July 10th will change everything. More tests, better care, new laws

From July 10, more research and better access to treatment for joint diseases

The amendment to the regulation on the pilot programme for comprehensive care for beneficiaries with early arthritis has been published in the Journal of Laws.

As we read in the Regulatory Impact Assessment: In the current pilot program KOWZS (Comprehensive Care for Patients with Early Arthritis - editor's note) there is no precise definition of disease entities for which national guidelines for diagnostic and therapeutic procedures are to be developed. This may result in a lack of coherence of the assumptions of the KOWZS pilot program, which concern selected rheumatological diseases in Early Arthritis care, and not all disease diagnoses in the field of rheumatology.

In addition, it was made possible to settle services provided so far under the KOWZS pilot program for beneficiaries who – for medical reasons – cannot continue treatment under the pilot program. However, the regulation does not provide for such a possibility in the event of a patient's withdrawal from further participation in the WZS program for reasons other than medical.

In addition, during the application of the current regulation, the following problems were identified:

• interpretation discrepancies in the method of calculating the correction coefficient referred to in § 12 section 1 item 1 letter c,
• no specification of the form of consent given by the beneficiary to the implementation of the KOWZS pilot programme obtaining from the National Health Fund medical data concerning the healthcare services provided to him,
• no task for WZS centers related to transferring data to the Inflammatory Rheumatic Diseases Database,
• determining the number of consultations provided by a specialist in the field of medical rehabilitation within the framework of the KOWZS organizational model,
• not all WZS centres have signed an agreement with the National Health Fund for the implementation of the KOWZS pilot programme,
• lack of clarification that in the organizational model of the KOWZS pilot program there is a possibility of providing diagnostic services in the form of one-day hospitalization,
• failure to provide, in cases requiring it, additional rheumatological advice,
• the catalogue of laboratory tests applicable in the KOWZS pilot programme does not fully exhaust the diagnostic possibilities for beneficiaries with suspected diseases referred to in § 6 paragraph 1 point 2 of the Regulation.

Therefore, the following changes were included in the amendment to the regulation:

1. Enabling WZS care providers to settle healthcare services provided to date resulting from the WZS Individual Care Plan also in the event of the beneficiary withdrawing from participation in the KOWZS pilot program, and not, as before, only in the event of discontinuation of WZS care solely for medical reasons.
2. Clarification of the wording of the provision related to the implementation of one of the objectives of the KOWZS pilot programme, which is to develop national guidelines for diagnostic and therapeutic procedures, together with standards for maintaining electronic medical records in the scope of care for beneficiaries with early arthritis, by adding appropriate disease diagnoses according to the current International Classification of Diseases and Health Problems.
3. Expanding the catalogue of laboratory tests, increasing their number from 71 to 89 tests that can be performed as part of WZS care, which will ensure the possibility of establishing a precise diagnosis of the disease at an early stage, and thus - for the purposes of developing an Individual WZS Care Plan.
4. Clarification of the method of calculating the coefficient of 1.15 referred to in § 12 section 1 point 1 letter c of the aforementioned regulation.
5. Adding a task for WZS centres to enter numerical data into the Inflammatory Rheumatic Diseases Database, which will coordinate the diagnostic and treatment process as part of the KOWZS pilot programme.
6. Clarification of the number of consultations provided by a specialist physician in the field of medical rehabilitation under the KOWZS pilot program.
7. Taking into account art. 188 sec. 1 item 4b of the Act of 27 August 2004 on healthcare services financed from public funds, provisions have been introduced specifying the form of consent by beneficiaries to obtain medical data from the National Health Fund by WZS centers concerning the healthcare services provided. The expected effect of the change will be to enable the organization and conduct of the diagnostic and treatment process in accordance with the individual needs of the beneficiary as well as full coordination of the beneficiary's treatment.
8. The possibility of performing diagnostic services in the form of one-day hospitalization in Module I as part of the first consultation has been clarified, which will affect the diagnosis of diseases in some beneficiaries under the KOWZS pilot program, which will increase the access to diagnostics in all possible modes, depending on medical indications.
9. Adding the possibility of signing contracts at the pilot program implementation stage.
10. Adding further advice to the organisational model depending on the needs of the beneficiary, which will result in increased access to treatment for beneficiaries in cases where it is required.

The regulation will enter into force on 10 July.

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