In the middle of the summer, after several months of negotiations, trade unions and public authorities reached an agreement on the promotion of advanced practice in liberal arts. Formalized thanks to the signing on July 27 of amendment 9 to the convention of liberal nurses, this compromise was reached between the three representative unions of Idels (FNI, Sniil and the convergence nurse) and the National Union of health insurance companies (Uncam). Joined by the National Union of Complementary Health Insurance Organizations (Unocam), which after its discussion on 20-25 August indicated his desire to sign the agreement. “Regarding the IPA model, Unocam notes with satisfaction the maintenance of a fixed fee per patient model which will allow complementary health organizations to participate in the development of IPAs for the benefit of policyholders,” she wrote in his consideration.
Multiple billable plans
Amendment 9 supplements and replaces Amendment 7, which since 2019 defines the terms of remuneration of IPAs. The 2019 text had set different fixed prices that APNs can charge: €20 per patient for a first contact; €58.90 per patient and per years if the follow-up is longer than one year; €32.70 per patient once per quarter. Finally, help was provided to start a freelance activity: €17,000 in the first year for monitoring at least 50 patients, €10,000 in the second year for at least 150 patients. “Endorsement 7 did not allow IPAs to make a living from their liberal activity”, emphasizes Ghislaine Sicre, president of the Convergence nurses’ union.
The 2022 text introduces new packages and upgrades startup help. Two courses have been set up with orientation towards IPA. The first concerns the regular follow-up of the patients. The packages are then revalued “by more than 20%”, Cnam states in a press release. The first contact can be billed at €60, after which the follow-up can give rise to two packages of €50 each. term. “Actually, it happens that a patient comes to us several times a month at some point, so not even for a quarter of an hour, explains Sébastien Chapdaniel, IPA and member of Convergence RN invited to the negotiation table. The text from 2019 was too rigid and did not correspond to the realities on the ground. On average, IPAs charged only two fixed rates per year. The new surcharge will make it easier for them to charge four.
The second orientation channel concerns patients who are treated ad hoc.t, for which a “one-time IPA assessment” has been created, worth €30 (once a year and per patient). “One-off IPA treatment sessions” at €16 complete this option and can be billed a maximum of four times a year per patient. “Until then, we had no way of invoicing our activity for, for example, a suture or a blood pressure hole,” explains Sébastien Chapdaniel. There are also planned increases of €3.90 linked to the age of the patients (under 7 years, over 80 years). Finally, the start-up support is extended to all IPAs and can reach €40,000 over two years in case of installation in an under-dense area.
Remuneration assessed but insufficient
For the signatories, the new text represents real progress. The agreement is “balanced”. “It’s up to the doctors […] to play the game and rely on these highly qualified professionals,” said FNI. “The proposed model will allow us to achieve a remuneration close to that of the Idels. It still lacks 20 to 30% to reach an intermediate income, between the Idels and general practitioners , but at least the activity is now viable,” adds Sébastien Chapdaniel.
On the Unipa side, the reception is more lukewarm. Unrepresentatively, the union was not invited to sign the text, but it participated in the hearings. “The endorsement 9 makes it possible to consider liberal activity more calmly, but the remuneration is still insufficient, insists Tatiana Henriot, the president. In addition, the IPA conversation must be recognized as such if we want to be able to fulfill all our missions. Finally, the active file planned by Cnam has 300 patients followed and 400 individual patients. It is imperative that doctors play the game.”
A review is expected in 18 months. Until then, unions will continue to push for regulatory changes that would allow direct access and first-time prescriptions.
Telehealth and vaccination: the other points in the endorsement
Amendment 9 also expands the possibilities of using telecare for Idels, whose conditions are based on those that apply to doctors. Included is, for example, follow-up at home after hospitalization for COPD, monitoring of insulin-treated patients and follow-up of a bandage. The text also expands nurses’ area of competence in the area of vaccination and upgrades several of these laws.