BUPA Physiotherapy Tender Process

[physiobob]

Here's the update from thephysiosvoice and the panel that lead last weeks discussions. Over this easter weekend anti-competition lawyers are taking a good look at the case and will present back to all next week. You can comment here or on the "What we can all do" link on thephysiosvoice website.

BUPA Tender - What can we all do?

What next?

We need to be very clear that all we can do is present the facts, pose the questions and let each and every individual make their own decision. We cannot take collective action and we cannot collude - that is anti competitive. What is interesting though is that the Opthamologists faced the same issues and were unhappy enough with the implications for their profession that were raised as regards clinical governance and professional autonomy that they individually decided not to take part in the tender process. Despite what BUPA might claim there is no effective opthamology preferred provider network in the UK.

It’s an understandable reaction to say that BUPA is so important to my business that I cannot afford to ignore the tender. The truth is our clinical independence and commercial autonomy is so important to us that we all have to think, independently, but very hard about the consequences of taking part in this process.

Let’s be clear that signing up to this tender will:

1. Start the erosion of the very clinical autonomy that allows us to deliver the best outcome for our patients.

2. Tendering will mean a loss of choice for patients and will effectively break our contract with them. Tendering will mean you have a legally binding contract with an Insurance company who will be able to dictate who you see and how you treat and the price you can charge for doing so.

3. Tendering is no guarantee of success - BUPA have made it explicitly clear that tendering at a level below the guide pricing is more likely to lead to success.

4. Tendering will mean agreeing to some very one sided terms and conditions and if you think for a moment that BUPA have the desire or resources to negotiate with us all separate terms and conditions then please think again.

5. The other insurers will follow if this tender process is successful - that’s almost guaranteed in my eyes.

6. I also think that what is on the table today and indeed not on the table today will change at some point and if you think your negotiating position is weak today then once you have a contract and a network is established it’ll actually be weaker.


What can we all do?

1. Write to BUPA the CSP and to PhysioFirst and let them know about your concerns and pose your own questions. Do not hope that someone else will do this on your behalf. We all owe to our patients and to the profession we care so much about to do that much.

2. Talk to your fellow practitioners both locally and nationally. Nobody is alone and nobody should feel bullied in to acceding to BUPA’s demands. We all share the same concerns.

3. Tell as many people as possible about this site to ensure that everyone is well informed. The site is a blog - it is open, everyone is allowed their say - we don’t agree with all the views expressed but we live in a democracy

4. All take part in the polls on The Polls Page we can use this in submissions to the press and the OFT so get voting - it’ll only take a few minutes!


What will we do?

There are potentially a number of angles we can follow up on but given the time constraints (imposed by BUPA) everyone needs to think very hard about submitting a tender as there are still many unanswered questions, valid concerns about clinical governance and autonomy and the outstanding legal action involving formal complaints to the OFT being submitted by the CSP. Our view is that we should not have to be rushed in to making decisions with such serious implications.

1. Continue to apply pressure to the CSP to do more. If I contrast the CSP’s efforts and the clarity of the messages they put out with other groups like FIPO I see a huge difference. I think that the CSP could do more to inform. They could do more to ensure every physiotherapist in the UK is better informed so they can make an independent and reasoned decision as to what to do. I think given the serious implications of this tender process the language the CSP use could be clearer and less ambiguous. Have a good look at the following website and you decide for yourselves. Federation of Independent Practitioner Organisations (FIPO)

2. We will continue to inform as best we can and keep the dialogue going by updating this site regularly.

3. We will attempt to get some independent legal advice on a number of aspects this tender process raises namely:

a. conflict of interest issues raised by BUPA’s role as an insurer and provider through its’ ownership of BUPA Wellness

b. possible abuse of dominant market position by both BUPA and PPP

c. legality of some of the contractual terms contained within the tender document

d. the cost implications and contractual obligations of providing the enhanced claims management and processing service as defined in the proposed terms.

e. to appraise and understand the requirement for physiotherapists to be registered with and regulated by the FSA to qualify them to advise their patients about insurance cover terms and conditions.

f. the cost implications and contractual obligations of providing the enhanced claims management and processing service as defined in the proposed terms.

g. the implications of the proposed contract terms being ultra vires i.e. beyond the capacity of physiotherapists to contract.

h. the conflict that arises with physiotherpaists obligations under their contract with their patients because of the application of “Sessional Averages” which constrains the physiotherapist from independently applying the full extent of his/her clinical expertise thereby increasing exposure to claims for negligence from patients.

i. the continual pressure for physiotherapists not to discuss matters with ‘BUPA members’ undermines physiotherapists obligations to their patients.

4. Consider lodging our own complaint to the OFT about both BUPA and PPP

5. Pursue the appropriateness of the clinical aspects proposed by BUPA

The meeting last night showed that there are lots of us who care deeply about this profession and want to hold on (rightly) to our clinical governance and autonomy because we care about what we do and our patients.

[phizzio]

I have also been following this thread. I would like an answer to a simple couple of questions please- I work in private practice in London and I charge what I deem fit to my skills and the outgoings for the successful running of a busy practice-
What is the cost of a unit of time for physiotherapy in the NHS and what is the cost in a BUPA hospital. Not I might add what the physiotherapist is being paid. Also what is that unit of time. ...

[thephysiosvoice]

Just in on TPV.....

Physio First Email Alert - Bupa Announces the Blind Tender Process

Q: How can I negotiate?
A: In short you cannot. This is a take it or leave it proposition.

This is a direct quote from Eric Lewis Chairman of Physio First.

How can this negative statement possibly be the only way forward or the right advice for a powerful body of 6000 (or is it 13,000) highly intelligent professional physiotherapists in the private sector running successful businesses?

Do physiotherapists have such a low opinion of themselves that they are prepared to be railroaded? Do something. Let your opinion be heard.

Nice one Eric!

[physiobob]

Another comment sent to us by email

Hi, Thanks for update.

This may seem useless now, but my initial proposal to the csp was that we as a profession refuse to recognise BUPA.
My idea was that if bupa refuse to recognise recent graduates and demand this 5 year post grad thingy before allowing us to register for bupa work then they are setting the clinical standard not us as a profession or even the hpc.............hope you follow this

If we had the guts to have an embargo, bupa would be unable to offer physiotherapy to its clien' base. Patients would complain, there would be downward pressure on bupa's insurance fees as patients would be getting less for their money.

This would also have stopped bupa dictating what we got for our services. We could have set a rate that they would have to pay us.

Anyway probably all too late and anyhoooo couldn't seeing the profession being sufficiently together on this, not to mention the short term losses to those who depend on bupa for their income................however even the threat might have brought them to the table.

Cheers derek adams mcsp.................still not bupa registered

[physiobob]

I have also been following this thread. I would like an answer to a simple couple of questions please- I work in private practice in London and I charge what I deem fit to my skills and the outgoings for the successful running of a busy practice-
What is the cost of a unit of time for physiotherapy in the NHS and what is the cost in a BUPA hospital. Not I might add what the physiotherapist is being paid. Also what is that unit of time. ...

I can't say first hand what the BUPA unit cost although it is said an NHS charges at least £48 for a half hr. And the BUPA wellness clinic around the corner from me £53 for a half hr. Yet they are asking us to charge less.

It's also worth considering the wish to :

1. Hold your money for 30 days post receipt of the invoice
2. Run a billing service and reconciliation for their services
3. Provide all sorts of reports and audits for their organisation

In any normal business these would be considered as added services. Thus your fees should be more for BUPA than for self paying patients or for patients whose PMI's do not request this additional (billable) work. Today I received a cheque for £20 from the Pru Health Insurance after thet requested a simple patient update and report. There letter told me they would be happy to pay for this service in addition to my normal charges. So I provided the service and they paid. This is what I expect from BUPA as well.

It is normal in many health care areas to charge more for insurance clients as the PMI's require more admin time than non-pmi clients. This is typical in the USA and in fact it is also common in the UK as well.

This is just another aspect why the BUPA tender agreement is unacceptable. Everyone should in fact consider how much more they should charge BUPA clients if BUPA want us to provide more non-clinical work for them.