UK Practitioners Alliance - Stop the Private Medical Groups | Preferred provider networks

[physiobob]

Hi all,

there isn't a day that goes by when I don't ponder how to take on the likes of BUPA/PPP etc against their controlling influence on our profession. The premise here is that they are seeking to control access to the vast majority of physiotherapists without any basis that benefits the patient. Mostly this is a priced based initiative and one that comes with huge manual and administrative overheads.

Hence the concept of some form of Alliance.

Here's what we are in the early stages of proposing.

1. We form a group whose mission is to provide ALL UK residents with access to treatment by ALL qualified physiotherapists who are deemed fit to practice by the HPC in the UK.

2. The group will endorse ALL private medical insurers who follow this basic premise and therefore who do not block access to all.

3. We will provide banners that can be used on third part websites that show a level of support and endorsement of that fact for those medical insurers.

4. For those companies who DO NOT follow that premise we will provide members of the group banners that clearly display that they DO NOT accept patients from those private medical insurers e.g. BUPA/PPP etc as they do not follow the basic premise of access to ALL for ALL.

5. We will seek to gain endorsement for the group from MP's Policiticans and importantly the CSP, Physio First and the HPC.

At this time I would welcome comments, especially from UK registered practitioners. I feel that this approach may be a far better way to have those not endorsed by the group to change their ways.

Comments?

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[helloplease]

Sounds like a great idea to me. You have my full support!

[MrPhysio+]

In Australia we have what is called a 'preferred provider' where the health funds give the patient a higher amount of refund provided the therapist agrees to take a lower amount of money for services provided. This is supposed to work as the health fund would recommend your practice via health fund advertising to increase patient numbers and increase overall income.
It is a restrictive trade practise and not recommended by the Australian Physiotherapy Association. Apparently similar schemes started in the U.S.A. Once most of the clinics signed up there was no advantage, so the health funds introduced a second tier premium refund system giving patients more refund if therapists agreed to charge even less. Such tactics are unsustainable as therapists eventually put lower experienced staff onto patients with these schemes and the patients end up paying more due to increased numbers of visits. The health fund monitors such increased treatment rates and then warns the clinic. Eventually it is a no win situation for everyone. The health insurers design these schemes dependent upon the laws in place where they operate.
It is necessary to fight back for our own survival as therapists and for ethical health care. Politicians need to be lobbied via patient and therapist feedback to show an overall decline in outcomes if such schemes continue to erode healthcare at high cost.
Just my opinion, for what it is worth.
MrPhysio+

[physiobob]

Thanks MyPhysio+ for your insights. I just can understand why, when we have so many international examples of why this does not work, why the profession as a whole suffers and why the bankers as a result get richer, that Physiotherapists (not just their associations) just DON'T GET IT!

Why will the UK have to follow the way of the USA and Australia to the detriment of the profession until they wake and and say...'Oh perhaps we should have stood out group against this at the beginning...

It is just as much an issue of the individual as the whole. So often I have thought to become more involved in either the CSP or Physio First but again and again my gut tells me that mine would be a lone single voice. It frustrates the crap out of me. We need to think way outside the box on this and come at healthcare from a totally different perspective where insurers and pharma's are not calling the shots.

I read a really interesting piece of information about the USA yesterday. Did you know that in 2007, a study by Harvard researchers found that medical problems caused an astonishing 62% of all personal bankruptcies files in the USA. Even more surprising was that 78% of those filers had medical insurance at the start of their illness. When we will learn that this is 'killing' not just us as professinals but the public who we support.

[MrPhysio+]

It is very frustrating. The Australian Physio Association is currently promoting therapists that openly state that the way to go is clinic franchising. The therapists that run these clinics are backed by the APA in ongoing education, public forums and the Associations magazines. These people are seen as guru's with the answer.
Unfortunately these same business people promise a nice world where the clinic works for you to the point that you can take as much time off as you like. The leading claimants proudly state how many clinics they have yet they no longer need to see patients at all. Deals are done via buying power and apparent acceptance by the APA to have business sent via health fund and compensable government nodies, sometimes locking out smaller truely independent clinics in the same region. The insurers buy cheaper services from these clinics, but the clinics value add onto the patients - and the patients are often given inferior services with multiple visits whils the therapist flits from room to room.
Patients experiencing these type of clinics often know no better and accept this as normal. The lobbying power of these guru's then affects the structure of the physio association and restrictive registration rules are brought in the squeeze the life out of ethical businesses.
I have had numerous patients that complain they were ripped off by over servicing disinterested therapists going through the motions with very poor assessments and diagnostic skills. Some of these clinics are manned by therapists that are professional students. The patients are told how wonderful the therapists are given their qualifications, but the patients see through this eventually and seek care elsewhere. The worse the problem becomes the less choice the patients have until they give up and treat our profession with the derision it deserves if change does not occur.

Utimately we reap what we sow. Our representatives have been deaf to the issues for years. In pandering to guru's and health insuers / government the way the profession has over the years outcomes are negatively impacted giving the third party payers and insurers the rod with which we are beaten down the next time negotiations commence.
I have tried for over 20 years to effect change, but as I am considered a thorny pest (I expect) rather than a guru giving platitudes to those in power I am ignored and sometimes deliberately undermined. The writing is on the wall but it seems that the reader is illiterate.
MrPhysio+

[physiobob]

Thanks for your learned reply. Seems that the APA are following what I saw happening in Canada in the early 90's. They went preferred provied via large clinic groups crazy. A lot made a lot of short term income, As you say the patients knew no better. Eventually the law stepped in and acknowledged the anti-competitive nature of what was going on and banned this preferred practice. The big clinics (including one I was working at) that were heavily exposed went under and became solo operations again. I think I may start a physio group section for this where people with various country perspectives can add commentary that perhaps may get picked up as points to discuss or ponder at association levels. As for the APA, well in the early 2000's Physiobase provided options and services that gave the APA a real shake-up. They weren't servicing their members long-term interests at all and they we financially in trouble. People don't' forget! I am pleased to say the competition did force the APA to get their act together, restructure, plan and provide better user benefits (not just what was a monopolistic place to get PI cover). They lost that battle. I fear now they are in danger of having members rise up again and defect in large numbers if the physio's , especially new graduates wake up. Really they act like they are some dictatorship some times that all should follow as they know best. Time will prove them wrong. Anyway I am now just personally ranting.....

[MrPhysio+]

I look forward to any movement that shines a light upon restrictive practise, cover ups or simply illogical policy.
To be clear, the APA has an official policy that states it is against preferred provider schemes. The APA also states that Government policy precludes it from directing members against certain practises as this would classify as restrictive trade practise in its own right. What is happening is a psuedo acceptance of the problem via supporting some super physio's against the small practice. Superficially the APA provides encouragement to all therapists to do well however the reality is different. The majority of APA policy makers are professional students with lots of letters after their names, cutting out the coal face experienced workers in favour of guru's. These professional students continue to work toward policy changes involving the physio registration board to begin systematic accreditation requirements and ethic changes that further hamstring our ability to treat without complete compliance to some rediculous evidence based info that often throws out the baby with the bath water via highly restrictive Pedro or Cochrane protocols.
The new students coming through are doing so after their course structures are structured for research by the powers that be and the above evidence base restrictions that do not allow for change or innovation are taught. These students are designed to be academics rather than clinicians and do not know any better after graduation, employment in super franchises clinics seems the cool thing to do for kudos in thge profession, thus perpetuating the changes and long term demise of our profession.
These students are unlikely to side with the coal face dinosaurs as we do not fit the bill for knowing anything due to a lack of letters and professional student / guru status.
The only way to break the pattern is to go to the power brokers that have control - that is the politicians that listen to votes and arguments for money saving methods. Politicians listen to these arguments when the lobby also means votes. These days, adding all the above to an embarrassing issue that gains public support results in change whereas logic comes a distant last in the race.
The media, once on board to increase their own credibility / sales is the weapon. The main problem is that control of the argument in the public eye can be lost by those attempting the changes and momentum is lost or worse the cause is damaged.
It would be paramount to ensure continued management of the issues before the public by co-ordinated sustained release of the embarrassments. Look to the celebrity pages where some of these people are always in the news - lessons to be learnt.
That is my version of a rant!

[physiobob]

To assist the Australian take on this here's the official APA commentary (as shown on their website 23-08-2011) on this which sounds good...But what is really being done. In the UK we (a large group of self funded physio's working in London) took BUPA to various authorities and they just didn't want to know. Perhaps if the PMI's are taking the load of the public system then perhaps the govt. is only to happy to see them prosper. I'll try to get some more official commentary from Physio First and the CSP in the UK. It would be nice to hear from any Canadians on this topic.

Private health insurer provider networks

In November 2009, Bupa Australia (encompassing HBA. MBF and Mutual Community) moved to consolidate its three separate preferred provider networks into one. As of 1st April 2010, the funds’ individual preferred provider schemes will be combined into one Bupa Australia network, and physiotherapists in the existing schemes are being asked to apply for membership of this new network.

The benefits of these schemes are obvious to practitioners, they encourage fund members to attend your physiotherapy practice, and provider higher rebates to some clients. But before making any business decision to participate or renew participation in a preferred provider network, there are some questions that you should consider.

Do all of the physiotherapists in your practice want to be members of a preferred provider network?

Private health insurers can join practices to their preferred provider schemes, not individual therapists. This can be problematic if one practitioner wants to join or leave a scheme independent of the other physiotherapists in the practice. The APA believes that individual physiotherapists should be able to make a decision on whether a preferred provider scheme is right for them.

Who decides on the value of your service?

Contracts for preferred provider networks usually require physiotherapists to agree not to charge fund members higher fees than each insurer's mandated amount per service – ie they cap physiotherapy fees. While this amount might be acceptable for some physiotherapists in a practice, a cap means that it might be impossible for more experienced or specialised physiotherapists to charge a higher, more appropriate rate.

Can you negotiate your agreement?

Many contracts for provider schemes are non-negotiable and offered to physiotherapists on a take-it-or-leave-it basis. The APA believes this is inappropriate, and that insurers should use a negotiation process to enter into contracts with APA members.

We also believe that the take-it-or-leave-it nature of the contracts offered by insurers is in contravention of the Trade Practices Act. The APA urges anyone who has been affected by a refusal to negotiate a provider network contract to make a formal compliant to the ACCC. Click here to go the ACCC’s website.

Will the fund support your clinical decision making?

While interference in the clinical aspects of physiotherapy treatment is not something that is common, some funds have been known to write to physiotherapists who are members of preferred provider networks if the practice’s average number of treatments varies from the fund’s recorded averages for the state. Such letters have contained notification that participation in a preferred provider’s network was partially contingent on average services per patient, and notification that the figures would be reviewed in the future. Physiotherapists have interpreted such letters as a suggestion that they have been over-servicing clients.

The APA’s code of conduct strictly prohibits client over-servicing, and the APA does not in any way support the unnecessary provision of a health service. However it is important to properly assess any case where there are grounds for suspicion, and the APA does not believe that it is appropriate to determine if a physiotherapist is over-servicing on the basis of statistics alone. The APA believes that funds should support their members and your clients to get the best possible service for their individual needs. If an insurer suspects that a physiotherapist of over-servicing, an investigation should be undertaken by the appropriate authority.
What the APA has done so far - publications and resources for APA members

Joining a health fund’s provider network is your choice, however the APA doesn’t endorse schemes that cap physiotherapists’ fees. We believe that that artificially lowering remuneration reduces the opportunity for physiotherapists to undertake professional development activities and fails to support the development of rewarding career pathways for physiotherapists. We are also concerned with the market penetration of these schemes in some jurisdictions, which give insurers unprecedented control over fees and service levels in some states.