BUPA Insurance and Orthopaedics
August 2008
BUPA Insurance is continuing its approach to orthopaedic surgeons by offering various groups of consultants a package-price for orthopaedic procedures. BUPA have admitted that some consultants may perceive a loss of autonomy (and that cannot be denied) but they insist that this will in some way enhance practice.
In package priced orthopaedics a fixed sum of money is given to the surgeon and with this he/she is expected to encompass the operation fees (anaesthetic and surgical) and all the post-operative consultations and physiotherapy for a period of nine months from operation. Hospitals are not involved in this initiative and will continue to work to their current contracts with BUPA.
FIPO has seen and reviewed the actual BUPA package price fees which was offered to one London based orthopaedic group (and rejected). Using this data an analysis of some common orthopaedic operations has been performed to show the funds available for post-operative care assuming the operative fees are at BUPA rates. It is evident that there would be a variable but limited amount of funding left over. As an example, in a hip replacement, assuming that the orthopaedic surgeon and the anaesthetist charged at the current BUPA rates, just £40 would be available for the surgeon for all the post-operative consultations and physiotherapy treatments for nine months. Effectively this cutback in reimbursement would induce conflicts between surgeons and anaesthetists and the quality of care could suffer as post-operative visits and treatments might be reduced.
Surgeons should consider the implications carefully before committing themselves to this type of arrangement. FIPO does not engage in any fee setting or fee negotiations and consultants are free to set their fees and charges as they wish. Nevertheless, the implications for patients are of major concern to FIPO and its members.
The BUPA orthopaedic initiative has had a similarly low level of uptake to the 2007 BUPA ophthalmology initiative. FIPO believes that the exercise would impact on patient care, and would also seriously affect consultant autonomy (a fact tacitly admitted by BUPA Insurance) as under the scheme consultants will lose the right to charge BUPA funded patients independently as they will be bound by a contract with BUPA.