New (8) Severity index
How to calculate the evaluation index (index)

Evaluate [inclusive range workpiece score] / [comprehensive score based on diagnosis group classification score table]
at the medical institution.
(H th h i l t th dd f h it li ti hi h h
14
*1 In consideration of specialized hospitals and

index coefficie standardi specialized medical care functions, the lower and
Specific settings nt Concept of minimum values are set at 30% tile values in Group
zation
Upper Lower minimu evaluation （※4） III.
limit limit m value *2 Set for the purpose of evaluating the difference
Medical treatment (Not set because of the fixed coefficient Assessed by group × in remuneration *3
covered by health value.) ） The upper limit shall be 70%.
insurance
*4 Standardization is performed so that the variance
efficiency 97.5%tile value 2.5%tile value 0 Evaluated for all ○
groups is equal (standardization to the average value of
the variance to be standardized).
Complexity 97.5%tile value 2.5%tile value 0 Assessed by group ○
Coverage 1.0 0（※1） 0 Assessed by group ×
Emergency 97.5%tile value 0（※2） 0 Evaluated for all ×
Medicine groups
Community 1.0 0 0
Medicine Assessed by group ×
(Quantitative)
(System). 1.0 0 0
97.5%tile value
Generic drugs (※3) 2.5%tile value 0 Evaluated for all ○
groups
Severity 90%tile value 10%tile value 0 Assessed by group ×
Image of standardization
Number of hospitals Revision of Functional Evaluation Coefficient II (2)
Weighting of Functional Evaluation Factor II
So that the variance of the coefficients
 The reward allocation (weighting) to each coefficient of the of
functional evaluation
interest is constant
coefficient
In theIIindex
shall bemedical
of each divided equally.
institution However, the weighting Standardize
of each to. coefficient is
d di1.59 power
d processing
Number of hospitals
15
Review of Functional Evaluation Coefficient II (3)

Review of each item in Functional
 We will make necessary revisions to the Health Insurance Treatment Index, Coverage
Index, Regional Medical Care Index, and Generic Drug Index.
①Health insurance treatment index (for all medical institutions)1After points are given, points are added or deducted according to
each evaluation item.）
0.05 pips plus • Evaluation of educational efforts to disseminate appropriate health insurance medical care (Group I only)
points • Publication of hospital information (from FY29)
0.05 points • Submission of appropriate DPC data (evaluation due to inconsistencies between forms)
deducted • Request a receipt with the appropriate injury or illness name code
• The main hospital of a university hospital with a branch hospital (DPC target hospital) with a higher function than the
main hospital (*) (Group I only)
* If five or more of the nine performance requirements for the selection of Group II hospitals exceed the main
hospital.
• The main hospital of the university hospital that fell under the outlier when determining the performance
requirements for group II (group I only)
• University hospitals that do not have psychiatric beds or have a track record of medical protection
hospitalization or hospitalization for measures (Groups I and II)
(4) Coverage index
• In group III, the minimum and minimum values are 30% tile values.
 After leaving certain considerations for the functions of specialized hospitals and specialized medical treatments, the
evaluation method will be changed so that the functions are better reflected.
(6) Regional Medical Care Index

• Abolished evaluation of regional cancer registries (from FY29)
• Added evaluation items for the system for providing advanced and advanced medical care (from FY29)
(7) Generic drug index

• The upper limit of the evaluation is 70%.
 The upper valuation limit was raised to the government's target of 70%.
16
17
Revision of Calculation Rules (1)

Review of the scoring method
 Day III (the end date of the comprehensive calculation) is an integer multiple of 30 from the date of hospitalization, and
the score of the hospitalization period III is adjusted.
-15% actual medical resource input

Extended to 60 days
Of the 2,410 payment categories 426 types
for hospitalization period III,
In the payment classification of average
resource inputs, adjustments are made In case of high
Adjusted to the average value.
Day I, Day II, Day 35 ,

Discharge Day 60 Conventional Day III.
sun
Distribution of Day III by Diagnosis Group Classification (Payment

Classification)
2000
1462
1500 1246
1000 806
645
500
60 19 6 p
0 Ⅲ
30 60 90 120 150 180 210 日
1
Revision of calculation rules (2)

Review of the scoring
B Classification of diagnostic groups with high medical
method Hospitalization resource input in the early stages of hospitalization
A General diagnostic Period I of
group classification
Medical 229classify
1,952 Resources per
Day
Ａ＝Ｂ
classificati
ons
Average input A
A 15% Ａ＝Ｂ
1 in hospital stay
per day with 1 hospital 1 Daily Exposure
B
stay Ｂ Medical Resourcesの
Average input Average input 15% or of medical
of medical 15% or of medical resources per day for
resources resources per day for hospital stay III
hospital stay III.
Of the average input, the
low
C
o
Length of Length of m
Length of Length of Length of e
hospital I. Hospitalizati
hospital I. Hospitalizati hospital stay ou
g on II
on II III t
o
o Length of hospital stay III. High
Day I , Day II , Day III
第Ⅰ日第Ⅱ日第Ⅲ日 (25 parsens (average hospital stay (average length of hospital stay +
(25 parsens (average hospital stay (average length of hospital stay + 2 SD
2 SD tile value) in days) or more than 30 integer multiples of the number of days )
tile value) in days) or more than 30 integer multiples of the number of days
)
D Classification of diagnostic groups related to
C Diagnosis group classification with low medical resource
input in the early stages of hospitalization high-cost drugs, etc.
per
A: Points
Ａ＝Ｂ hospitalization ithi th
B: Points per hospitalization of
Heisei28Revision
1Length of
of annual
hospital stay 39
で 190 classification classifications
Ａ 10% Ａ
Thick dotted line: Conventional point
1 day of 10% or length of hospital stay III.
Average input Ｂ Low average daily input of Average daily
of medical medical resources input of
resources medical Conventional method (15% or
resources 10%) or medical treatment per day
during one for hospitalization period III Low
hospital stay average resource input
Length of Length of Length of hospital stay III yie yie
hospital I. Hospitalizati ld ld
on II
Ｂ
Day I , Day II , Day III

(25 parsens (average hospital stay (average length of hospital Day I , Day II , Day III
stay + 2 SD
Tile Value） days） More than 30 integer nu
(Fixed in 1 day）
hospital.)＋２ＳＤ
(Average in.)院 (Average number of days in
19
multiples日
days) or more than 30 integer multiples of
the number of days)

Review of the scoring system D
Viewpoints related to target selection of the scoring method D
○ Sufficiently widespread (sufficiently large number of cases nationwide, performed at many facilities, including a
certain percentage of the total number of cases for which chemotherapy is performed for the disease)
○ The number of discharges from hospitalization within 7 days is above a certain level.
○ Drugs related to chemotherapy, etc. per hospitalization are high
○ Excludes those performed more than once during hospitalization
* Chemotherapy was analyzed by regimen (combination of cancer chemotherapy drugs used in hospitalization units).
* Regarding examinations, etc., we examined the tests defined in the diagnosis group classification score table in 26.
The following six items are newly scored.DAdded as a target ofる

H28DPC Averag
cont
(No minor injury or e
disease branching) ent number
of days
in
hospita
l
060020xx99x7xx Malignant tumors of the stomach Ramucilumab 5.7
080005xx99x2xx Melanoma Nivolumab 3.7
010070xx9910xx Cerebrovascular accident E003 Contrast injection 2.6
procedure
100020xx99x2xx Malignant tumors of the thyroid gland I131 Internal 6.0 20

Review of the scoring method
 Introduced an evaluation method (CCP matrix) that takes into account severity into part of the diagnosis group classification score table
Conceptual
diagram Hand surgery and treatment 2 severity, etc.
(Tree CCP Matrix Payment
diagram) Nashi Classification
classifi
cation 01 Classification p01
Pear
Classif
ication 02
Pear
なし
diabetes classif
y03
Ari
Classif
ication 04
A
Nashi r
i
classifi
cation 05
Pear
Classif
Ari
tion 07 Classific p05
Classif ation
ication 08 p01
classific
ation
p02
classific
ation
p04
classific
ation
p01
classific
ation
p01
classific
ation
p05
classific
ation
s
There are 5
final payment
classification
Diagnostic group Number of diagnostic group Payment
Comorbidity classification classifications Classification
Complication 010060 Cerebral infarction 1584 classification 7 classification
Procedure 040080 Pneumonia, etc 1104 classification 16 classifications

100060 ~100081 Di b 144 l ifi i 27 l ifi i
21

Review of the diagnosis group classification score table
 The diagnosis group classification was reviewed and the classification was as follows in the 28th
MDC DPC Code Inclusive Payment

Timing of revision Number
number (Total) Counterpart Classificatio
of injuries DPC数（※２）
（※１） n
and （※３）
illnesses
April 16 575 2,552 1,860
April 16 591 3,074 1,726
April 16 516 2,347 1,438
April 18 506 2,451 1,572
April 18 507 2,658 1,880
April 18 516 2,927 2,241
April 18 504 2,873 2,309
April 18 506 4,918 4,244 2,410
*1 MDC: Major Diagnostic Category Major diagnostic group

*2 Number of DPCs covered at the time of revision
*3 In the classification using the CCP matrix, multiple diagnostic group classification
numbers are
They have the same payment classification. 22
23

Review your billing method
 While admitted to a ward subject to DPC, either the calculation based on the diagnosis group classification score
table or the calculation based on the medical score table shall be unified for one admission.
July Aug
ust
Disc
harg
e
Diagnostic group DPC算定（A） Volume calculation
classification A
Date of admission III. Changed to diagnosis group

classification B at discharge
Diagnostic group DPC calculation （B）

classification B
Unadjustable in inclusiveness and

volume
Current billing DPC算定（A） Volume calculation
methods
How to claim DPC Calculation (B) DPC Calculation

hospitalization (B)
Unified (revised) July will be re-billed
・It was found that the rate at which the DPC code was changed for each hospital was different for each
hospitalization period.
・It is thought that medical institutions can reduce the number of cases that are subject to rebilling by
working on more appropriate coding.
24

Review of treatment of readmission within 7 days
 If a "non-classifiable code" is used for the name of the disease that triggered readmission, it will be
treated as a series of hospitalizations due to hospitalization under the same disease name.
In and out
DPC：A
①②③④⑤ ⑥ ⑦⑧⑨⑩
7Within [How to think about the number of days related to "7
days days or less"]
○ Date of discharge from the most recent DPC calculation bed
○ Date of readmitted to DPC hospital bed
In and out
DPC：A Ineligible wards DPC：A'
①②③④⑤ ⑥⑦⑧⑨⑩⑪⑫ ⑬⑭⑮⑯
【Concept of "same injury or illness"】
Within 7 days ○ If the first two digit codes (MDCs) of the DPC are the
same depending on the "name of the injury or illness for
入退入退 which the most medical resources were invested" at the
DPC：A Not DPC：A' time of the previous hospitalization and the "name of the
applicable
①②③④⑤ ⑥ ⑦ ⑧days⑨⑩ ⑪⑫⑬⑭
injury or illness that triggered hospitalization" at the time
7Within
of readmission, it will be a series.
○ If a "classification incompetence code" is used as the
入退入退 name of the disease that triggered hospitalization at the
DPC：A Not DPC：A'
applicable
① ② ③ ④ ⑤ ⑥ ⑦ ⑧7Within
⑨ ⑩ ⑪⑫⑬⑭ Example of "unclassifiable
days code" ○ R06.0 Difficulty breathing
○ R00.2 Palpitations ○ R63.0 No appetite振
Entry/ Not
○ R05 Cough
exit
DPC：A DPC：A'
①②③④⑤ ⑥⑦⑧⑨ ⑩⑪⑫⑬⑭
等
Within 7
days 25
26
Heisei28Revision of annual medical service fees
Review of requirements as a DPC

Important as a DPC target
hospital
 In order to strengthen the system for appropriate coding, the requirement for the number of
coding committee meetings will be raised from two to four times a year.
Requirements: Twice a year Requirements: 4 times a year
(It is desirable to hold it monthly) (It is desirable to hold it monthly) ・ Multidisciplinary participation
・Deepen understanding of the DPC
system and promote appropriate
coding.
・When discussing actual cases, the
attending physician shall attend and
inform them that they will not
discuss the amount of medical
service fees.
Reference: Requirements for DPC target hospitals

Notification of 17:1 hospitalization basic fee or 10:1
hospitalization basic fee 2 A207 Notification of addition to
medical record management system
(3 ) Participation in the "Discharged Patient
Survey" and "Special Survey" The value of
the data bed ratio per month is 0.875 or more
(5) The system necessary for determining the appropriate classification of diagnostic groups is in place. Appropriate coding
committee quarterly
Holding etc.
2
28
Review of the Discharge Patient

Review of the Discharged Patient Survey (DPC data)
 Review the survey items.
Form 1 [Review of existing items]

Project name Target patients cont way of
ent thinking
Discharge All patients Enter "cured and light" as an To improve the accuracy of input of survey items.
Information outcome at the time of
discharge
Readmission All patients From the DPC target ward, To improve the accuracy of input of survey items.
survey and "Plan
relocation survey Enter in case of "unplanned"
readmission
CAN0040 Cancer Patients with Added subcutaneous to the If the current
patients/chemot
herapy chemotherapy "presence or absence of item is 0.none
not chemotherapy" item. 1. Yes (oral)
2. Yes (transvenous or transarterial)
3. Yes (other)
However, since there are also drugs that are administered
subcutaneously.
M040020 If you are over 15 years Apart from the current According to the current survey, pneumonia associated
Patients with old, and the medical
pneumonia/sever resource disease name classification of with medical and nursing care is included in community-
ity is "040070 Infu "community-acquired acquired pneumonia (the name of the disease at the time
Luenza, viral pneumonia" of hospitalization is pneumonia), but it is closer to
"040080 pneumonia, pneumonia" or "nosocomial
In case of "acute pneumonia", nosocomial pneumonia than community-acquired
bronchitis, acute Added "pneumonia pneumonia, making it difficult to intervene and long-term.
bronchiolitis" associated with medical and
nursing care".
29

Review of the Discharged Patient Survey (DPC data)
Form 1 【New Item】
Project Target content way of
name patients thinking
Hospitalizatio All patients Added "presence or absence of self- As an inpatient treatment for depression, moderate rest hospitalization is
n Information harm or suicide attempt" the amount of medical resource input
(psychotherapy, drug therapy, etc.) is presumed to be very different.
M050010 Major injury or For patients with heart failure, (1) body According to a registry study of acute heart failure, body blood pressure,
heart rate, and heart rhythm are related to severity. Since the NYHA
heart illness, medical blood pressure, (2) heart rate, and (3) classification could not show the relationship with medical resource input,
Incomplete
patients resources, or heart rhythm are added immediately it was replaced with the existing NYHA classification.
after hospitalization or visit. It is necessary to consider whether it is possible to make a precise
medical
/NYHA assessment of the severity.
resources 2
But in case of
heart failure
[Other simplified and refined items]

Project Target content way of
name patients thinking
Patient All patients Investigation of current pressure ulcer Currently, it is mandatory to be described in the survey at the time of
Profile/
bedsore scores is essential admission and discharge, but the survey items
Only patients who have calculated the In order to simplify the situation, why not limit the scope only to the time
basic hospitalization fee and additions of entry and exit of the ward, which is required in the medical score
are required to be listed. table?
Diagnostic All patients Writing of the injury and illness When requesting a receipt, a claim is made by the Injury and Illness
information name code by the injury and illness Name Master for Receipt Computer Processing.
name mask for receipt computer
processing.
Diagnostic All patients Describe the presence or absence of From January 1, 27, the Act on Medical Care for Patients with
Intractable Diseases"
information designated intractable diseases (patients
eligible for medical expense subsidies) It was enacted, expanding the number of diseases eligible for medical
and the name of the disease (notification expense subsidies to 306. Medical Institutions
number, etc.). Because it is necessary to grasp the status of each initiative.
Diagnostic All patients In the case of scheduled hospitalization, In order to request a more accurate description of the disease name, in
information on the day of hospitalization, " the case of scheduled hospitalization, the date of hospitalization
The name of the disease that triggered to determine the name of the disease that triggered hospitalization. In
it. addition, even in the case of unplanned hospitalization, it is desirable to
confirm the name of the disease within 3 days.
Diagnostic All patients Maximum number of comorbidities and The limited number of names of injuries and illnesses that can be entered
information sequelae that can be filled (currently "names of comorbid injuries and diseases at the time of
to 10. hospitalization (four)" and "names of injuries and diseases that develop
after hospitalization (four)") may prevent the appropriate names of minor
injuries and illnesses.
In addition, the expandability of Form 1 has been improved by making it
vertical.
30

Review of the Discharged Patient Survey
(DPC data)
EF Integrated Files way of thinking
Item nameTarget patient
content
Medication to Patient outputting EF If you use the medicine Include score information in the EF file for consideration of medication
bring files you brought in, output it to bring.
for each drug. Ask for a description.
Patients admitted to a
Medical convalescent ward Description of medical The scope of data submission has been expanded to
classification classification and ADL include convalescent wards. In addition, there was an
・ADL classification. opinion calling for a fundamental investigation and
differentiation examination of the ideal medical and nursing care
categories for the next simultaneous revision of medical
and nursing care. (From a report by the "Subcommittee
on Investigation and Evaluation of Inpatient Medical Care,
etc.", an organization specializing in medical fee survey)
D Files
Project name Target patients cont way of
ent thinking
Diagnostic group Some patients not DPC code (14 digits) Even for patients who are not eligible for comprehensive
evaluation, in the following cases:
classification eligible for the Expansion of the scope and Write DPC code
number comprehensive description of the reason for (1) When it falls under the DPC code of piecework billing
assessment billing piecework
(2) In the case of high-cost drugs, in the DPC code
notified
Where applicable
(3) When the date of hospitalization of the calculated
DPC code exceeds III
H Files
Project Target patients content Concept As notification of
name 7-to-1, 10-to-1, Describe each item of additional data submission is required in 7:1 wards, etc., it
Severity, medical inpatients in severity and medical is thought that more accurate analysis based on data will
and nursing community-based nursing necessity. be possible by including "severity and medical / nursing
necessity integrated care (wards necessity" in the submitted data. (Medical service fee
that require evaluation report of the "Subcommittee on Investigation and
based on an evaluation Evaluation of Inpatient Medical Care, etc."
sheet) From the summary) 31

Summary of Transitional Measures for Discharged Patient Survey (DPC Data)
 Appropriate transitional measures shall be established for each item.
proje Hospital Type Target cont Transitional

ct Wards ent Period
Severity, medical and 7-to-1, 10-to-1, community-

・Submit data for each patient for patients who Until the end of
nursing necessity All Hospitals based integrated care
are eligible for medical and nursing needs. September
(H file) (Wards that need to be
(6 months)
evaluated by evaluation sheet)
・Even when hospitalization fees that include
medical treatment and drug fees are
Psychiatric ward group and calculated, the medical treatment performed is
Submission of detailed Until the end of
All Hospitals other ward groups output to the EF file.
medical practices September
(convalescent ward, community ・Until now, some hospitalization fees have not
(EF file) (6 months)
comprehensive care ward, etc.) been covered, but all hospitalization fees,
including basic charges for admission to
convalescent wards and specific hospitalization
fees for psychiatric wards, are now eligible.
Output the medication DPC target ・ When using the medicine you bring with you, Until the end of
7-to-1, 10-to-1 (DPC wards)
you bring hospitals・ the drug name and usage fee September
(EF file) Preparatory exert oneself (6 months)
Hospital
(1) When it falls under the DPC code of
piecework billing
Output 14-digit code Until the end of
DPC Hospitals 7-to-1, 10-to-1 (DPC wards) (2) In the case of a high-cost drug, when the
(D File Receipt) September
DPC code is applied to the notification
(6 months)
(3) When the date of hospitalization of the
calculated DPC code exceeds III
10:1 (more Until the end of

Reference: Data All wards -
than 200 March
submission addition
beds) (1 year)
hospitals
32

Japanese Fee Schedule Revisions

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Heisei28Revision of annual

Version as of March 4, 2016

Overview of medical fee revision

2 Revision of coefficients by medical institution

3 Revision of the diagnosis group classification score table

4 Revision of calculation rules

5. Review of requirements as a DPC target hospital

6 Review of the Discharged Patient Survey (DPC data)

DPC/PDPSBackground of introduction (1) Heisei 2 3 January 2

 The DPC system (DPC/PDPS) was introduced for special function

「PDPS; Per-Diem Payment SystemDaily Blanket Payment System"

Changes in DPC target hospitals

• After the introduction of the system,DPC/PDPSThe target

2 Revision of coefficients by medical institution

3 Revision of the diagnosis group classification score table

4 Revision of calculation rules

5. Review of requirements as a DPC target hospital

6 Review of the Discharged Patient Survey (DPC data)

Revision of adjustment factor (1)

(1) Review adjustment factorsResponse to

〔Number of provisional coordinators at Medical institution A〕

Revision of adjustment factor (2)

25% 50% The

Ａ Ｂ Ｃ Hospital Hospital Ａ Ｂ Ｃ Hospital Hospital

Method of calculating medical fees in

Piecework evaluation part (doctor-fee remuneration part, not

Review of medical institutions

(3a): Surgical case Gaihoren Surgery Index per Case

Gaihoren (3b) : DPC calculated index per hospital bed

medical care for critically ill patients

Revision of medical institutions and basic coefficients

Revision of Functional Evaluation Coefficient I (1)

1． Evaluate the difference in (Example).

Revision of Functional Evaluation Coefficient II (1)

activ Revised in Heisei

How to calculate the evaluation index (index)

*1 In consideration of specialized hospitals and

Review of Functional Evaluation Coefficient II (3)

(6) Regional Medical Care Index

(7) Generic drug index

2 Revision of coefficients by medical institution

3 Revision of the diagnosis group classification score table

4 Revision of calculation rules

5. Review of requirements as a DPC target hospital

6 Review of the Discharged Patient Survey (DPC data)

Revision of Calculation Rules (1)

-15% actual medical resource input

Day I, Day II, Day 35 ,

Distribution of Day III by Diagnosis Group Classification (Payment

Revision of calculation rules (2)

Day I , Day II , Day III

Revision of calculation rules (3)

The following six items are newly scored.DAdded as a target ofる

Revision of Calculation Rules (4)

Procedure 040080 Pneumonia, etc 1104 classification 16 classifications

Revision of calculation rules (5)

MDC DPC Code Inclusive Payment

April 18 506 4,918 4,244 2,410

ＡＢＣ Hospital Hospital ＡＢＣ Hospital Hospital