National Cardiology Network: what changes do patients and medical facilities need to prepare for?

The National Cardiology Network Act came into force today. It reorganizes the cardiology care system, introducing a uniform scheme of operation and cooperation between facilities within the National Health Fund. The aim of the changes is to improve the quality of services through better use of health care resources.

The Act, following the example of the Act on the National Oncology Network, assumes the systematization and coordination of patient health care by creating the National Cardiology Network (hereinafter referred to as the National Cardiology Network), consisting of medical entities that have concluded contracts with the National Health Fund for the provision of services. Medical facilities will be classified into one of three levels of securing cardiology care. In addition to the medical entities that are part of the National Cardiology Network, patient care will also be provided by cooperating centers.

The qualification of healthcare entities for a given level of protection will depend on the results of the qualification conducted by the President of the National Health Fund. The qualification criteria themselves will be set by implementing regulations to the Act.

The structure of the National Cardiology Network will be created by medical entities qualified for one of three levels of cardiology care security.

Level I cardiology centers , hereinafter referred to as "OK I", will act as cardiology centers providing mainly basic cardiology diagnostics and treatment under an agreement concluded with the Fund for the provision of health care services and will include outpatient cardiology care or hospital care. Level I may therefore include specialist clinics and hospitals providing services based on appropriate agreements concluded with the National Health Fund.

Cardiology centers of the second level of cardiology care security , hereinafter referred to as "OK II" will act as centers ensuring coordination and continuity of cardiology care, including in particular in the scope of comprehensive cardiology diagnostics and cardiology treatment. In order to obtain the second level of security, the medical entity must simultaneously provide services under contracts with the National Health Fund in a cardiology clinic, a hospital ward with a cardiology profile, in the Admissions Room or the Hospital Emergency Department. Moreover, such an entity must independently provide or ensure coordinated access to services provided in a hemodynamics laboratory or interventional radiology laboratory, a cardiac rehabilitation department, a day care facility or in a center or day care for cardiac rehabilitation.

The cardiology center of the third, highest level of cardiology care , hereinafter referred to as "OK III" will ensure coordination and continuity of cardiology care, in particular in the scope of comprehensive cardiology diagnostics and treatment, as well as cardiosurgical treatment. Such an entity must provide or ensure coordinated access to the same services as OK II, and additionally provide services in the cardiology surgery department and the anesthesiology and intensive care department, as well as in the electrophysiology laboratory.

It will be the only one to provide multidisciplinary cardiology treatment in at least one of the three profiles: internal medicine, vascular surgery or neurology.

A cooperating centre is an entity not qualified for the KSK (and therefore not having any of the three levels of securing cardiological care) that simultaneously provides healthcare services based on contracts concluded with the National Health Fund in the scope of hospital treatment, outpatient specialist care, primary health care, medical rehabilitation or long-term care . It therefore refers to all those centres that may provide services in the scope of cardiological diagnostics, rehabilitation or post-treatment observation.

The qualification for the National Cardiology Network and for a given level of cardiology care provision will be made by the President of the National Health Fund based on the qualification criteria established by implementing provisions, i.e. in the Regulation of the Minister of Health on detailed criteria for qualification for the National Cardiology Network. The assessment will include the number and qualifications of medical personnel, the diagnostic and therapeutic potential of the facility, including its organizational units, and the organization of providing health services, taking into account the appropriate quality and safety of the services provided and the type of medical procedures performed. The draft regulation is in the phase of review and consultation.

After completing the qualifications, the President of the National Health Fund will publish a list of cardiology centers in the Public Information Bulletin. This list will be valid for 2 years from the day following the date of its publication, however, this period may be extended by the President of the National Health Fund by (maximum) 3 months.

It should be remembered that the procedure described above does not apply to the first qualification under the Act, which has its own, separate regulation.

The differences will concern the qualification criteria, the period of validity of the list, the obligations imposed on individual cardiology centres and the time of their implementation.

First of all, the Act provides that the President of the National Health Fund will make the first qualification within 6 months of the entry into force of the Act, and the KSK system itself will be launched within 24 months of the date of entry into force of the Act. However, it should be assumed that the President of the National Health Fund will make the first qualification sooner, similarly to the case of the qualification of entities to the National Oncological Network.

Moreover, the first qualification will be valid for 3 years, and each subsequent qualification will be valid for only 2 years.

The first qualification will be based on the criteria specified in Article 16, paragraph 2 of the Act, further specified by the relevant Regulation of the Minister of Health.

The status of the CDK, or the status of the Cardiac Excellence Centre, will be awarded by the President of the National Health Fund to a cardiology centre that stands out in terms of the quantity, quality and safety of the health services provided. The procedure for awarding the status of the CDK is consistent with the procedure for selecting cardiology centres of a given level. Detailed conditions will be specified in the draft Regulation of the Minister of Health on the types of Cardiac Excellence Centres and detailed criteria for awarding the status of the Cardiac Excellence Centre to a cardiology centre.

Currently, the Regulation provides for the creation of two types of CDK: the Cardiological Centre of Excellence for Congenital Heart Defects in Adults and the Cardiological Centre of Excellence for Pulmonary Vascular Diseases.

The criteria for ranking a cardiology centre will include, among others, the number of medical procedures performed or the number of patients who receive healthcare services, taking into account the high level of expert knowledge and interdisciplinary diagnostics and treatment of the type or disease entities of circulatory system diseases.

In the event of non-qualification for the KSK or incorrect classification to a given level, the healthcare entity has the right to file a protest.

The protest must be submitted to the President of the National Health Fund within 14 days of the date of validity of the list, only in electronic form. The protest must meet all formal conditions specified in the Act and also contain justification.

The President of the National Health Fund shall consider the protest within 21 days in the form of a decision. In the decision upholding the protest, the President of the National Health Fund shall qualify the medical entity for a given level of protection or change its qualification.

An appeal against the decision of the President of the National Health Fund may be lodged with the Minister of Health, which must also be filed within 14 days. The Minister of Health, when considering the appeal, may uphold the decision of the President of the National Health Fund or repeal it and refer the case to the President for reconsideration.

The results of the first qualification for the KSK will be valid for 3 years from the launch of the program. The launch of the program itself is to take place no later than July 2, 2027. This means that the results of the first qualification may decide on the financing of the medical entity even until mid-2030. Therefore, it is important, from the point of view of the medical entity, to prepare for the qualification process and then, if it does not proceed as expected, to submit formally correct and justified protests and appeals.