La téléconsultation est une consultation à distance réalisée entre un médecin « téléconsultant » et un patient assisté, éventuellement, par un autre professionnel de santé.
Si le gouvernement reconnaît que la télémédecine contribue notamment à répondre aux enjeux d’accès aux soins, il estime que le développement de sa prise en charge par l’Assurance maladie doit « s’accompagner d’une grande vigilance sur la qualité des pratiques et sur les dérives qui peuvent en découler ».
Plus particulièrement, le gouvernement souhaite prendre des mesures contre les arrêts de travail non justifiés. En effet, il a constaté que plus du quart (27 %) des arrêts de travail issus d’une téléconsultation sont aujourd’hui prescrits par un médecin qui n’est pas le médecin traitant de l’assuré. De plus, une étude menée par la CNAM sur une plate-forme de téléconsultation montre que ces arrêts de travail sont de plus en plus nombreux, de plus en plus longs et que les trois quarts d’entre eux ne sont accompagnés d’aucun autre soin remboursé (médicaments, kiné, analyses biologiques…).
En chiffres : en 2021, le montant des indemnités journalières versées aux assurés dans le cadre d’arrêts de travail prescrits en téléconsultation par un médecin autre que leur médecin traitant s’élevait à 95 millions d’euros.
Aussi, afin d’éviter les arrêts de travail non justifiés ou qui exigent un examen clinique en présentiel, le projet de loi de financement de la Sécurité sociale limite les cas dans lesquels les arrêts de travail prescrits dans le cadre d’une téléconsultation pourront être indemnisés.
Ainsi, à compter du 1er juin 2023, ces arrêts de travail ouvriraient droit au paiement d’indemnités journalières pour l’assuré uniquement s’ils sont prescrits par son médecin traitant ou par un médecin qu’il a déjà consulté dans la dernière année. Ce dernier cas répondant notamment aux besoins des patients qui rencontrent des difficultés pour trouver un médecin traitant.
Seraient concernés les arrêts de travail prescrits en raison d’un accident ou d’une maladie d’origine personnelle ou à la suite d’un accident du travail ou d’une maladie professionnelle.
À noter : le médecin devrait mentionner, sur le formulaire de déclaration d’arrêt de travail, si celui-ci est prescrit à la suite d’une téléconsultation ou d’une consultation.
Art. 43, projet de loi de financement de la Sécurité sociale, n° 274, 26 septembre 2023
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