Haro on the visios? On the occasion of the presentation of the Social Security financing bill on Monday, the government announced its intention to further regulate the issuance of work stoppages during teleconsultations. Faced with the rapid development of this practice, often without recourse to the attending physician, “we must be extremely vigilant with regard to abuse of use”, justified the Minister of Health, François Braun, Tuesday, September 27, on franceinfo. Here is the underside of this reform, which could come into force next summer.
What new rules are being considered?
In his bill (PDF), the executive proposes to restrict the conditions for covering work stoppages. From June 1, 2023, if a stop has been prescribed as part of a teleconsultation, it cannot give rise to the payment of a daily allowance. “only if the physical incapacity has been noted (…) by the treating doctor (…) or by a doctor who has already seen the person concerned in consultation for less than a year”.
In other words, if you call on a doctor whom you have never met physically, you can always be prescribed a sick leave from a distance, but this will not be compensated. Teleconsultation will remain well reimbursed according to current criteria. Exceptions will be “possible”, however suggested François Braun, for example, for the elderly who would not have a doctor and who would find themselves in a medical desert. Stops prescribed during a physical consultation will all remain compensated, regardless of the doctor chosen.
Why is the government attacking teleconsultations?
In the text that will soon be submitted to Parliament, the executive says it wants to tackle “drifts” which accompany the rise of remote consultations, “particularly in terms of unjustified work stoppages”. Some patients would thus indulge in a “nomadism” doctor on teleconsultation platforms, multiplying online appointments until they find a professional who agrees to prescribe them sick leave.
In the facts, “in eight out of ten cases”work stoppages prescribed remotely concern patients who have not called on their general practitioner even though they have one. “It questions”, according to the Minister of Health. His colleague in charge of Public Accounts, Gabriel Attal, stresses that “twice as many of these sick leaves do not subsequently give rise to any prescription for medication, care or other”.
“The government will table an amendment so that fraudsters are now charged management fees in addition to the recovery of undue sums,” says @GabrielAttal.#DirectAN #PLFSS2023 pic.twitter.com/8numTjrQPw
—LCP (@LCP) September 26, 2022
Gabriel Attal sees in it a form of “fraud” and evokes an invoice of “nearly 100 million euros last year” related to these judgments “sometimes a little complacent”. If the reform is adopted, the budgetary saving could be greater than this amount. The executive expects the number of judgments resulting from teleconsultations to double in 2022, compared to the 110,000 recorded in 2021.
How is this announcement being received?
The government’s project responds to an expectation expressed by the sector. In July, in its annual report (PDF)the National Health Insurance Fund recommended “remove coverage for work stoppages prescribed in teleconsultation (hor attending physician)”. “What is needed is to set new rules of the game (…) to put an end to what we could call a bit the Wild West of teleconsultations”still pleaded its director general, Thomas Fatôme, on September 19, on TF1.
The initiative of the executive was welcomed within the medical world, in particular by the French Union for a free medicine, one of the representative unions among general practitioners and specialists. “What is needed is to return to quality medicine, medicine where the patient is known to his doctor and where we have the possibility of giving the French people treating doctors everywhere”, reacted its president, Jérôme Marty, on franceinfo. He sees in this reform “a masterful kick” given to certain companies “low cost medicine” who are surfing the wave of teleconsultations.
According to the MG France union, the reform could make it possible to curb this “derivative” and put the attending physician back at the center of the game. “Treating physicians do not issue work stoppages in the same way, they do it in a more thoughtful way”defends its vice-president, Florence Lapica, on M6.