Podiatrists play a vital role in managing foot conditions, particularly through the prescription and fitting of foot orthoses. Recent legislative changes have given them greater responsibilities and capabilities in this area. Here's an overview of the current legal provisions and the requirements that must be met.
Podiatrists and their prescription rights: what you need to know in 2024
Since May 2023, chiropodists can directly prescribe orthopedic insoles without a prior medical prescription. This development, resulting from the RIST law, simplifies access to podiatric care. Patients can now consult a podiatrist without going through their primary care physician to obtain foot orthoses, while still benefiting from coverage by Health Insurance.
Legal framework for podiatric prescriptions
The Public Health Code precisely defines the prerogatives of chiropodists and podiatrists in terms of prescription. Article R. 4322-1 authorizes these professionals to prescribe topical products for external use and dressings.
The list of prescribed products includes in particular:
- Antifungals for skin conditions
- Keratolytics for softening purposes
- Alginate dressings for wounds
A 2009 decree expanded the scope of action, allowing social security to cover certain prescribed products. Podiatrists can also renew prescriptions for therapeutic shoes for diabetic patients, under specific conditions.
Types of care and prescriptions authorized
Podiatrists have a wide range of therapeutic skills. They can perform clinical foot examinations, perform pedicure treatments, and design custom-made foot orthotics.
For people with diabetes, these professionals play a crucial role in preventing complications. They assess podiatric risk and determine the number of sessions needed, now without a prior prescription.
Podiatrists are also authorized to:
- Treating skin and nail conditions
- Perform podiatric rehabilitation procedures
- Advise on choosing suitable shoes
Their scope of action extends to the management of postural and gait disorders, thus contributing to improving the quality of life of patients.
Orthopedic insoles: new autonomy
Recent legislative changes grant chiropodists greater autonomy in prescribing orthopedic insoles. This advancement significantly simplifies the patient journey, reducing processing times and optimizing care.
Practitioners can now adapt foot orthotics to each patient's specific needs, without intermediaries. This proximity facilitates personalized monitoring and rapid adjustments if necessary.
Direct access to podiatric care has several benefits:
- Increased responsiveness to podiatric problems
- A reduction in redundant medical consultations
- A valuable time saving for patients
This new prerogative strengthens the position of the chiropodist as a key player in foot health, while facilitating access to care for the general public.
Reimbursement and coverage of care
Reimbursement for podiatric procedures varies depending on the patient's profile. For people with diabetes, Social Security fully covers preventive sessions, with a number defined according to the risk level.
Non-diabetics benefit from limited coverage, generally supplemented by mutual insurance. Orthopedic insoles are reimbursed at 60% of the standard rate by Health Insurance, with the remainder being paid by the patient or their complementary health insurance.
Certain specific procedures, such as the treatment of plantar warts or the creation of orthonyxias, are not reimbursed by Social Security. Mutual insurance companies often offer annual flat rates for these non-regulated treatments, allowing patients to reduce their costs.
The gradation of podiatric risk, now achievable directly by the podiatrist, facilitates access to appropriate care for diabetic patients.
Care pathway: with or without a prescription?
Consulting a podiatrist-chiropodist now takes place through two distinct channels. Direct access applies to clinical foot examinations, pedicure treatments, and the design of foot orthotics. Patients can schedule an appointment without consulting their primary care physician.
However, a prescription remains essential in certain cases:
- For the reimbursement of orthopedic insoles by Health Insurance
- When monitoring chronic conditions such as diabetes
- For the management of certain specific treatments
Diabetics benefit from a special approach. The podiatrist can directly assess the patient's podiatric risk and prescribe the necessary sessions, thus optimizing therapeutic monitoring.
Podiatrist-doctor relationship: complementarity
Collaboration between podiatrists and physicians is essential for comprehensive patient care. Podiatrists systematically share their diagnostic assessments and treatment reports with their primary care physicians. This two-way communication allows for the refinement of treatment strategies.
In the case of diabetic patients, the podiatrist informs the doctor of the evolution of the podiatric risk, facilitating the adjustment of treatment if necessary. For complex pathologies, regular exchanges between these professionals ensure a consistent and personalized approach.
This synergy improves the quality of care provided by combining the podiatrist's specific expertise with the practitioner's general medical knowledge. It contributes to better prevention and more effective monitoring of foot conditions.
Fees and agreements for podiatrists
Fees for chiropodists and podiatrists vary depending on their sector of practice. In sector 1, they apply the rates set by the national convention. Sector 2 allows for additional charges, with a requirement for moderation.
The fee structure varies depending on the procedure performed. For example, an initial podiatric assessment generally costs more than a follow-up session. Specific treatments such as orthoplasty also have their own scales.
Displaying prices in the office is mandatory. It must include:
- Prices for routine consultations
- The amount of any excess charges
- Billing conditions for medical devices
The agreement directly influences the practitioner's freedom of pricing and the payment terms for patients.
Recent developments: RIST law and perspectives
The promulgation of the RIST law in May 2023 marked a major turning point for the profession of chiropodist and podiatrist. This reform significantly expanded the scope of these practitioners' activities, allowing them to directly prescribe foot orthoses.
The impact of this law is already being felt on the ground. Patients benefit from easier access to podiatric care, reducing treatment wait times.
Looking ahead, we can envisage a shift in the podiatrist's role towards a more preventative approach. The ability to assess podiatric risk in diabetics opens the way to better anticipation of complications.
This increased autonomy could also lead to a redefinition of interprofessional collaborations, strengthening the role of the podiatrist in the healthcare pathway.
