News Update on the BUPA Ophthalmology Tender
July 19th 2006
update: 2nd October 2006
background on this article
Consultant Ophthalmologist and Anaesthetist Reactions
The current situation in the BUPA Ophthalmology tender is that the whole process has seemingly been stalled by the reluctance of consultants to furnish BUPA Insurance with any of their professional and clinical data. There has been no objection to filling in the first part of the BUPA form which gives only administrative data such as practice addresses, secretarial contacts and phone numbers. However, this does NOT imply that consultants have agreed to sign up to the whole process.
A further anxiety by consultants has been to sign up to the declaration at the end of the BUPA document, as this is perceived as being one sided in favour of the insurer.
Hospital Reactions
The independent hospital groups have reacted in slightly different ways. By and large they are against this type of Managed Care implicit In the BUPA proposal although a few embrace it possibly because they are faced with competitive issues in different localities. For this reason many hospitals have said that they would comply with the BUPA Approved Network subject to obtaining sufficient consultant backing (which currently is uncertain). There is some evidence that BUPA Insurance is putting more pressure on hospitals to try and force consultants in to the network.
In most hospital groups there has not been any major response to this BUPA pressure to enrol consultants and hospitals realise that the BUPA Insurance strategy is not in their best long-term interests. As ophthalmology only represents about 2% of private hospital revenue, this is something that hospitals could contend with despite the inevitable reduced returns. However, hospital directors are well aware that orthopaedics and other specialties will follow quickly if this tender process is to continue and that would carry more severe financial implications for all of them, whether successful or not in any bid for BUPA work.
Professional Organisations and Their Reactions
FIPO has been working alongside the BMA, HCSA and all the relevant specialty organisations to constantly review the situation. This group has been writing on a regular basis to all ophthalmologists via the BMA. FIPO has written again to the major hospital providers to explain the professional position and to ask them not to pressurise consultants to apply to the BUPA Approved Ophthalmology Network.
In addition all the professional bodies have maintained a link to BUPA Insurance but it must be stressed that this does NOT mean that any formal negotiations are in progress. The professional bodies have examined the “quality” aspects of ophthalmic care in the UK and they do not find any major concerns. This does not mean that this specialty, working in an ever-evolving technological field is immune from further audits, reviews or changes of practice. However, the profession does NOT agree with the BUPA approach to this issue or recognise the bona fides of an insurance company in the assessment or management of clinical matters. This is made clear in the latest letter to BUPA Insurance which stresses that the profession is more than happy to look at any ways of improving standards and cost effectiveness but NOT within the type of contractual and insurance dominated Network format as proposed by BUPA Insurance.
For the latest letter as at this date to Consultant Ophthalmologists and to BUPA Insurance click here: www.bma.org.uk/ap.nsf/Content/BUPAOphthalmologyletter170706
BUPA Insurance Reactions
There have been a number of articles written in trade and other magazines that have been part of the BUPA Insurance campaign to summarise and present their position. It is not always possible to reproduce these fully but they appear, for example, in Private Healthcare News July 2006, Independent Healthcare Magazine, July 2006, Hi-Mag July 2006, Post Magazine June 2006 and Employee Benefits, July 2006.
The main BUPA argument has been laid out in the July issue of Independent Practitioner and is reproduced here with the full consent of the Editor.
Click here to view this article
In this report in Independent Practitioner, BUPA Insurance has made a number of statements one of which is to compare the new Ophthalmology Approved Network to its previous cancer “networks” for breast and colon malignancy. It should be made clear that these previous arrangement are loosely structured local agreements with which the profession has no dispute (for example the concept that surgeons should only work within their own scope of practice).
These so called networks are not the same as the new proposed ophthalmology network as there are no detailed provisions for the recognition and approval of consultants, no direct intrusions in to clinical care, no major reduction in patient choice, no specific contract for consultants to sign, no requests for audit data and no attempts to remove the consultant contract with the patient by package pricing.
The other messages coming out in publications and statements from BUPA Insurance are often inconsistent as in some statements BUPA are saying that the vast majority of their subscribers are perfectly happy with the consultant attention that they have received and at the same time BUPA are saying that they need to improve quality of care.
It is evident from the other BUPA comments that the main theme coming out is that BUPA Insurance is primarily interested in cost containment and that the quality issue is just a “wrap”. Thus it is stated in Independent Healthcare Market News - “Dr. Paula Franklin of BUPA has, meanwhile, not denied that cost is a consideration”. In “Media Benefits”, an insurance-based magazine, Dr Paula Franklin, deputy medical director for BUPA Health Insurance, said the company wanted to provide a more efficient and cost-effective service for clients - "We will agree prices with [the consultants] that will be related to the quality of service they provide. If the service is more efficient, everybody gains," she said. As the quality of service cannot easily be measured except by throughput (“efficiency”) this really means volume discounts which can only be achieved by a limited number of consultant providers and this would therefore imply reduced patient choice.
In Private Healthcare News Dr Franklin has stated that consultants have no incentive to be efficient and says “doctors have nothing more to gain from working in a more efficient manner, as they get paid a fee regardless of efficiency”. Others from BUPA have stated that they would pay more for better quality but fail to define this.
The medical profession, via its representative bodies, has made it absolutely clear to BUPA Insurance (and to other insurers) that the profession will always agree to cost effective treatment provided that such manoeuvres incorporate patient choice and appropriate medical care. The medical care extended to patients is the responsibility of the consultant and not the insurer. The danger implicit in the managed care scenario as proposed by BUPA (and has been exemplified by the American experience) is that clinical quality will actually suffer. There are ways in which costs can be contained and the profession has always agreed to work to this end. Over recent years there have been major advances in treatments that have meant that surgery is less invasive and more cost efficient (and laparoscopic surgery is just one case in point).
However, the medical profession cannot control hospital charges or future advances in therapy. Technological advances do not come cheaply and an example is the new treatments for cancer which insurers are struggling to fund. The situation will get more difficult with future therapeutic developments such as monoclonal antibodies coupled with increasing longevity. This will be a massive problem for all national healthcare systems not just the independent sector and healthcare economists are drawing parallels with the pension crisis. There is no easy answer to this but the tinkering with a managed care system is not the solution.
Thus, the response to BUPA Insurance from the profession is to agree to medically driven cost effective care plans based on professional guidelines and imposed locally with strict clinical governance. These must not compromise patient choice or standards of care. These are the terms by which the profession can work with all insurers but not within a tendering and managed care structure.