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2012年2月14日 (火)

平成24年診療報酬・介護報酬改定(161)    1点(10円)の評価の大きさ

保健医療経営大学学長

 橋爪 章

2012 年 2 月 14 日 平成24年診療報酬・介護報酬改定(161)

診療報酬で最も小さい評価は「1点」(10円)です。

今回の改定で、1点の項目が新設されています。

現在、「地域医療貢献加算」として3点の評価が与えられているものについて、算定要件を緩めたものです

逆に、算定要件を強めたものも新設され、5点の評価が与えられています。

現在の地域医療貢献加算の算定要件は、

 標榜時間外の準夜帯において、患者からの電話等による問い合わせに応じる。休日、深夜又は早朝は留守番電話等で対応しても差し支えない。

 原則として自院で対応する。

というものです。

この加算を、わかりやすく「時間外対応加算2」という名称に変更したうえで、5点の「時間外対応加算1」と1点の「時間外対応加算3」が新設されました。

「時間外対応加算1」の算定要件は、

 標榜時間外において常時、患者からの電話等による問い合わせに応じる。

  原則として自院で対応する。

となっており、24時間対応が要求されますので診療所にとってハードルが高くなっています。

しかし、実際に24時間対応の努力を行っている診療所については、そうでない診療所と同じ3点の評価であるよりは手厚く評価していただきたいものです。

ここで、1点の「時間外対応加算3」の算定要件ですが、次のようになっています。

 地域の医療機関と輪番による連携を行い、当番日の標榜時間外の準夜帯において、患者からの電話等による問い合わせに応じる。当番日の深夜又は早朝は留守番電話等で対応しても差し支えない。

 当番日は原則として自院で対応する。

 連携する医療機関数は、3以下とする。

 連携に関する情報は、院内に掲示するとともに患者へ説明する。

3つ以下の医療機関と輪番で準夜帯の対応を行うことが要件ですので週に2~3回の当番で患者からの電話等による問い合わせに応じることができれば、1点の加算が取得できるというわけです。

「地域医療貢献加算」は、平成22年改定の際、診療所の再診料が2点引き下げられたことの代替措置「的」に設けられた3点の加算でしたが、準夜帯の毎日の自院対応のハードルが高く、再診料の引き下げに見合う加算を取得することができずじまいの診療所も数多くあります。

わずか10円、20円の上下に診療所は一喜一憂しているというわけですが、夥しい数の診察ごとに生ずる加算ですので、塵も積もれば大きな額になります

(保険医療経営大学学長ブログ転載)

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