Optometrists to prescribe your glasses: CPAM Charente sees red and files a complaint

Optometrists to prescribe your glasses: CPAM Charente sees red and files a complaint
Optometrists to prescribe your glasses: CPAM Charente sees red and files a complaint

A completely legal system since different texts have expanded their missions. An idea from Alexandra Bonniol, herself an orthoptist, in conjunction with Dr Hospital, ophthalmologist at Laser Vision, a consultation and surgery center located at the Soyaux clinical center (but independent).

We had a very competent team. We did an incredible screening.

This originally virtuous system could well find its epilogue in court. In March, the CPAM discovered that each of these branches had no longer hosted orthoptists but optometrists for sometimes almost two years. Even if their missions are similar (see box), the former, trained for three years in a medical school, are recognized health professionals, the latter not at all. They hold a BTS optician-eyewear specialist and additional training. However, their actions continued to be reimbursed because Health Insurance had not known that the positions were now filled by optometrists. Their billing “was carried out under the professional number of an orthoptist”, she specifies.

The CPAM filed a complaint and Alexandra Bonniol hired a lawyer. If the system was designed with Dr. Hospital, who retired at the end of last year, it is she who carries it alone, from a legal point of view. To employ these employees, it created two SARLs. Since these turmoil, some of these optometrists have left, breaking their agreement, others are still practicing but they are no longer approved. Their €28 consultations are only reimbursed by a few cents.

“Don’t leave these cabinets empty”

Alexandra Bonniol pleads good faith. “The orthoptists left and I was unable to replace them. It’s complicated to bring people to rural areas. So I turned to optometrists. As some work in ophthalmology practices, we thought we could afford this small difference. I know I shouldn’t have done it but it was so as not to leave those cabinets empty. We were overwhelmed with people who we could not relieve. It was supposed to be temporary, until I found orthoptists.” If the procedure comes to an end, she could have to reimburse everything that Health Insurance has unduly paid to patients for almost two years.

“We had a very competent team,” she continues. We did an incredible screening. The benefit of working in a network means that as soon as we detect a problem, we refer it to an ophthalmologist who can respond quickly.” She insists on the medical check-up carried out by an ophthalmologist from Laser Vision, Dr Hospital (1) until the beginning of the year then Dr Peres since mid-February.

“Who are we laughing at?”

The latter confirms that he monitored prescriptions, particularly in the event of a sharp decline in vision or to check certain test results such as eye pressure. “We looked to see if everything was consistent,” points out Dr. Peres, who claims not to have been aware that it was optometrists who were officiating. “If she told me, it went over my head.”

Local elected officials salute these branches for “the service provided to the population”, underlines Benoît Savy, president of the CDC de Charente limousine. The Ruffec hospital defense association issued an open letter. “At a time when specialist doctors are such a rare commodity that the inhabitants of our living area are no longer entitled to them within 50 km, at a time when internet consultations are recommended as an alternative solution to medical deserts, the consultations of an optometrist on site in Ruffec, in permanent contact with the Soyaux office by tele-imaging, would not be compliant. Who are we kidding?” chokes up Edith Pot, tireless activist. Especially since the optician who traveled the Charente at the beginning of the month, aboard his Sym Optic truck, carrying out assessments and allowing a prescription to be obtained after remote validation, is fully reimbursed. Difficult for patients to see clearly.

Today, Alexandra Bonniol managed to recruit three orthoptists for Aigre, Ruffec and La Couronne, who will arrive in July and September. Ribérac has closed. The union of optometrists continues to fight to obtain a legal framework like their orthoptist colleagues. But it is not won.

On January 30, Prisca Thevenot, government spokesperson, reiterated “that several elements stand in the way”: the risk of complicating the care pathway for the patient, and the fact that “optometry constitutes a hybrid profession of caregiver-seller who potentially presents major risks of abuse.”

(1) He did not respond to our requests.

Who does what ?

In France, three professions are recognized: the ophthalmologistdoctor, who prescribes glasses and lenses, detects diseases, performs eye surgery, the orthoptist who is not a doctor, performs rehabilitation, screening and exploration of vision directly or on medical prescription, can prescribe and renew glasses or lenses under certain conditions and the optician which issues glasses and lenses on prescription, and is authorized to renew prescriptions under certain conditions. The optometrist carries out eye exams and prescriptions in offices or stores but has no legal existence.

The orthoptist was in Calais, the ophthalmologist in Guadeloupe

Vincent Dedes (photo CL), the president of the union of ophthalmologists of France (SNOF), reaffirms that optometrists “are not a recognized profession”. For him, the system put in place in Charente can be compared to “the illegal practice of orthopsy or medicine”. The union is very vigilant regarding the working conditions of the various professionals involved in the vision care process, within a very strict regulatory framework.
“In France, we have counted that 250 orthoptists are listed as ophthalmologists on online sites,” he points out. In certain cases, orthoptists must, through protocols, have their prescriptions validated by an ophthalmologist, but here again certain abuses exist, which are “harmful to the profession”. “Ethics requires that we respect a principle of territoriality. However, recently we saw an orthoptist from Calais who worked with an ophthalmologist from Guadeloupe. And we cannot blame the patients, who are ready to do anything to get a prescription,” supports Vincent Dedes who will also host a national press conference on June 13 around these questions in particular. Abuses, involving opticians, have also been noted in Tarbes or Agen.
However, the doctor emphasizes the importance of cooperation between ophthalmologists, orthoptists and opticians. “They made it possible to divide the waiting times for an appointment by 70.” And today, the renewal rate “is the same in cities as in areas in tension”.

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