Current situation and issues related to claiming of charges for the operations of nutrition support teams

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  • Sato Reiko
    Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
  • Kunisawa Susumu
    Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
  • Sasaki Noriko
    Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
  • Ikai Hiroshi
    Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
  • Imanaka Yuichi
    Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University

Bibliographic Information

Other Title
  • 栄養サポートチーム加算の現状と課題
  • 栄養サポートチーム加算の現状と課題 : 管理栄養士とNSTの業務実態を踏まえた全国多施設の診療報酬請求データ分析
  • エイヨウ サポートチーム カサン ノ ゲンジョウ ト カダイ : カンリ エイヨウシ ト NST ノ ギョウム ジッタイ オ フマエタ ゼンコク タシセツ ノ シンリョウ ホウシュウ セイキュウ データ ブンセキ
  • ── 管理栄養士とNSTの業務実態を踏まえた全国多施設の診療報酬請求データ分析 ──
  • ──Analysis of data on claiming fees for medical services based on the actual operations of registered dietitians and NSTs at multiple facilities in Japan──

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Abstract

Of all the hospitals with active nutrition support teams （NSTs）, only about a half claim charges for the operations of the NSTs, and the charges claimed are small at many of these hospitals. The present study analyzed the diagnosis procedure combination （DPC） data based on a questionnaire survey related to the operations of NSTs and registered dietitians. The results from the 200 surveyed hospitals revealed that the range of the proportion of cases claiming NST charges in all cases of each sample hospital was 0 to 33%, and that the percentage of cases claiming NST charges for total parenteral nutrition and tube enteral nutrition （TPN/EN cases） varied widely from less than 20% to more than 80%. Hospitals with a higher percentage of claims for the operations of NSTs among all claims had higher percentages of claims for both TPN/EN and non-TPN/EN cases as NST charges. Based on a case study of 5 hospitals combined with the above results, it was considered that the use of an efficient and proactive system for extracting target cases at the hospital level may facilitate placement of claims for the services of the NSTs. In addition, we found that some of the hospitals which did not claim charges for the operations of NSTs actually provided an equivalent amount of NST services as the hospitals which claimed charges for the services of the NSTs. In future, it may be necessary to review the system, including modification of the full-time worker stipulation, standardize the operations and activities of the NSTs, and develop outcome indices that can be used for evaluation at different facilities.

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