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Last year (Oct 27, 2009) I was appointed by Japan’s Minister of Health, Labour and Welfare Akira Nagatsuma to serve as an “expert member” of the Central Social Insurance Medical Council. The Council met on average twice a week and was focused on revisions to the medical fee remuneration system. We submitted a report of our findings to the Health Minister on February 12, 2010.
My appointment to this Council as a representative of the paramedical community was related to my having been chosen and recognized in my role as a representative to the “Council for the Promotion of Team Medical Care,” a group made up of 13 medical professional-related organizations, which began last year. This was the first time for a Central Social Insurance Medical Council representative to be chosen from a profession other than a doctor, dentist, pharmacist, or nurse.
The “Council for the Promotion of Team Medical Care” was established with the goal of working to put into practice in hospitals nationwide “Team Medical Care” based on the principle of “medical teams that stand together with regard to the patient’s method of treatment, respect each other’s professional specialties, and continually work to improve their specialist skills in order to provide the best medical care that will satisfy patients.” In actual practice in the field, the reality is that instead of “Team Medical Care,” there are “Medical Teams.” The difference depends upon the extent to which the voices of professionals other than doctors are recognized. In order to make suggestions that will bring to fruition “Team Medical Care,” the Council actively investigates and analyzes the conditions and problems occurring in medical service situations around the country, works to promote mutual understanding between members of medical teams, develops younger staff, works to secure top talent, and conducts activities which inform citizens about the content of the work and its appeal.
Though the 2010 revisions to medical fee remunerations occurred under severe financial restrictions, the meager 0.19% increase was indeed the first increase in 10 years and so represents a major change for those working in medical settings.
Of special note is that the points for emergency care, obstetrics/pediatric care, and surgery increased. In addition, with the Democratic Party of Japan coming to power, major changes in the membership of the Central Social Insurance Medical Council meant the content of discussions changed.
In these recent revisions, the rating system for general x-rays were revised and a new system introduced for digital film. Moreover, we can evaluate these revisions highly because they were both on the positive side and reflected recognition that the work of radiological technologists should receive a technical fee. The role of radiological technologists in properly using medical devices to provide images for clinical use occupies a very important role. Considering that up until now little attention had been paid to the radiology charge, this is a great step forward.
On the other hand, though a new rating was introduced for multi-row (16 or more) computed tomography scans and the points assessed for using a 1.5T device in MRI examinations was raised, these assessments are simply for the number of lines scanned and the strength of the magnetic field. I believe careful consideration should be given to not just the skill of the radiological technologist but to the level of difficulty of the filming procedure and the degree of skill with which it is performed. Comprehensive consideration should be given to the clinical effectiveness of the work, including the QOL of patients. Since the second examination in any given month is now evaluated at 80%, however, it can be said that the efforts of radiological technologists is now being appreciated. As in the past, this is something we have been emphasizing and so one can say that this shows that our work has been recognized.
The Japan Association for Radiological Technologists has already set up a committee to consider policies regarding medical fee remunerations and been working toward the establishment of fair evaluations for “taking radiological exposures, for examinations, and for treatment.” Through our cooperative setup with the Japan Industries Association of Radiological Systems, we have conducted questionnaire surveys to gather evidence. Based on this, we submitted petitions to the Ministry of Health, Labour and Welfare and are confident the recent revisions strongly reflected our performance record. I would like to take this opportunity to again express my sincere appreciation to all the members of JIRA.
Since one of the focal points of the recent revisions related to “reducing the work load of doctors practicing in hospitals,” the “evaluation of team medical care” became a subject of discussion. Though matters such as the evaluation of palliative treatment were made in previous discussions of team medical care, discussions this time by the Central Social Insurance Medical Council were made in earnest and led to positive evaluations.
The revisions call for the evaluation of the manner in which generous staffing and cooperation by interdisciplinary teams of professionals can provide high quality care and contribute to an increase in patient QOL. New areas to be evaluated are interdisciplinary teams involved in nutritional care, as well as teams involved in the management of mechanically ventilated patients, i.e. Respiratory Care Teams. Other new areas to be evaluated are the cooperation between medical institution staff and care managers, the role of Cancer Boards in promoting cancer treatment, medical procedure safety policies, and patient rehabilitation conducted by teams.
Nevertheless, the aim of evaluating the work of various professionals in order to reduce doctor workload is not really the same as evaluating team medical care. I believe the skills of various medical specialists have yet to be truly recognized and appreciated. When one considers the flow of things to people, the work of the various specialists should be valued even further. This is an issue we need to tackle going forward.
The next revision to medical fee remunerations is scheduled for 2012 and will take up fee revisions for both medical treatment and nursing care. The Central Social Insurance Medical Council has already begun working on the revisions. We are discussing and inspecting matters related to the supplementary opinions to the 2010 revisions. The Japan Association for Radiological Technologists must begin itself preparing for the 2012 revisions. We will need to complete and submit a petition by June 2011. In this regard, the work we do this year is of great importance. We need to examine the results of the 2010 revisions and build evidence based on these results. We will work together again with the members of JIRA to conduct a questionnaire survey. Unless our requests have value for Japanese citizens and for patients, they will not gain the people’s support. It is with this in mind that I will work on behalf of revisions to medical fee remunerations. In this regard, I ask for the understanding and cooperation first of the members of JIRA, and of all those working in the radiological industry.
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