Specialists subject to transparency

If the amount of the total fee exceeds 80 euros, doctors, regardless of their sector of activity, must first give the patient a quote. A decree should formalize this measure in the coming weeks. For the government, the objective is to promote price transparency. “This follows the overruns of fees, deemed too numerous and too frequent, explains UMP deputy Jean-Pierre Door, cardiologist by training. The General Inspectorate of Social Affairs (IGAS) sounded the alarm bells last year in a report.
In fifteen years, the overall amount of overruns has doubled to reach 1.578 billion euros in 2005. IGAS also noted that in terms of overruns, practices are very disparate between practitioners, and especially within the same specialty. For example, 90% of ophthalmologists practice an average exceedance rate of 27% but the remaining 10% have an exceedance rate greater than 119%. “Even we general practitioners have a problem of readability,” testifies Dr. Fabien Quédeville, president of the union of young doctors (SNJMG). When we send a patient to a specialist, we do not know what to expect if we do not have a regular correspondent in the specialty concerned ”.
For IGAS, the quality of the information provided to policyholders is “very insufficient”. “Not only are the texts on the display very poorly applied in the practices, but the information provided by the health insurance is extremely poor”, underlined the authors of the report in April 2007. These findings weighed heavily on the discussions on the Social Security financing for 2008.
This is why the Minister of Health added last November a provision obliging liberal physicians to present: “prior written information specifying the price of the procedures performed as well as the nature and amount of the overrun invoiced, since its fees exceed a threshold set “by the ministers responsible for health and social security”. It is the implementation of this obligation which is currently being prepared. The ministries of Roselyne Bachelot and Eric Woerth have set the amount at 80 euros.

This amount was defined on the basis of studies carried out at the CNAM, which showed that the average fee overruns from the most common acts were between 80 and 100 euros. For now, the low range has been chosen, but it is possible that at the last minute, this threshold will be raised to 100 euros. “We think that the threshold of 80 euros is too low, considers the president of the CSMF. This includes all imaging procedures, for example, and as soon as a consultation is combined with a technical procedure, this threshold is quickly reached. “Conversely, the vice-president of the ophthalmologists union, Dr. Jean-Bernard Rottier, believes that the threshold of 80 euros will not be reached by a majority of ophthalmologists. “I remind you that in sector I the price of the consultation is 28 euros, and that in sector II the basis for reimbursement is from 23 euros. So for the majority of practitioners who do not exceed excessively, this measure will not concern them. This will add more paperwork to heavy procedures like laser treatments, “says Dr. Rottier.

Basically, the majority of doctors’ unions approve the principle of price transparency. And everyone reminds that they have models of price posters available to practitioners to pin in their waiting rooms. In addition, the 2008 Social Security financing law recalls that “the health professional must display in a visible and legible manner in his waiting room or, failing that in his place of practice, information relating to his fees, including the overruns it charges ”. Under penalty of penalties to be further defined.

Questions to Dr Marie-Pascale Quirin, president of the association of liberal anesthetists

A measure that hides others

Does the implementation of this quote surprise you?
Dr Marie-Pascale Quirin. The general principle does not bother us. The patient and the mutual have the right to know exactly what is the amount of the reimbursement or the support they are going to have to pay. Moreover, we have already undertaken to make additional quotes. Particularly for supplements in the context of pain management which are not yet included in the nomenclature. And I remind you that a majority of anesthesiologists work in sector I.

What is the problem?
Dr MP. Q. Fear is what this measure hides. Today, we are establishing an obligation of 80 euros, professionals accept, then after this supervision will go how far? It is not trivial to create this information obligation. In addition, I do not understand why this threshold applies to all sectors combined. Are we going to sacrifice Sector II? Create the optional sector? It is necessary to see within the framework of the bill of financing for the year 2009, if the tariffs for the technical platforms increase or not. The surgeons made proposals, we, the anesthetists too. Will they be selected?

How to explain this choice of 80 euros?
Dr MP. Q. The CNAM had shown us that the national average for excess fees was around 100 euros. However, this does not correspond to anything because the practices are very disparate according to the specialties, the regions. It can range from zero to 3000 euros. I believe they focused on the most common surgical procedures, such as varicose veins. And the government chose the low range to leave room for negotiation. Interview with MG