FIPO News Update
IPT – Bupa remote consultations contract
Bupa has just released its new contract concerning terms for the billing and delivery of remote consultations, one that consultants are being pressured to agree to. FIPO urges consultants to carefully read all the terms and conditions of this new document before signing. Our Vice-Chairman, Mr Ian McDermott, explains further in the latest Independent Practitioner Today, which you may read here.
Following its publication, Bupa responded to these concerns in their own article, which you will find in the link above.
As reported in our Autumn – Winter 2020 newsletter Healthcode announced that it was to introduce clearing charges in its billing process due to the financial knock-back from this coronavirus pandemic, which made the free service no longer sustainable. Many consultants got in touch with FIPO to complain and many more voiced their grievances on social media. FIPO was in touch with Healthcode to enquire about the change and to cascade consultants’ and our own concerns over this proposal. Healthcode has now since responded that they have “postponed the introduction due to the uncertainty caused by the second coronavirus lockdown”. We anticipate a further update in 2021.
FIPO recently held its Annual General Meeting with its Council Members to reflect on the year drawing to an end and looking to the future to strategise on how FIPO can continue to support the healthcare sector; its consultants and most importantly, its patients in promoting quality care and portability of choice – particularly as we recover from the coronavirus pandemic and this second lockdown.
CMA – an examination of the CESP and Spire cases
The FIPO Executive recently hosted a Competition Law webinar for its Council members. Louise Baner of the Competition and Markets Authority (CMA) led a short presentation explaining the complexities of Competition Law in the world of healthcare using the recent Spire case and 2014 CESP case as examples of anti-competitive activity, and what evidence would be needed for the CMA to conduct a market investigation. You may view the slides here.
Some issues raised by our Council members concerned the delisting of consultants and “price fixing” by the private medical insurers (PMIs). Is this restriction of patient choice and this distortion of the healthcare market in breach of Competition Law? Or indeed, is it enough to warrant a investigation of the PMI market, which was not previously examined in the 2014 CMA ruling? Ms Baner explained that evidence would be needed showing that either:
- collectively the PMIs are price fixing as competitors between themselves; or
- one PMI is exerting its dominance and acting independently of the other competitors and setting fees.
Case law assesses “dominance” to having a buying power of 40-60% over the market, but it depends on what you can see in the healthcare market:
- is it constrained by one competitor?
- how are the consumers (patients) harmed – choice, quality of care?
- to what extent is it different to patients seeing the consultant of their own choice?
From Ms Baner’s perspective, ultimately it is very difficult to prove “collective dominance” and meet the threshold triggering a market investigation. The CMA would need to look at the market in its entirety and so the evidence of improper activity and real consumer detriment would need to be substantial to merit prioritisation over other pending investigations.
Council members were concerned that whilst the fee market for consultants was static, premiums for consumers were rising. Ms Baner explained that consultants’ fees staying at the same level is not indicative of a lack of competition under Competition Law, but again, may give reason for the CMA to use their second power to investigate the market if this suppresses the market. Who shares the pie of the premium? How is it distributed? How does it harm the consumer? If these actions result in a decline of consultant availability and if the PMIs continue to “fee cap” then surely it would show that the current market is not working and thus consequently and importantly, not achieving its purpose: to offer patient choice and quality of care.
There are many Financial Ombudsman cases evidencing PMIs interfering with patient care by “de-listing” consultants, taking over the care of the patient and controlling patient treatment via what they will and will not reimburse for. This means that patients are unable to make an informed decision with regards to their care and subsequently may be harmed. Ms Baner appreciated the issue, but unfortunately the CMA’s role is to balance this against the whole picture; it is an insured service and a commercial market with alternative avenues (NHS) and insurance policies have limits. Are there other ways to remedy this? Can Her Majesty’s Government intervene with regulations that are proactive in monitoring the private healthcare sector to ensure that it is fair in supporting all parties to ensure that quality care is deliverable to patients?
FIPO will continue to press all of the above issues and those that affect private healthcare industry, its consultants and its patients to ensure that the independent healthcare sector delivers on quality, safety and patient care.
Take care and stay safe.