The role of pharmacist and registered dietitian

“The success of co-medical will change medical care in the future.”

How will the role of medical professionals called co-medicals change in the future? The 2022 revision of medical fees highlights the way the Ministry of Health, Labour and Welfare (MHLW) thinks about promoting team-based medical care. This is because co-medicals are more involved in team-based medical care, and along with the expansion of the role of pharmacists, the involvement of registered dietitians has been perceived with great interest.

Since the 2010 revision under the emblematic “Reform of the Working Styles of Doctors,” the role of co-medical has been included in the facility standards as a requirement for calculating medical fees. Among them, there were some that incorporated the concept of nutritional management into the care of patients centered on “nutrition support team additional fee”, but as a medical institution, it was also necessary to create a system to meet the full-time requirements of facility standards. Many people said that it was difficult, and only 1,700 facilities (the number of reports from the Health and Welfare Bureau as of the end of May 2021) have reported the facility standard for “nutrition support team additional fee”. However, concretely in the medical field, the level of active participation by registered dietitians is steadily expanding, for example by being directly involved in patient care with nutritional guidance for cancer patients; the 2022 Reform fully clarifies and reinforces this position.

* Ministry of Health, Labour and Welfare November 12, 2021 496th Chuikyo General Assembly Hospitalization (Part 3)

https://www.mhlw.go.jp/content/12404000/000853842.pdf

Since the establishment of the “Pharmacist Management Guidance Fee,” which allows pharmacists to work directly with hospitalized patients, there has been a continuous change, expanding the range of roles pharmacist can assume, not only in dispensing work but also in treatment phase. In particular, in the 2022 revision, the title “from things to people” appears, and the medical fee evaluation regarding how hospital pharmacists are involved with patients as well as pharmacists at dispensing pharmacies has become an topic of discussion. The importance of the pharmacist role is therefore increasingly emphasized.

* Ministry of Health, Labour and Welfare December 8, 2021 – 503rd Chuikyo General Assembly Appendix (Part 8)

https://www.mhlw.go.jp/content/12404000/000863565.pdf

The Ministry of Health, Labour and Welfare presented their analysis regarding registered dietitians and pharmacists and an evaluation of medical fees at a brainstorming session entitled “Study Group on Promotion of Task Shift / Share to Promote Work Style Reform for Doctors”. From this perspective, it is clear with the FY2022 Reform that Japanese Health Authorities are paving the way to transform the current “doctor-centered medical care” into “team medical care” and we shall expect this evolution to steadily progress.

Online medical care and medical management utilizing ICT

“How the revised point system of the Reform contributes to a new environment?”

The general perception is that Japan is only slowly adapting to the utilization of information and communication technology (ICT) in the medical practice. However, it is possible to observe that advanced medical technology is actively supported by policies and reforms, such as the extension of insurance coverage for surgery supported by surgery robots and the initiation of insurance coverage for nursing care robots. It is strange that these two seemingly different technologies are discussed in the same forum under the ICT label.

The certified nurse system was established in 1995 for the purpose of training highly specialized nurses, and the revised Public Health Nurse, Midwife and Nurse Law (改正保助看法) was enforced in October 2015, describing specifically the actions that nurses can carry out. A training system (specific action training) was established. In FY2020, specialization training has been included in the curriculum for certified nurse education by the Japanese Nursing Association.

The very first introduction of remote consultation into the insurance scheme dated back the 2010 Revision, when the requirements to determine re-examination fee admitted the response by telephone. And in the 2018 revision, along with allowing medical treatment using smartphones as “online medical treatment fee”, some management fees related to telemedicine were newly established. Under such circumstances, the management fee for remote monitoring such as sleep apnea syndrome or pacemaker management, which were established in principle, are now concretely incorporated in the revised version. However, the points allocated to online medical treatment fee were back then much less than expected.

* Ministry of Health, Labour and Welfare December 22, 2021 – 507th Chuikyo General Assembly Outpatient (Part 5)

https://www.mhlw.go.jp/content/12404000/000870642.pdf

Due to the spread of the new coronavirus infection from the beginning of 2020, medical institutions have been forced to take immediate action to limit the contact in the practice of medical care that complements outpatient care. That propelled a completely different level of discussion and a clear call for an alternative model for outpatient care. For the first time in Japan, we witnessed the emergence of online medical care.

Partly due to this, the 2022 revision has significantly relaxed the calculation requirements for initial re-examination using ICT (information and communication technologies), and it has significantly added on top of the previously limited medical management fee to patients with home medical care. The range of use for home counselling has also been added. The mechanism for sharing information using communication technology has finally been incorporated into medical fees in earnest.

* Excerpt from the Ministry of Health, Labour and Welfare, March 4, 2022, outline of the revision of medical fees in 2022 (overall version)

https://www.mhlw.go.jp/content/12400000/000915589.pdf

Utilization of ICT and promotion of Digital Therapeutics (DX) in the medical field are steadily progressing while following a completely different course from the development of medical technology. The remuneration system has approached face-to-face medical care in order to promote online medical care, but the next focus will be whether it will actually take root in the field.