BUPA Insurance Initiatives (March 2006)
BUPA Insurance announced in October 2005 a series of “Initiatives”, which if implemented could change the face of independent practice in the UK. These will involve speciality tendering (i.e. for clinical services) with the first important step being a tendering process for MRI scans. The results of this bid have just been announced. Other measures under consideration include an increased involvement by BUPA Insurance into clinical aspects of care with detailed Care Plans produced by and American Company called “Millimans” but “anglicised” for the UK market. There is a new schedule of coding for operative and other procedures with specific lengths of stay for many conditions.
All consultants will need to re-register with BUPA Insurance and complete a new detailed consultant recognition form. Part of the new recognition process will involve a contract between BUPA Insurance and consultants which will give the insurer greater power to de-list individual consultants over rather vague “complaints” (without any appeals process) and also allow the insurer greater control over the referral process of patients. There is a clause that allows BUPA Insurance to demand audit data (unspecified) from consultants. Another clause gives BUPA Insurance the right to recognise whomsoever they wish as a specialist, although they do insist that it is not their intention to recognise anyone other than properly trained NHS consultants.
This whole process is a step towards a much more “Managed Care” type of scenario and FIPO will be responding to all these matters via different means.
The results of the first tender for MRI have just been announced and some concerns have been expressed at the outcome. FIPO is keen to hear from any consultant or manager who feels that there have been clinical difficulties as a consequence of this tender. In London there are problems brewing with the failure of certain major hospitals to get recognition. The London Consultants’ Association has made its views known through a recent Statement.
Consultant radiologists throughout the UK were against the BUPA Insurance tender and saw considerable dangers in the process with risks of reduced clinical standards and consultant relationships. There was strong opposition to the concept of BUPA Insurance as a regulator of the profession or as an instigator of clinical care plans or audit.
All situations, of course, have their opportunities and some groups of consultants did bid for the MRI contract. This website contains an article by Dr Ray Stanbridge, the well-known accountant/journalist who presents an alternative business picture of Managed Care. Dr Stanbridge surveys the scene in purely commercial terms and makes comparisons with supermarkets and normal commercial forces. FIPO understands these arguments but would maintain that a patient seeking help for a cancer does not see the situation in the same way as when buying a car or something from Homebase. There are complex factors at play and patients and their care packages are not simple commodities.
If you have an opinion about any of these matters please contact us at email@example.com
Further Details about the BUPA Insurance Initiatives and the Professions Response
FIPO is unable to link to the BUPA Insurance documentation for this item as there are no links within the BUPA Insurance websites. However, this documentation has been placed in to the public domain by BUPA Insurance and readers are advised to contact us (firstname.lastname@example.org) for further information.
FIPO Review of the BUPA Insurance Initiatives
A statement by FIPO about this whole matter can be read here...
Press comments previously made by BUPA and other Insurers about Managed Care
There seems little enthusiasm for Managed Care from other major private medical insurers in the UK.
Conflicts in London over the MRI Tender
The statement from the London Consultants’ Association can be seen here on their website:
Consultant Radiologists Questionnaire Results
The views of consultant radiologists from around the UK about the BUPA Insurance MRI tender have also been obtained and can be seen on the AIR (Association of Independent radiologists) website...
Managed Care – An Accountant’s Views
Dr Ray Stanbridge has written on the opportunities for consultants in the changing scene of independent practice. The big question here is whether quality of care can be maintained in the face of ever increasing cut pricing. Experience in the USA would suggest not but read this article...