Wednesday, January 9, 2019

The delicate grouping of health professionals


Back on the run for the actors of health. While the bill to implement the health system transformation plan should reach the Council of State in the coming days, several conventional negotiations will be held simultaneously during the first quarter. The Board of Medicare validated the guidelines on Monday. The aim is to restructure access to care as quickly as possible in order to thwart the expansion of medical deserts and relieve overstretched health professionals.

Resources for professional communities

Physicians, pharmacists, nurses and other health professionals will hold the first conventional bargaining session on territorial occupational health communities (CPTS) on January 16th. Objective: to develop these communities, which were only 200 in mid-2018 and which will have to turn around a thousand in 2022, in order to entrust the responsibility of the local population to a collective of caregivers.

The missions of the CPTS eligible for permanent financing by the health insurance will have to be defined in the negotiation. The idea would be to ensure access to a doctor for all inhabitants (12% of French people are deprived) or unscheduled consultations, but also to promote hospital-care transitions in both directions, to make prevention or continuing education, according to an internal document of the health insurance. It will also be necessary to equip these communities with information systems and other e-prescription software.

A penalty for the lonely

Negotiators will also need to define the notion of"Coordinated exercise" between health professionals, "Which implies at least participation in a CPTS"insisted the Minister of Health, Agnès Buzyn, in her letter framing 20 December. The government has planned to modulate the remuneration of health professionals to encourage them to abandon the isolated exercise. At this stage, the goal of Medicare is to create a bonus, but also a penalty, which may raise a storm among liberal practitioners.

Physicians should be the first to take the test. The negotiation of an amendment to their agreement begins one week later, and must be completed simultaneously with the other negotiation, at the end of March. They will say whether this modulation should relate to the consultation fee or the standard elements of remuneration (13% of the total), and what it will look like.

Assistants' jobs with degressive support

The doctors will also have to agree on the profile, missions and management of the 4,000 medical assistant positions to be created by 2022. These medical office jobs will be fully funded initially by the Medicare, to free up care time. Only physicians in coordinated practice and in pooled mode will be eligible; they will have to commit to a measurable increase in the patient followed.

Over the years, with more patients and more doctor's income, Social Security's financial support would decrease. Furthermore, "Failure to achieve the objectives should lead to calling into question the aid granted". Conditions that will undoubtedly be fiercely discussed.

The four headings of the bill on the organization and transformation of the health system were communicated in December to the professions concerned, for a month of consultation: local hospitals, reform of medical studies, innovation and digital, various measures.

The government hopes to be able to vote this text during the first quarter, because it is urgent to organize the removal of the first year of medical studies (Paces), which will take place in September 2020. Conversely, other topics require in-depth consultation. That is why the bill will provide the authority to legislate by ordinance: on the renovated status of local hospitals, which will multiply and benefit from new resources; on the recertification of doctors; on a single status of the hospital practitioner who will facilitate the joint liberal and salaried exercise; the use of the contract for hospitals; on the deployment of the e-prescription.

Solveig Godeluck


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