News Update on the BUPA Ophthalmology Tender
April 8th 2007
BUPA Insurance has stated that they will be announcing the outcome of their ophthalmology tender on the 16th April. It is presently unclear how many hospitals and consultants have combined to enrol in this tender. Of course, most hospitals will have made it clear to BUPA Insurance that they provide ophthalmic services and thus may be “approved” but this does not necessarily mean that local consultants are enrolled as envisaged by the tender.
BUPA Insurance have also now indicated that the patients of consultants within the network (“approved consultants”) will be reimbursed differently to those patients being treated by “recognised consultants” (outside the network). It has to be made clear that an insurance company does NOT pay the consultant’s fees; they will reimburse their subscribers for consultant fees within the constraints of their particular policy.
The actual patient reimbursement rates announced by BUPA Insurance show that for the less common ophthalmic operations reimbursements for patients under the care of recognised consultants will remain the same whilst there may be increased reimbursement to patients who see approved consultants within the network. For the more common cataract procedures the reimbursement rates to patients for recognised consultants have been cut by almost 50% but less so for patients treated within the network. Inevitably this means that patients may receive shortfalls which they will have to fund personally.
It is also clear that from BUPA Insurance documentation that their subscribers will be divided into three bands (A, B and C) and that their reimbursements will vary accordingly with less benefits to those in C band and maximum benefits to those in A band. What is less certain is if all the patients are aware of this matter.
Previous documentation from the BUPA Insurance has indicated that the company will do everything in its power to direct patients to their approved or networked partners (at pre-authorisation and by other forms of persuasion). In announcing these differential types of patient reimbursements BUPA is using a financial lever to try and enforce this principle. Of course most patients will not wish to have their choice of consultant dictated by an insurer.
BUPA Hospitals have made their own announcement in support of the Insurance division by stating that the “BUPA Panel” will become operational for the BUPA Insurance ophthalmic tender. The BUPA Hospital Panel was previously announced by the hospital division as a method of engaging their local consultants with practising privileges into a separate sub-group predominantly to allow for NHS contract work. Membership of the Panel will be obligatory for new consultants who apply for practising privileges at a BUPA hospital but optional for established consultants.
It now seems evident that this Panel will be utilised as part of the BUPA Insurance ophthalmic tender. However, consultant ophthalmologists who do enrol will be required to practise according to BUPA Hospital clinical care pathways which have not been defined. FIPO has made it clear that the profession does not consider it appropriate that clinical guidelines should be dictated by non-professional bodies who have vested financial interests.
The professional response to the current situation has been expressed by various letters from the BMA and also FIPO...
letter from FIPO and the Association of Ophthalmologists (UK)
link the Association of Ophthalmologists (UK)