JP5007421B2 - Medical cost calculation device - Google Patents

Description

  The present invention relates to a medical cost calculation apparatus that calculates a medical fee for a patient in an insurance medical institution and creates a medical fee remuneration statement (hereinafter referred to as a receipt).

  In a medical institution, for example, there is one described in Patent Document 1 for calculating the medical expenses of an inpatient. In this case, for patients admitted to the general ward, the medical expenses are calculated based on the volume obtained by adding the individual medical treatment points, and a receipt is issued monthly. The medical cost calculated for issuing the receipt is held in the storage device of the medical cost calculation device for each patient and for each month. Thus, until now, except for special cases, the medical expenses for hospitalized patients were basically paid for.

  However, a comprehensive payment system for inpatient medical care for specific function hospitals, etc. has been started. According to this, according to the combination of disease and patient condition, technique, treatment, etc., called diagnosis group classification (DPC), Medical expenses (insurance points, especially comprehensive evaluation points in the comprehensive payment system) are determined, and medical expenses are calculated by multiplying the number of hospitalization days and the comprehensive evaluation points regardless of the actual volume. In addition, the comprehensive evaluation score is not constant, the hospitalization period is divided into 2 to 3 periods according to the diagnosis group classification, the comprehensive evaluation score is determined for each period, and the comprehensive evaluation score gradually decreases as the period progresses. The longer the is, the lower the number of calculation points.

  Here, the diagnosis group classification includes about 600 basic diseases belonging to 16 main diagnosis groups based on ICD-10 (International Disease Classification 10) defined by WHO (World Health Organization), and further includes “severity”, “age” ”,“ Presence / absence of operation / treatment ”,“ Sub-injury name ”, etc., and subdivided into 1438 patterns (as of 2006). The diagnosis group classification is defined by a 14-digit code system as illustrated in FIG. 12, and the above-described requirements are given to specific digits.

In addition, FIG. 13 shows how the comprehensive evaluation score is gradually decreased. In this example, the hospitalization period is divided from the first day of hospitalization to the 8th day, the hospitalization period is 1), the 9th to the 19th day is the hospitalization period 2), and the 20th to 49th day is divided into the 3 hospitalization periods. The comprehensive evaluation score is 3248 points, 2517 points, and 2139 points per person per day. Hospitalization period 1) to 3) The number of days and the comprehensive evaluation score differ depending on the diagnosis group classification. In this example, the specific hospitalization period for calculating the in-patient medical expenses based on the comprehensive evaluation score is 49 days, and thereafter, it is switched to the volume calculation.
JP2002-092153

  The diagnosis group classification is often changed during hospitalization due to the onset of complications, unscheduled surgical treatment, and review of the disease group by receipt inspection. The basic idea of the DPC comprehensive payment system is to calculate the medical expenses according to the finally determined diagnosis group classification throughout the hospitalization period from the first day of hospitalization to discharge. However, since the receipt is issued monthly and charges the insurance organization for medical expenses, if the diagnosis group classification is changed in the current month, the medical expenses for the previous month are calculated based on the diagnosis group classification before the change, and a receipt has already been issued. In some cases, insurance is claimed. In such a case, the difference between the comprehensive evaluation score requested in the diagnostic group classification before the change and the comprehensive evaluation score for the previous month recalculated with the new diagnostic group classification will be charged at the time of discharge. Yes. In other words, the medical expenses for the past months for which the receipts have already been issued are not recalculated immediately with the new diagnosis group classification, but are calculated at the time of discharge, that is, the receipts for the discharge month.

  However, if you change the diagnosis group classification for hospitalized patients who are pending receipt (submission to the payment institution) from the first month of hospitalization due to reasons such as applying for public funds, hospitalization after applying public funds In some cases, a receipt is issued with a comprehensive evaluation score recalculated from the diagnosis group classification after all changes from the first month.

  In this way, when the diagnosis group classification is changed during hospitalization, whether the comprehensive evaluation score for the past month should be recalculated at the same time in the changed month, depending on whether a receipt was issued with the diagnosis group classification before the change in the past month It will be different.

  However, with the conventional medical cost calculation device, it is necessary to determine whether it is necessary to recalculate the calculated comprehensive evaluation score for the past month going back to the first month of hospitalization while the operator performs the operation of changing the diagnosis group classification. Was not easy. For this reason, incorrect recalculation processing was performed, and the contents of the receipt were inconsistent, and were often returned as a result of the payment institution's examination. Therefore, in this application, when changing the diagnosis group classification, a medical cost calculation device is provided that automatically checks the receipt of receipts in the past month and then confirms with the operator whether the comprehensive evaluation score needs to be recalculated. To do.

  The present invention provides an input means, a display means, a score master database for storing a comprehensive evaluation score for each diagnosis group classification related to comprehensive payment, a medical information database for storing patient medical data, and a patient medical data as medical information. Medical data registration processing means to be registered in the database, a receipt issuance information database for storing whether or not a receipt has been issued on a monthly basis, and a receipt based on the patient's medical data and issued to the receipt issuance information database A receipt issuing processing means for recording the information of the patient, a diagnosis group classification database for storing information of the patient's diagnosis group classification and hospitalization period, and a patient diagnosis group according to an input or change instruction of the diagnosis group classification from the input means A diagnostic group classification registration processing means for registering classification and hospitalization period information in the diagnostic group classification database, and registering the diagnostic group classification In response to the instruction to change the diagnosis group classification, the medical means refers to the patient diagnosis group classification database and the receipt issuance information database to check whether there is a month in which a receipt has been issued during the hospitalization period. When there is a month, a message to that effect is displayed on the display means, thereby solving the above problem.

  According to the medical cost calculation apparatus of the present invention, when trying to change the diagnosis group classification in the middle of hospitalization, the apparatus automatically determines whether there is a month in which a receipt is issued after the first month of hospitalization, and there is a month that has already been issued. In this case, since the operator is inquired whether or not to recalculate the medical expenses based on the new diagnosis group classification, the operator can perform recalculation as necessary. In addition, in this way, even if the medical treatment contents before the previous month have been corrected, it is possible to prevent inconsistency between the contents of the previous month's receipt and the already issued receipt. Thus, inconvenience such as receipt return can be reduced.

  FIG. 1 shows the configuration of the medical cost calculation apparatus 1 according to the embodiment of the present invention. 2 is an input means such as a keyboard, 3 is a display means such as a CLD monitor, 4 is a printing means such as a laser printer, 5 is a temporary storage means composed of a semiconductor memory, 6 is a program storage means for storing various programs, 7 Is a control means for performing various functions such as calculating and calculating the medical expenses based on the medical data of the patient by the MPU introducing and executing the program stored in the program storage means. The storage means stores a score master database 11, a diagnosis group classification database 12, a patient headline database 13, a medical treatment information database 14, a receipt issue information database 15, and the like.

  The score master database 11 stores a master code, insurance score, code name, name, and the like for each medical practice that is a basis for calculating medical expenses. The master code is a unique code assigned to uniquely designate a medical practice among all medical practices. The code name is a code uniquely set by the user so as to be easy to use at the medical institution. The name is the name of the medical practice. The medical practice includes inspection act, prescription act, medicine and treatment material, and also includes a comprehensive score master for calculating comprehensive evaluation score. Here, not all medical treatments for which insurance points are determined are stored, but only specific medical treatments used in the medical departments advocated by the medical institution are selectively stored.

  The diagnosis group classification database 12 records information on the diagnosis group classification applied to the patient, and FIG. 3 shows a registration example thereof. The diagnosis group classification, the date of comprehensive calculation, that is, the date of hospitalization, and the date of completion of comprehensive calculation, that is, the date of discharge are recorded in chronological order by insurance type and hospitalization / outpatient for each patient. From this, you can tell from when to when the patient was hospitalized, and what was the diagnostic group classification at that time.

  The patient heading database 13 records patient specific information for each patient, such as the patient's name and address, the number of insurance to be used, the identification of the person's family, the burden ratio, and whether there is a public bill. ing.

  The medical information database 14 records data relating to the insurance medical treatment performed on the patient and the medical expenses calculated based on the medical treatment performed for each patient and each medical treatment date.

  As illustrated in FIG. 4, the receipt issuance information database 15 records the issuance status of whether or not a receipt has been issued every month for each patient, each insurance, and each outpatient / hospital.

  Next, the operation of the present embodiment will be described. FIG. 5 is a display example of a score master management screen that the score master registration processing 61 outputs to the display means. In this embodiment, diagnostic group classifications that may be used in the medical institution are registered in advance on this screen. The code name is an easy-to-remember and easy-to-remember user code assigned to the diagnosis group classification by the user. The diagnosis group classification is the 14-digit diagnosis group classification number described in FIG. The name is a name of a diagnostic group classification such as “vertebral osteoporosis” expressed in Chinese characters. The score is an insurance score, and here it is a comprehensive evaluation score. The master replacement information sets a master code corresponding to the hospitalization period 1) to 2).

  An example of the comprehensive score master set and registered in the score master database 11 is shown in FIG. By referring to this, the code names “D001” to “D003” for the hospitalization periods 1) and 2) and the specific hospitalization period thereafter for the “brain tumor” whose diagnosis group classification code is “0100103099 × 01 ×” The comprehensive evaluation score is 3248 points, 2517 points, 2139 points, the hospitalization period is up to the 8th day, the 19th day, the 49th day, and in each period The master code to be calculated is known.

FIG. 2 is an example of a diagnostic group classification registration screen output by the diagnostic group classification registration process 62. At the time of patient admission or at the stage when the diagnosis group classification is decided, as shown in FIG. 5A, the operator sets the diagnosis group classification code diagnosed by the doctor or the medical information manager and the date of comprehensive calculation, that is, the year of hospitalization. The date is input from the input means 2. Since the comprehensive calculation end date is the discharge date, this is not usually decided. Therefore, the device automatically outputs the maximum date (future month) as an initial value. In this example, the patient is hospitalized on May 1 and the diagnostic group classification is “0100103099 × 01x” or brain tumor. The discharge date includes a default maximum value , that is, the future month . Then, the diagnostic group classification registration process 62 records this content in the diagnostic group classification database 12. FIG. 3A shows the contents of registration.

  FIG. 8 is a display example of a medical data input screen output to the display means by the medical data registration process 63. As described above, since this patient with the patient ID “123” was admitted on May 1st and assigned a brain tumor diagnosis group classification, the calculation date for each of the code names “D001” to “D003” In the column, “1” is set from May 1st to 8th, 9th to 19th, and 20th to 31st. This is automatically calculated by the apparatus from the registered contents of the patient's diagnosis group classification and the hospitalization date and discharge date. Further, as shown in FIG. 5B, for June, the code name “D003” is calculated from the first day to the 15th day following the last month.

  Then, the calculated content is registered in the medical information database 14 of the patient by the medical data registration processing 63. FIG. 6 shows the contents of the medical care information database 14. The code “D001” is calculated from May 1st to 8th, the code “D002” is calculated for 11 days from May 9th to 19th, and the code “D003” is calculated from May 20th to 31st. You can see that it is calculated.

  Consider a case where the diagnosis group classification of this hospitalized patient is changed to June. When the receipt issuance process 64 issues a receipt in response to an instruction, it records the issuance status in the receipt issuance information database 15. As shown in FIG. 4, regarding the inpatient with the patient ID “123”, the receipt information database 15 indicates that the previous month's May 2006 issue has been issued and the June receipt has not been issued yet. You can see by reference.

  In this state, when the operator instructs “change” of the diagnostic group classification already registered on the diagnostic group classification registration screen shown in FIG. 2A, the diagnostic group classification registration processing 62 first stores the diagnostic group classification database 12. The hospitalization period related to the current diagnosis group classification of this patient is referred to, and then, it is checked whether or not a receipt has been issued in the past month during the hospitalization period with reference to the receipt issuance information database 15 (FIG. 14). Step S11). If no receipt has been issued since the first month of hospitalization, control is performed so as to directly correct the diagnostic group classification of serial number 1 (S18). This is because since the receipt in the initially registered diagnostic group classification has not been issued, there is no contradiction even if the receipt is issued after recalculating the diagnosis group classification after the change. The same processing is performed when the diagnosis group classification is changed in the same month as the hospitalization date.

  On the other hand, if the receipt has been issued in the past month, the diagnosis group classification registration processing 62 alerts the operator that there is a month in which the receipt has been issued, and comprehensive evaluation is performed with the changed diagnosis group classification. A dialog for inquiring whether or not to recalculate the score is displayed on the display means 3 (S13). Specifically, an inquiry is made as to whether to recalculate all, not recalculate, or recalculate only the month in which the receipt has not been issued.

  When the operator instructs to recalculate all (same as S15; yes), the diagnosis group classification registration processing 62 performs the diagnosis group with serial number 1 as in the case where no receipt has been issued since the first month of hospitalization. Control to modify the classification directly. Then, according to the input of the diagnosis group classification by the operator, the comprehensive evaluation score calculated from the date of hospitalization until the current day is deleted, and all calculations are recalculated with the changed diagnosis group classification, and the patient medical information database 14 is registered.

If the operator instructs to recalculate only the month in which the receipt has not been issued (S16; Yes), the diagnostic group classification registration process 62 newly displays an input frame for serial number 2, and a new diagnostic group classification is input. Control is performed so as to be possible (S20). This is shown in FIG. At this time, the last day of the month in which the receipt has been issued is automatically set as the comprehensive calculation end date before the change of serial number 1. In this example, May 31 is set. In addition, the comprehensive calculation date of serial number 1 is set to the newly calculated comprehensive calculation date of serial number 2 as it is. This is because it is basic to calculate the medical expenses with one diagnosis group classification throughout the hospitalization period. In addition, the maximum date (future month) of the system is set as the comprehensive calculation end date. Thus, by checking the comprehensive calculation end date for each diagnosis group classification, it is easy to know which is the latest diagnosis group classification.

  Therefore, the operator inputs the diagnostic group classification of serial number 2 from the input means 2 and instructs registration. Here, it is assumed that the diagnosis group classification “0100103097xxx” with the same brain tumor and surgery is input. In response to this, the diagnostic group classification registration processing 62 adds a new diagnostic group classification to the database and registers it. FIG. 3B shows a registration example of the diagnostic group classification database 12 when the diagnostic group classification is changed in this way.

The name of the new diagnostic group classification “0100103097xxxx” is “Brain tumor 15 years of age or older with other surgery”, and the code name is “D021”, “D022” and “D023” for hospitalization periods 1), 2) and 3), respectively. It is assumed that Moreover, the score table of the diagnostic group classification before and after change is shown in FIG.

  After that, the diagnosis group classification registration processing 62 deletes the comprehensive evaluation score calculated up to that day for the month in which the receipt has not been issued, and recalculates all the changes in the diagnosis group classification after the change. Are registered in the medical information database 14 (step S21). FIG. 7 shows the registration contents of the medical care information database 14 recalculated and corrected in this way. As can be seen from the figure, the May data remains unchanged, and the June medical data is replaced with the code “D022” from the 1st to the 9th and the code “D023” from the 10th to the 15th. . That is, the comprehensive evaluation score of the new diagnosis group classification “0100103097xxxx” is replaced. From the score table of FIG. 10, in the new diagnosis group classification, hospitalization period 1) from May 1 to 19 on the first day of hospitalization 1) hospitalization period 2) from May 20 to June 9, and This is because the hospitalization period 3) will be from June 10 to July 29. And, of course, the comprehensive score master for this diagnosis group classification is registered in the score master database 11.

  As a result, in the month in which the receipt has not been issued, the comprehensive evaluation score can be calculated with the new diagnosis group classification and the receipt can be issued, and for the month that has already been issued, the comprehensive evaluation score is also corrected with the diagnosis group classification at the time of issuance unchanged. Therefore, the insurance claims in the past month written in the receipts from the current month will not contradict the contents of the receipts issued in the past. In addition, the difference between the charge amount based on the diagnosis group classification before the change and the charge amount based on the diagnosis group classification after the change in the past month can be correctly settled in the discharge month.

It is a block diagram which shows the structure of the medical cost calculation apparatus of embodiment. It is an example of a display of a diagnostic group classification registration screen. It is a registration example of a diagnostic group classification database. It is an example of registration of a receipt issue information database. It is a display example of a score master management screen. It is an example of registration of a medical treatment information database. It is an example of registration of a medical treatment information database. It is a display example of a medical data input screen. It is a display example of a medical data input screen. It is an example of the score table of a diagnostic group classification. It is an example of registration of a comprehensive score master. It is a figure which shows the code system of a diagnostic group classification. It is a figure which shows the mode of a gradual decrease of a comprehensive evaluation score. It is a flowchart which shows operation | movement of embodiment.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Medical cost calculation apparatus 2 Input means 3 Display means 4 Printing means 5 Temporary storage means 6 Program storage means 7 Control means 10 Secondary storage means 11
Score master database 12 Diagnosis group classification database 13 Patient headline database 14 Medical treatment information database 15 Receipt issue information database

Claims (2)

Input means and display means;
A score master database for storing comprehensive evaluation scores for each diagnosis group classification related to comprehensive payment;
A medical information database for storing patient medical data;
Medical data registration processing means for registering patient medical data in a medical information database;
Receipt issue information database that stores whether or not a receipt has been issued on a monthly basis;
A receipt issuing processing means for issuing a receipt based on the patient's medical data and recording the issued information in the receipt issuing information database;
A diagnostic group classification database for storing a patient's diagnostic group classification and hospitalization period information including a calculation start date and a calculation end date ;
Diagnostic group classification registration processing means for registering the diagnostic group classification of the patient and information on the length of stay in the diagnostic group classification database in response to an input or change instruction of the diagnostic group classification from the input means,
The diagnostic group classification registration processing means refers to the patient's diagnostic group classification database and the receipt issuance information database in response to an instruction to change the diagnostic group classification, and determines whether there is a month in which a receipt has been issued during the hospitalization period. If there is an issued month, a message requesting an instruction on whether to recalculate medical expenses based on the new diagnosis group classification is displayed on the display means, and at that time, at least all hospitalization periods are re-established. Display whether to calculate or recalculate only the month in which the receipt has not been issued ,
In response to the selection instruction to recalculate only the month in which the receipt has not been issued, the diagnostic group classification registration processing means sets the calculation end date of the diagnostic group classification before the change to the last day of the month in which the receipt has been issued, and the diagnostic group after the change A medical cost calculation apparatus that registers a classification, and then registers the diagnosis group classification after the change by taking over the calculation start date of the diagnosis group classification before the change . In the medical cost calculation apparatus according to claim 1,
The diagnostic group classification registration processing means is a future in which the apparatus manages the calculation end date of the information related to the hospitalization period when registering a new or changed diagnostic group classification in response to an input or change instruction of the diagnostic group classification. A medical cost calculation device characterized in that the month is set and registered .

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