Family doctors want changes in coordinated care

The General Board of the College of Family Physicians in Poland, having gathered more than a year's worth of experience from the implementation of coordinated care in the PCP, and with a sense of responsibility for the health of its patients, proposes changes in the organization of coordinated care.

Among their goals is to equalize access to primary care coverage. The College of Family Physicians in Poland represents family medicine specialists from all over Poland. More than 34 million Polish women and men have chosen their doctor in primary care. After more than a year of implementing coordinated care in primary care, as of the end of 2023, about 70% of providers still have not decided to expand the scope of care, and some of those implementing coordinated care provide it in single therapeutic areas. Experience from the implementation of coordinated care across the country indicates the need for change in this regard.

- In our opinion, the current organization of coordinated care has led to a disparity in the scope of health services in the PCP. It has also led to inequalities in access to diagnosis and treatment of diseases treated by specialists. Moreover, we believe that some areas of coordinated care should not be changed, while others require improvement and organizational changes," KLRwP President Dr. Agnieszka Jankowska-Zduńczyk wrote in a letter to Health Minister Izabela Leszczyna.

And what are KLRwP's demands for coordinated care?

(1) We support and propose to leave the current flexible organization of coordinated care, carried out independently by primary care clinics based on subcontractors consulting in their own offices, as well as based on specialists employed by primary care clinics and using the equipment of these clinics.

(2) In order to expand the list of PCPs offering a range of coordinated care services, assistance is needed from the NFZ in organizing coordinated care for these providers by having the NFZ create a list of specialty clinics and private specialty offices ready to cooperate with family physicians in coordinated care throughout the country in all proposed therapeutic areas. We propose using a solution similar to the organization in the National Cardiology Network (NCCN), that is, the NHF will prepare a list of medical facilities qualified to implement coordinated care. PCPs will be able to select entities qualified by the NFZ for cooperation.

3 It is necessary to legally normalize the provision of services in the field of dietetics and to regulate the profession of dietitian as a person providing health services. The existing solutions do not list the profession of dietitian among the health professions.

4 We propose to expand the scope of diagnosis under the nephrology pathway to include testing of serum parathormone and phosphorus levels, as well as the performance and additional Funding of renal ultrasound during the consultation of a nephrologist specialist in coordinated care, with regard to the treatment of chronic kidney disease.

5 We propose to improve the way of financial settlements of coordinated care, so that there is no need to return funds for benefits that have the status of "warning" (so that such benefits are not converted after some time to benefits with the status of "error", which results in the return of funds). Most often, the status of "warning" in financial settlements concerns the implementation of benefits from the entrusted budget and coordinated care in a single visit (e.g., test results - then a warning is generated and after some time an error of the MZ code, which forces the return of funds for the services performed). Having to wrongly reimburse funds is very frustrating and discouraging for providers. Two medical appointments have to be artificially created in order to properly fund benefits. We believe that the solution may be to create a single MZ code for coordinated care providers regardless of the type of diagnostic test funding.

6 Analyzing the recent reports from various provinces about the reduction of funding and/or non-payment of overdeliveries, we postulate that all services and overdeliveries should be accounted for, since the reduction of funds allocated in a given entity for coordinated care and non-payment of overdeliveries reduces the willingness of entities providing coordinated care to continue providing services and discourages new entities from starting coordinated care.

Source: College of Family Doctors in Poland