Consultant Fee Arrangements in the Independent Sector
Fee Compliance and Competition Law – December 2015
In the light of the large fine on Consultant Eye Surgeons Partnership (CESP) see here FIPO met with the CMA. Following this FIPO has produced two documents to explain the legal issues behind fee charging by consultants. A Newsletter to consultants can be seen here (click here). FIPOs two information documents on Competition Law Compliance are:
The CMA has published a Press statement acknowledging the help of FIPO, along with some further documentation about Fee Compliance and Competition Law. The CMA Press Statement contains links to further information. (click here).
Fee Remedy for Consultants following the CMA report - August 2015
The CMA report in April 2014 mandated a Cost / Quality remedy for all consultants in the private sector. The 'Cost Remedy' will involve the publication of fee schedules by all consultants, this to be carried out by PHIN (Private Healthcare Information Network). At this juncture the fee remedy has not been implemented pending FIPO's appeal to the Court of Appeal. The 'Quality Remedy' is being developed by PHIN which is engaging with hospitals and the profession. FIPO is the "conduit" for the professional input and a small advisory group has been set up to facilitate this. Part of the CMA's fee remedy requires consultants to provide fee estimates to patients whenever feasible. Although the fee remedy is the subject of an appeal FIPO's position on fee estimates is perfectly clear and has been our position for some years as indicated below. Patients should be given fee estimates whenever possible for treatments proposed in the private sector.
The FIPO Patient Charter
FIPO launched its Charter on the November 26th 2007 at Church House Conference Centre, Westminster with presentations by the Chairman of FIPO and the Minister of Health Professor Lord Darzi to an audience of patients, professionals, politicians, hospital providers and think tank representatives.
Fee Arrangements for Patients in the Independent Sector
Guidance for Patients, Consultants and General Practitioners
Fee Arrangements and the Consultant/Patient Contract
Patients may sometimes be confused about the contractual financial relationship between themselves, their private medical insurance company and their consultant and hospital. The situation is, however, fairly straight forward. The patient has a contract with the consultant which is entirely separate from their contract with their private medical insurer or any hospital they may attend.
Consultants charge fees and private medical insurers pay benefits (which may or may not fully compensate the patient for the consultant’s fees).
Thus, the patient is responsible for his/her consultant and hospital fees but may reclaim all or some of these amounts from their private medical insurer (if they have one). Usually the private hospitals will bill the insurer directly and the patient does not have anything further to pay unless there are some specific exclusions or copayments that they have previously agreed with the insurer. This shortfall must be settled by the patient with the hospital.
Consultant fees are handled by a different route. Consultants may submit their fees to the patient although in many cases the consultant will bill the insurance company directly. In any event, if there is any shortfall then this becomes the responsibility of the patient.
Consultants should always endeavour to supply an estimate of fees prior to treatment although this cannot always be achieved if there is an emergency clinical situation. FIPO does not recommend any specific fee levels and always suggests that consultants are reasonable and open about their fee structure.
Preauthorisation for Treatment from an Insurer
Patients may find when seeking preauthorisation of treatment by specific consultants that they have been referred to, that the insurer attempts to intervene in this referral process by stating that the particular consultant is “expensive” or an “over-charger”. Patients should always insist on seeing the consultant of their choice and should always request an estimate of fees prior to treatment if the clinical circumstances allow this.
Supporting Documentation and Information for Consultants, Patients and General Practitioners
In order to assist consultants and patients FIPO has provided a template consultant booking letter which is one method of outlining the potential fees for patients. In addition there is a Fee Explanation note that can be downloaded and given to patients. This document answers in more detail some of the questions raised by patients.
For General Practitioners there is another more detailed explanation and a suggestion that they should always warn their patients not to be diverted from seeing the consultant of choice when they seek preauthorisation from the private medical insurer.
To access these documents, please click on the links below:
Rights & Responsibilities Leaflet
As part of its service to the profession FIPO has produced a leaflet on Patients' Rights & Responsibilities which has been supported and printed by the MPS (Medical Protection Society).
This leaflet covers both clinical and contractual issues which are so important in the independent sector where different market forces and economics apply. It has been approved by the MPS and the Patient Liaison Group of the Royal College of Surgeons of England and has been presented to the Independent Healthcare Association (IHA), the representative body for all independent hospitals and groups in the UK.
It is being sent to all of FIPO's groups in the hope that it
will be announced to membership who can then order their copies
via email at email@example.com
We hope that consultants will find this of value.
The leaflet is also being circulated to the MAC Chairmen of all independent hospitals.
Future print runs of this leaflet may be made available subject to demand. We would welcome feedback on this project - please email us.
The Association of Anaesthetists of Great Britain and Ireland
The Association of Anaesthetists has issued general guidance about Independent Practice which can be seen at http://www.aagbi.org/publications/guidelines/docs/independent_practice_08.pdf
In addition they have produced a voluntary code about billing procedures which is available here http://www.aagbi.org/publications/guidelines/docs/code_of_practice_08.pdf
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