They worked on rehabilitation with a scalpel – Newspaper Kommersant No. 142 (7343) dated 08/08/2022

The Ministry of Health has prepared additions to the order on medical rehabilitation, which, as Kommersant told Kommersant, caused criticism from representatives of the industry. Doctors, in particular, predicted that due to increased requirements for equipment and personnel, small regional centers might simply not survive. The department partially went along with the arguments of the critics, however, experts interviewed by Kommersant believe that the additions change little the “essence of the order”. In the meantime, rehabilitation, according to experts from the Ministry of Health, is needed by 100% of citizens who have had a severe form of coronavirus.

The Ministry of Health has developed additions to Order No. 788n on the procedure for organizing medical rehabilitation for adults. It is proposed to allow the use of existing departments, physiotherapy exercises, physiotherapy and other similar units of medical organizations to provide such assistance without creating a specialized department.

The order of the Ministry of Health “On the procedure for organizing medical rehabilitation of adults” was registered by the Ministry of Justice of the Russian Federation in September 2020 and entered into force on January 1, 2021. As Kommersant told (see issue dated April 30, 2021), industry representatives criticized the document. He divides existing medical institutions into four types, regulates the stages and intensity of rehabilitation activities, and suggests that they should be an expanded contingent of a rehabilitation team of doctors created for each specific patient. Doctors warned that these rules were designed for large federal centers, and small regional institutions might simply not survive. For example, critics said, a multidisciplinary team should be led by a specialist in medical rehabilitation, and there are very few of them in the country. The requirements for equipping specialized departments were also called excessive.

It was assumed that in order to obtain a license for rehabilitation (this must be done before June 1, 2023), a medical institution must have round-the-clock functioning departments in the field of “anesthesiology and resuscitation”, a ward or an intensive care unit (to provide “including high-tech, medical care according to the profile of the underlying disease”), as well as the department of X-ray diagnostics. Now all these requirements do not apply to medical institutions that are engaged in the rehabilitation of patients on an outpatient basis and in a day hospital, as well as those that accept not the most difficult patients in a round-the-clock hospital.

Sergey Galizdra, head physician of the Saki Special Hospital for Medical Rehabilitation of the Republic of Kazakhstan, emphasizes that the changes do not change much in the essence of the order itself, since physiotherapy procedures could previously be received on an outpatient basis, but this is not rehabilitation in the literal sense. Another source of Kommersant, who is well acquainted with the work of rehabilitation centers, also notes that an outpatient visit to the exercise therapy room does not provide rehabilitation, and a multidisciplinary team led by a rehabilitation doctor instead of a narrow specialist, in particular a neurologist, cardiologist, orthopedist or rheumatologist,— high-quality personalized rehabilitation for each individual patient. “There should be an integrated approach to treatment, and not the organization of procedures, and additions to the order do not provide it,” concludes the interlocutor of Kommersant.

Sergei Galizdra believes that, in general, the order of the Ministry of Health on organizing medical rehabilitation is still a “headache” for small rehabilitation centers, designed, for example, like his medical institution, for 30 beds. According to him, in order to meet the new requirements, the Saki Special Hospital for Medical Rehabilitation must spend “hundreds of millions of rubles” only on design estimates and the purchase of equipment. But, Sergei Galizdra continues, the institution may still not receive the “cherished license”.

It should be noted that earlier ONF experts recommended that the Ministry of Health and the Federal Compulsory Medical Insurance Fund simplify obtaining a license for medical rehabilitation services (albeit for outpatient clinics) in order to “bring care closer to citizens” and set a reasonable tariff for it.

The problem of rehabilitation has been one of the most difficult in healthcare over the past 30 years for authorities, doctors and patients, says Yan Vlasov, co-chairman of the All-Russian Union of Patients (VSP). At the same time, the issue of rehabilitation has become even more massive due to the COVID-19 pandemic. According to the chief freelance specialist in medical rehabilitation of the Ministry of Health of the Russian Federation, 100% of patients who had a severe infection, 70% of those with a moderate disease, and 25–40% of those with a mild illness need additional restorative treatment. In June 2021, President Vladimir Putin announced the creation of a program to develop a system of medical rehabilitation after the coronavirus until 2026. In the next three years, the state allocated 60 billion rubles for these purposes. Oksana Drapkina, director of the National Medical Research Center for Therapy and Preventive Medicine, explained that the program involves in-depth diagnostics at the first stage, after which a number of patients are placed for dispensary observation, and someone is sent for rehabilitation in an outpatient clinic or hospital.

Yan Vlasov also believes that the additions developed by the Ministry of Health to the order on the organization of medical rehabilitation “will not change much for the patient.” “The two to three weeks allotted in the clinical guidelines for recovery after treatment is not enough for comprehensive rehabilitation. The patient must not only restore health, but also have time to adapt to the new conditions of life after the illness,” he explains. The VSP “repeatedly” applied to the authorities with a proposal to allocate rehabilitation as a separate type of assistance with funding and a system of rehabilitation institutions licensed to carry out medical activities. According to Yan Vlasov, “a different conceptual approach to this issue” is required.

Kommersant turned to the Ministry of Health with a request to comment on the changes made to the organization of medical rehabilitation, but at the time of publication did not receive a response.

Natalia Kostarnova; Alexandra Larintseva, Pyatigorsk