From Brittany to the Côte d'Azur, via the Paris region, liberal doctors, on the front line facing the inexorable advance of the coronavirus, adapt their practice to the crisis. As in China, where millions of confined, or simply anxious, people have massively adopted the use of medical teleconsultation in recent months, the Covid-19 is taking off telemedicine in France. “We have increased the number of teleconsultation slots because for several days we have observed an increase in requests from our patients for remote consultations, especially related to covid-19”, says Dr Bruno Didier, general practitioner in Cannes. Particularly confined patients, having been in contact with positive cases of coronavirus or having similar symptoms. “This allows us to give them medical advice from a distance and, if necessary, redirect them to the 15th for dedicated care.”
© All Rights ReservedCare path, prices, reimbursement: telemedicine, instructions for use
For doctors, consulting remotely above all makes it possible to smooth and reduce passages in the waiting room in order to control the risk of cross-contamination. “We seek to prevent our patients with a benign pathology, such as an angina or a cold, from meeting potential patients with coronavirus,” agrees Dr Gwenaël Roth, general practitioner in Saint-Malo. So he does not hesitate to use it as widely as possible. “When it is enough, I also offer it to my patients with chronic diseases for their follow-up. I will not see some of them this quarter and will refill their prescription remotely.” In fact, some doctors have little choice. They have to adapt to an urgent request from their patients for teleconsultation appointments. “Most teleconsultation requests are for acts that have nothing to do with the coronavirus. Sometimes patients simply want to stay at home,” confirms Dr. Marine Crest, general practitioner in Marseille, referring to cases of patients put telework or this young mother who preferred not to expose her baby and make her monthly remote control visit.
A decree to lift the brakes
To facilitate this takeoff, especially since the government itself sees it as a remedy to limit the impact of the epidemic, the Minister of Health Olivier Véran announced Sunday evening that he would sign a decree “to soften considerably the conditions for carrying out telemedicine “, which was published in the Official Journal on Tuesday March 10. Concretely, the text aims to break down the obstacles which, according to companies in the sector, hinder the generalization of the practice in medical offices: “I decided to waive the obligation to go through his attending physician and to have had a face-to-face consultation the 12 months before carrying out a remote consultation,” said Olivier Véran in particular. The “coverage field” and the “limitation on the number of annual remote reports” are also relaxed, the text provides. However, the decree specifies that these provisions concern people exposed to covid-19 and that they must always contact a practitioner in their territory. These measures will last until April 30, 2020.
If the practice of teleconsultation started timidly in France, the epidemic of covid-19 shuffles the cards. And on the ground, the dozens of players who have bet big on the development of the telemedicine market in France, especially since Health Insurance reimburses teleconsultations under conditions, did not wait for these announcements to get in order of battle. “For the past two weeks, and the arrival of the virus in Italy and then in France, we have exceeded the bar of 100 new doctors registered with our service each week, a rate 1.5 times higher than the usual trend,” says Stéphanie Hervier, co-founder of Medaviz. The acts performed via the platform have more than doubled. The same goes for the Doctolib steamroller, which last week saw a 40% increase in the number of teleconsultation appointments via its platform and received “hundreds of requests from doctors to install teleconsultation”. To capitalize on this craze, and lift any remaining reluctance of practitioners, the unicorn led by Stanislas Niox-Château announced last Thursday that it offered free access to doctors across the country to its teleconsultation service. A service usually billed 79 euros per month to doctors who take out a subscription. “Since the announcement of full coverage of the cost of the subscription, we have received a thousand requests from doctors to install teleconsultation,” said one at Doctolib headquarters. The effort will be costly for Doctolib, which currently equips 3,500 practitioners – including a majority of general practitioners – in its teleconsultation service. They carried out 180,000 remote consultations in 2019.
Teleconsultations in pharmacies
Others reach for the wallet. Qare, which recently bought Doctopsy to challenge the quasi-monopoly of Doctolib and carried out 80,000 teleconsultations in 2019, also offers its teleconsultation service – normally charged 75 euros per month – to doctors for free. “The practitioners who work with us have increased the number of slots allocated to teleconsultations by 10%,” notes Olivier Thierry, CEO of Qare. A trend that does not only affect general practitioners, on the front line facing the virus. “We offer many specialties, and among them, doctors working in pediatrics, where waiting rooms can be nests for microbes, are very interested in teleconsultation.”
As new cases emerge, will telemedicine go fast enough to stop the spread of the virus? Will there be enough doctors to handle the surge in demand? “Our top priority today is to recruit new doctors,” recognizes Jonathan Ardouin, France's general manager of Livi (owned by the Swedish group Kry), who works with more than 300 salaried doctors. Several dozen practitioners are currently joining the ranks of society each week. “We want to speed up the pace, because after having seen a 25 to 35% increase in our traffic on coronavirus symptoms last week, we estimate that these cases will weigh for 10% of our activity by the end of this week, “said Dr. Maxime Cauterman, Livi's medical director. Other relays are being set up. Since endorsement 15 signed in late 2018 with Health Insurance, pharmacies can equip themselves with tools to offer teleconsultations. “With a network of 21,000 pharmacies, pharmacists are an essential link in access to local care, especially in areas where there are no doctors,” says Arnault Billy, CEO of Docavenue, who also notes real “coronavirus effect” on equipment requests. Large pharmacy networks have thus contacted the company. Betting on a “sustainable democratization” of teleconsultation, according to its co-founder Nathaniel Bern, Medadom, which markets a teleconsultation booth to pharmacies, plans to install 2,000 in 2020 after having deployed 200 in 2019.