BUPA Physiotherapy Tender Process

It seems if I have bucked the trend by tendering but as 90% of my work load is from consultants and of that by far the biggest insurer is BUPA I (and my colleagues) felt we couldn't afford not too. Presumably those of you who haven't tendered have a much smaller % of patients who have PMI. Also we know that both the Nuffield and the BMI group have tendered. Perhaps we will regret it -who knows! I will let you all know in six months. The whole thing stinks but I am not convinced that our local competitors won't have tendered or am I convinced that BUPA will return to all of you that haven't tendered with their tail between their legs. Don't underestimate how powerful a group they are - you only need to look at how they have affected the price of diagnostics - halved the price of an MRI scan in two years! What I am really saddened/maddened by is how ineffective physioFirst and the CSP have been but I guess I wouldn't have expected anything less.:mad:

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Originally Posted by SunnyJim

It seems if I have bucked the trend by tendering but as 90% of my work load is from consultants and of that by far the biggest insurer is BUPA I (and my colleagues) felt we couldn't afford not too. Presumably those of you who haven't tendered have a much smaller % of patients who have PMI. Also we know that both the Nuffield and the BMI group have tendered. Perhaps we will regret it -who knows! I will let you all know in six months. The whole thing stinks but I am not convinced that our local competitors won't have tendered or am I convinced that BUPA will return to all of you that haven't tendered with their tail between their legs. Don't underestimate how powerful a group they are - you only need to look at how they have affected the price of diagnostics - halved the price of an MRI scan in two years! What I am really saddened/maddened by is how ineffective physioFirst and the CSP have been but I guess I wouldn't have expected anything less.:mad:

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Your position is perhaps classic of anyone that did tender. It shows the precariousness of your operation and how you are already under the control of the PMI. Perhaps you'll look to strengthen your future expansions into non-reliant PMI referrals. Sorry to be so blunt but you are already enslaved in a way that saying NO to the tender is all about. Of course we understand your reasoning.. :o

p.s. I wholeheartedly agree with your comments on the CSP and Physio First...

The BUPA take in our practice has shrunk from 40% to 20% in the last 5 years, yet overall turnover is maintained, so we voted 'no'. Just shows how worried they must be at the reduction in their market share and also explains their 'desparation' tactics with the tender, in which they might well have shot themselves in the foot. Time will tell.

We still stand to take a pretty decent 'hit' if it doesn't go tits upwards, like I hope it will, but we could not stand by and see our professional autonomy take an even bigger 'hit'!

i tendered. For many reasons.
medgen and bupa wellness tendered. 2 of my biggest competitors.
I collect most of the stats they ask for anyway.
The clinical care pathways i found are what we do anyway.
My average session rate and fees are competitive.
Physiotherapy in central london is now more competitive; i believe that for the first time, supply outstrips demand. My experience is that the 'big boys' don't play by the rules of mutual respect and professionalism. Frankly I would rather deal with BUPA than expect solidarity from some physio businesses. I would not be at all surprised if some of those who made the greatest noise tendered in order to clean up.

Before this tender process a successful business model for private practice could be one which charged the most, for the maximum amount of sessions you can give. The patient doesn't care when it is covered by BUPA, so the competitiveness of the marketplace is skewed and the normal market dynamics have not taken place. Now, finally, recognition for practices based at least partly on efficiency will take place. If there are specialisations your stats should be able to demonstrate this; thus valid reasons for significantly higher sessional averages. If there is no specialisation, we will all ahve to change our business models to attract a greater volume of new referrals.

I don't believe my clinical autonomy is at risk. I can back up my assertions with lots of statistics, which include outcome measures (however reliable they are). Most of what BUPA ask are what we do to keep up our standards anyway. When I saw more complex cases, I was able to back up my stats and I was still recognised without having to give a discount.

But...I did not offer a reduction on fees. IMO that would be the beginning of the end. This is where the MRI went sour: they all offered reductions based on the expectation that they would get an increase of volume. But everyone tendered! so no increase of volume.

BUPA are more than 50% of my business. The cost/benefit analysis for me has been simple.

You should look to the USA for examples of where tendering leads. Fewer competitors, tougher terms every 2 years to continue. Then the inevitable sign or go out of business. Shame really but everyone has to make up their own minds for their own reasons.

I response to your comments on charging the most for the max sessions, that is easily fixed by paying a max per session and a max number of sessions and or a max yearly cover for physio. That's what most do and the market and who sees who generally works itself out. BUPA's actions are likely to be destroying the competitive market until there is one winner.

Best of luck :o.

Dear 'londonphysio',

Your first paragrah disappointments me greatly, particularly as you feel that your competitors would 'ditch' you in such a way. If that is true, you have my sympathy. I am pleased to say that, outside of London (as I am), that appears, so far, not to be the case. Time will tell!

I don't agree that a successful business model is to get what you can out of each and every patient that attends. Each should receive what their condition demands - no less and no more.

Your clinical autonomy is always at risk when you have to justify, to a third party, your actions, based on your professional opinion. The contract for provision of service is between you and the patient, not involving any third parties. How that patient funds their treatment is their affair and should not be yours.

I applaud the fact that you did not drop your fees. From the sound of it, you provide a valuable service which should receive a market based remuneration, and not one that is 'capped' by a third party.

If you could adjust your targetted market to achieve (much) less than a 50% dependance on one diminishing PMI, maybe your cost/benefit analysis could work more in your favour than in theirs.

Whatever, I wish you the very best with your tender, although I am unable to support the action, for reasons well described on this blog.

Best wishes,

Mr Manipulator

mr manipulator, what i could tell you could really make your hair curl! I will not elaborate as i would not put it past the protagonists to sue me for libel. (and they would be identifiable from the most serious of allegations) My reference to successful business models was a thinly veiled finger pointing towards those practices that I know, have this approach as a policy. I find that those practices are as guilty, or even more so, of interfering with a physio's autonomy than BUPA currently are.

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Originally Posted by londonphysio

mr manipulator, what i could tell you could really make your hair curl! I will not elaborate as i would not put it past the protagonists to sue me for libel. (and they would be identifiable from the most serious of allegations) My reference to successful business models was a thinly veiled finger pointing towards those practices that I know, have this approach as a policy. I find that those practices are as guilty, or even more so, of interfering with a physio's autonomy than BUPA currently are.

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We all understand where you are coming from and indeed I could name a few of them as well. This however does not have a bearing on the tender issue. It does of course on your financial and local business viability issues. I have always found that doing a good job gets you business, perhaps not as fast a growing clinics as others but a more stable, more loyal client base. This becomes highly important in situations like those we are currently in. The 'Big Guys' are usually billing a lot on the old PMI cheque book and so they are the ones forced to tender or lose some staff. The small, high quality, stable practice with excellent word of mouth won't be affected much at all with no BUPA referrals. And if they're good their clients will come back anyway.

In a world where tenders are the winners you'll have both those large highly competitive practices and a PMI driving your prices down....surely a place worse off?..

not if you refuse to drop your prices. I think, for central London, having 40% self paying patients is pretty high. The only reason my BUPA % is high is because of a corporate contract. I have tried to diversify the way my patients are funded and not 'put my eggs in one basket', but in central london the fact is that the majority of patients will be claiming on their work policy. I have takent he view that it is best to fight this from within. I agree that the tender as stands may be the thin end of the wedge, but I can 'out statistic' pretty much anyone. I audit 100% of patient notes for example.
I think other peoples practices are relevant in this discussion. I think they have brought this on us. I am not surprised that BUPA says that 80% of the physio bill goes to 10% of practices. With a variation of £20+ between the cheapest and the most expensive physio 30 min sessions in central London, it is quite feasible that the cost could easy be quadruple when comparing one practice to another, in the same area, if you take sessional averages into account.
Until we can evaluate outcomes reliably, this cannot be justified. this is why i take outcome measures for all patients, even if they are not deemed reliable at present. It is my 'insurance policy' against further, more sinister actions by the PMIs.

I think a very clear dividing line is being drawn between practices that have had to tender because of their high proportion of Bupa patients and those that have a low amount.

I am outside London and PMI patients account for 20% of my list. Of that Bupa and AXAPPP make up most of the insurance work.

From a purely business point of view, I have not been forced to tender.

What happens next?
I didn't tender so do I just keep accepting/treating BUPA patients until advised by BUPA?
My latest BUPA patient this morning has been told that she has to phone for a new authorisation number on May 1st and isn't sure whether it is just that it is her policy renewal date or that they wil ask her to go to another physio.

Hi 'ckaren', Looking at everything that came with the process, the cut off date for authorisations on the old system is 15.5.09, after which the new network (such as it might be) goes live on 17.5.09.

However, it will be intersting to see if BUPA has enough people to form a network and, if they haven't, the above could change!

Looking at the polls here and on thephysiosvoice.co.uk they might have a bit of a problem. I sincerely hope they do!!

Even if they don't to start with, they probably will down the line when their client base starts to complain about availability of choice of practitioner.

Just thought I'd let you know, I received the following email after informing several government ministers of BUPA's "process". Perhaps another helping hand to come? Also, If ANY of you are Federation of Small Business members, they would love to hear from you. They are one group which do lobby hard on behalf of their members, and advised me to speak to my local MP, giving me details of the direct line to him in the Houses of Parliament. Believe me, the FSB could be an invaluable tool in our fight.

Email as follows
"

Thank you for your email regarding BUPA's change in their service terms that affect physiotherapists. I am passing your email to Stephen O'Brien MP, Shadow Health Minister, who leads on this issue for his consideration.

Yours sincerely

Andrew Lansley "

Keep fighting. From within, or without.

Has anyone emailed the BBC Watchdog yet, they are running a series on Insurance Companies at the moment and this would probably be of interest to them.

Dear archersusie - I hope you have? I wrote to Jane Dreaper last week, and have had two replies, unfortunately, as you can see on TV, she is rather occupied with Swine flu at the moment, but I did urge her to read the discussion here and on physiosvoice, and to check FIPO, as they have the connection with the opthalmologists, and to look at the original prees release form CSP. Maybe you can do the same to Watchdog.

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Originally Posted by londonphysio

i tendered. For many reasons.
medgen and bupa wellness tendered. 2 of my biggest competitors.
I collect most of the stats they ask for anyway.
The clinical care pathways i found are what we do anyway.
My average session rate and fees are competitive.
Physiotherapy in central london is now more competitive; i believe that for the first time, supply outstrips demand. My experience is that the 'big boys' don't play by the rules of mutual respect and professionalism. Frankly I would rather deal with BUPA than expect solidarity from some physio businesses. I would not be at all surprised if some of those who made the greatest noise tendered in order to clean up.

Before this tender process a successful business model for private practice could be one which charged the most, for the maximum amount of sessions you can give. The patient doesn't care when it is covered by BUPA, so the competitiveness of the marketplace is skewed and the normal market dynamics have not taken place. Now, finally, recognition for practices based at least partly on efficiency will take place. If there are specialisations your stats should be able to demonstrate this; thus valid reasons for significantly higher sessional averages. If there is no specialisation, we will all ahve to change our business models to attract a greater volume of new referrals.

I don't believe my clinical autonomy is at risk. I can back up my assertions with lots of statistics, which include outcome measures (however reliable they are). Most of what BUPA ask are what we do to keep up our standards anyway. When I saw more complex cases, I was able to back up my stats and I was still recognised without having to give a discount.

But...I did not offer a reduction on fees. IMO that would be the beginning of the end. This is where the MRI went sour: they all offered reductions based on the expectation that they would get an increase of volume. But everyone tendered! so no increase of volume.

BUPA are more than 50% of my business. The cost/benefit analysis for me has been simple.

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Thank you London Phys for voicing the sentiments I've been feeling for some time - hence my decision to tender, but at my full rates and conditions.
I know that when you have a payroll to meet, responsibility to your staff, already do the extras they ask for, and BUPA are a large share of your revenue, you are swayed towards tendering, but would hope when they come back to you to renegotiate you will reply with the same response - i.e this is what we're worth, and this is what we do.

Loved this letter sent to BUPA by a Scottish Colleague of mine !
.hmmessage P { margin:0px; padding:0px } body.hmmessage { font-size: 10pt; font-family:Verdana }
Dear Jane Gallagher,
Following 26 years as a bupa provider, I thank you for your invitation to submit a fresh tender.
Now semi-retired and complete retirement in the near future a probability, I have decided to remain with my present agreement with bupa.
I assume your youth may render you unaware of the history of your profession, At the conception of the NHS in 1947, physiotherapists gave up professional autonomy to gain entry to the hospital service. It has been a long struggle since the 1970's to slowly regain lost ground which will be eroded if the profession is at the commercial whims of insurance companies.
However, as there will be a shortage of bupa registered practitioners in this area, causing inconvenience to your clients I will continue as a provider, in the interim , till my retirement unless I hear from you to the contrary. In which case I will display this correspondence in my waiting area so your clients can be informed,

I am wondering if someone might attach their letter or an outline of their letter to any third party/local member/council blah blah so that we might together work on a template that all might use.

Also any useful names and addresses that you can post to the forum to provide the contact points to send them to. This approach worked wonders in the banking world so let's see if we can perhaps make it as easy as possible to get us moving on this. :)

Totally agree, physiobob, but I can't believe how quiet it's gone around here and on the other blog! What are we all waiting for?

I am sure it will start hotting up once the results of the tender process are known! Has anyone who tendered heard yet?

Now here's an interesting thing.
I have heard a whisper that a Practice - which shall, of course, remain nameless - recently entertained JG at its premises and made a confidential arrangement on (quite high) fees. There seems to have been a successful "pre-tender" in this case.
Has anyone else got wind of this?
If it is true, I wonder about the morality of this..........

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Originally Posted by physiosteo

Now here's an interesting thing.
I have heard a whisper that a Practice - which shall, of course, remain nameless - recently entertained JG at its premises and made a confidential arrangement on (quite high) fees. There seems to have been a successful "pre-tender" in this case.
Has anyone else got wind of this?
If it is true, I wonder about the morality of this..........

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Interesting but then BUPA were writing to me in a back and forth discussion about fees right up to the tender process and there was NO mention of the tender process during that correspondence. Should your comment be true to the facts then this does strengthen the position of not tendering and let everyone individually come to an arrangement with BUPA, much the same as it has been for the past yrs.

The tender situation has pretty much stated publically that BUPA no longer values the 5 yrs + post graduation period before registration with them. I wonder if the tender has failed whether they would be able to enforce that on fair trading grounds. Kind of a double standard issue without any justification. Maybe the OFT guys would be interested in any justification of maintaining that 5yrs+ position as well.

If that is true, it is probably illegal.
I wonder who can have been buttering up JG?...
I'm sure it won't be too much of a surprise...

Oh dear. This is sounding rather 'clubby' vis a vis the London based practitioners. Where does that leave the rest of us, North of the Watford Gap?

After all, only 25 votes on the 'who did and who didn't poll' on this site is hardly a substantive reflection, unlike the one on 'The Physios Voice', which basically shows a one third/two third split in favour of not tendering.

How this all will reflect across the Country remains to be seen, as does how BUPA will react, but I am beginning to sense that those contributing here are mostly 'inner City' and, as such, not a reasonable representation of Country wide opinion.

I think a very clear dividing line is being drawn between practices that have had to tender because of their high proportion of Bupa patients and those that have a low amount.

I am outside London and PMI patients account for 20% of my list. Of that Bupa and AXAPPP make up most of the insurance work.

From a purely business point of view, I have not been forced to tender.