Assessment of the Effects of Medical Fee Revisions on Acute Rehabilitation Therapy after Total Knee Arthroplasty
- VernacularTitle:人工膝関節全置換術後の急性期リハビリテーション医療に対する診療報酬改定の影響評価
- Author:
Takako MOTOHASHI
1
;
Osamu NAGATA
2
;
Kiyohide FUSHIMI
3
;
Ayako TAKATA
1
Author Information
- Keywords: total knee arthroplasty; acute rehabilitation; medical fee revisions; quality of health care
- From:The Japanese Journal of Rehabilitation Medicine 2022;59(9):939-950
- CountryJapan
- Language:Japanese
- Abstract: Objective：To assess the effects of increased financial incentives in medical fee revisions on acute rehabilitation quality by elucidating the changes in the timing and quantity of rehabilitation services provided after total knee arthroplasty.Methods：The analysis was conducted using nationwide Diagnosis Procedure Combination data from 2010 to 2017. Hospitals were divided into two groups (≥1,000 cases and＜1,000 cases), and the differences in basic characteristics, clinical findings/course, and rehabilitation practices were analyzed according to medical fee revision years. Multiple linear regression analyses were performed with the following dependent variables：duration before postoperative rehabilitation initiation and the number of rehabilitation therapy units provided. Independent variables included medical fee revision years and case volume.Results：Throughout the 8-year study period, there were reductions of 0.4 days (hospitals with ≥1,000 cases) and 1.3 days (hospitals with＜1,000 cases) before rehabilitation initiation. There were also significant increases in rehabilitation therapy units provided in the first 2two weeks after surgery. Earlier rehabilitation initiation was associated with case volume and medical revision year. Similarly, increases in rehabilitation therapy units were associated with case volume, medical revision year, and comprehensive rehabilitation plan evaluation fees.Conclusion：Higher reimbursements to hospitals, especially hospitals with＜1,000 cases, were associated with earlier rehabilitation interventions, and increased rehabilitation services provided within a short duration. These medical fee revisions appeared effective in raising the quality of acute rehabilitation therapy.
