Number and types of caregivers in French CF Centers

Question

Hello,

Is there a national directive (or recommadation) which set out the minimal number of caregivers of the CF Centers according to the number of patients followed up?
Where could I find the information about the medical staff of the 49 French CF Centers: number of patients and types of caregivers ?
thanks in advance.

Answer

Hello,

There is currently no national guidelines or recommendation setting out the minimum number of caregivers of a CF Center according to the number of patients followed. Nevertheless there is a medical publication entitled "Standards of care for patients with cystic fibrosis: a European consensus." This publication reports on a percentage of professional time needed for 50 patients. It does’nt bind, however, the health authorities of the countries. Currently, virtually none of the 49 CF Centers reaches this level of resources.
In France, staff resources should theoretically meet:
• the obligations defined by the October 22th 2001 circular on the organization of care for CF patients. This circular defines the "specifications" of CF Center which were selected in 2002 on the tender of the Ministry of Health;
• National Protocol for Diagnosis and Treatment (PNDS), issued in 2006 by the Supreme Health Authority in accordance with the National Plan for Rare Diseases 2005-2008.
These two regulatory documents engage both Health authorities and the selected CF Centers. However, their practical application is limited by several obstacles:
• Professionals involved in CF patients care are administratively assigned to various units or medical services that do not match the contours of the CF Centers. It is therefore difficult to identify the percentage of time actually spent for CF patients.
• The various funds are hardly traceable to the CF Center which should be addressed;
• In other words, there is no accounting for tracing the CF professional activity and specifically, on the one hand, the cost of CF resources mobilized by the hospital, on the other the amount of funds collected on this purpose.
An audit carried out in 2008 at the request of the French Ministry of Health has found that many CF Centers (including adults), "victims of their success," were struggling to meet their missions lack of resources. As a solution, consultants advocated an adaptation of the hospital funding for CF according to the "pricing activity" (T2A).
In the remainder of this assessment, and after consultation with the Ministry of Health, the two National Expertise CF Centers in Nantes and Lyon, the French CF Society and the French CF Association entrusted to an expert for a study of the staff actifivity related to CF outpatient visits. The survey was carried out in September 2010 and its conclusions were presented to the Ministry of Health. In the report of the study (which does not take into account the issue of hospitalization) the solution recommended by the experts is to organize the CF outpatient visits, not as "External Consultation", but as "Hospital Day" with appropriate coding (according to the French Medical Coding Program – PMSI – including the International Classification of Diseases) and subject to prove the mobilization of a multidisciplinary team.
Accordingly, a recommendation for management and coding was co-signed by the two coordinators of National Expertise Centres, the Presidents of the French CF Society and the French CF Association, then spread out to all CF Centers Directors to allow the fair value of their work and the provision of a multidisciplinary team at each CF outpatient visit.
The purpose is to initiate a virtuous circle:
• Hospital to provide resources, including the multidisciplinary team, allowing the CF Center to meet its tasks in accordance with the 2001 circular and PNDS;
• CF Center to organize a "Day Hospital" for CF patients who come for regular follow-up or for a complication visit, to make the appropriate coding of this activity and to record its evidence in the patient’s file;
• Hospital to receive "T2A" funding corresponding to the reported PMSI CF activity;
• The payer, Health Insurance, to check the evidence of CF reported activity, possibly to reclassify it as a simple visit if the institution fails to prove the mobilization of resources expected for a "Day Hospital" and demand the reimbursement of overpayment (possibly with heavy financial penalties).
To date this recommendation has been implemented by some hospitals but not by others.
I hope my answer, necessarily somewhat technical, respond to your actually burning question.
Wishing you a merry Chrismas an a happy new year.

Gilles RAULT, MD

02.01.2012