There is a final report from KSO

In its main conclusions, the report focuses on presenting proposals for significant milestones, comprising a set of key and process-coherent steps to prepare a so-called "complete regulatory package.

 Develop key recommendations for clinical organization and management, quality assessment metrics appropriate to them, and model patient pathways for specific oncology disease entities for publicly funded services.

 Develop on the basis of clinical guidelines reference diagnostic and therapeutic pathways in BPMN2 notation and continuously monitor the compliance of data reported by providers with the developed pathways.

 Prepare an analysis of a decision problem concerning:

discrepancies; guaranteed, and necessary in the context of the clinical condition; safety - not recommended by clinical guidelines; elements of the benefit description, developed with the participation of domain experts.

 In addition, according to the position of members of the Steering Committee, within the framework of the above actions it is expected to verify and clarify all medical procedures included in the lists of guaranteed benefits containing the terms "other", "not otherwise specified" due to the negative consequences for beneficiaries caused by the imprecise definition of guaranteed benefits, but also the lack of identification of benefits by the payer, and consequently constructive changes in the billing system.

 Correction of the list of model radiological procedures as well as the introduction of new model procedures in view of ensuring consistency in the proposed legislative changes.

 To redefine and update the benefit packages in the system of Uniform Patient Groups for inpatient treatment and the benefit packages dedicated to rapid oncology diagnosis and therapy, in order to identify and mandatorily require, among all publicly-funded guaranteed benefits, the key services occurring in the diagnostic and therapeutic pathway in oncology.

 Changes in the area of rules for verification and validation of benefits, which, in the opinion of the authors of the report, do not reflect patterns of practice, e.g., the requirement by the National Health Service for the DiLO card at the monitoring stage, or the lack of the possibility of billing for specialist advice or diagnostic tests (follow-up after surgery) at the treatment stage.

 Target changes in the Oncology Diagnosis and Treatment Card by individualizing the template of the diagnosis card in each cancer (including information on diagnosis). Due to the specificity of some cancers (e.g., lung, ovarian, HCC, etc.), the current division is not substantively justified. Currently, also due to the parameters of the payer's billing products, preliminary diagnosis is equivalent to in-depth diagnosis (e.g., diagnostic and treatment procedure). In addition, the clarification of the consilium's recommendations with information on the therapeutic procedure proposed and accepted by the patient, i.e. active surveillance/surgery/radiotherapy/radiochemotherapy simultaneous or sequential therapy/ stand-alone systemic treatment/hormonal treatment/palliative treatment/clinical trial/no patient consent to treatment, requires amendment. An important element in discussing the data in the chart is whether the treatment will be at the center where the consilium was held or where the patient was referred for oncology treatment, and information about the actual start of the treatment process (date of surgery - not the date of admission to the hospital, start of the radiotherapy cycle - not showing the planning stage, date of administration of chemotherapy or other form of treatment, e.g. clinical trial).

 In order to increase the process of transparency, information about the recipient's possession of the DiLO card should be visible to all specialists in the entities where the diagnostic and therapeutic process is carried out.

Report: TU

Source: MZ