BUPA Physiotherapy Tender Process

[fizzysmiles]

Hi, I have just signed up to the forum as I have been reading the threads for the last week or so. I am a sole practitioner, working from home and have been registered with BUPa for the last 19 years.
On careful consideration I have decided to boycott the tender but wondered whether it would be in my best interests to inform Jane Gallagher of my decision. Would what you advise??
Thank you all for your blogs and helping me to reach a decision x

[physiobob]

As for the 'Arms Length' between BUPA Insurance Sales and BUPA Wellness here's another interesting commentary

Paul, Well done for not being “bullied”. I’ve always disliked bullies personally. On the BUPA Wellness bit, whilst we all know it’s rubbish, if you wanted to cause any mischief you might want to clarify why this does not simply add up - the level of operational integration at a senior level e.g. The finance director is Mike Dugdale – one of his direct reports is the head of contracting who is doing the tender, and another of his direct reports is the financial controller for all the BUPA wellness activities. There is a similar level of integration at senior management level on the sales side also – they all report to Fiona Harris – insurance sales and wellness sales.

Enough said…enjoy your weekend, R

[physiobob]

Hi, I have just signed up to the forum as I have been reading the threads for the last week or so. I am a sole practitioner, working from home and have been registered with BUPa for the last 19 years.
On careful consideration I have decided to boycott the tender but wondered whether it would be in my best interests to inform Jane Gallagher of my decision. Would what you advise??
Thank you all for your blogs and helping me to reach a decision x

Many have informed her of their intention not to tender. There is an overview of some suggested copy for that a few threads above this one. Thanks for standing firm.

[physiobob]

Well midnight came and went and we're all still alive!

[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.

[physiobob]

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.

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..

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

[Mr Manipulator]

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'!

[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.

[physiobob]

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 .

[Mr Manipulator]

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

[hockeyphys]

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.

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.

[Deedee]

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,

[physiobob]

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.

[Mr Manipulator]

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?

[londonphysio]

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

[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..........

[physiobob]

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..........

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.

[londonphysio]

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...

[Mr Manipulator]

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.

[hockeyphys]

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.

Looking back on the individual posts again, I don't think this is so- it's predomiantly South yes, but a high distribution from around the country. -However the most vociforous posts are the London ones. It also seems that the London clinics had little to loose (Unless they were seriously overcharging!) as BUPA seemed to quote a fair rate for them - it was the 'rest of the country' rates that were a pittance
However, I think it does show a division between the 'big business' polyclinics, who are trying to corner the market, and those running, single,(large and small) clinics or working on thier own, and are happy to work alongside their competitors in the area. ( I may be wrong on that- it's just a feeling.) THe fact that BUPA had an 'if you have more than 10 clinics contact us directly' clause in the tender makes me feel that they did invite such clinics to discuss terms outside these tender restrictions.
I would hate to think that we may have been manipulated by this process, but it's starting to feel a bit like that - it will become obvious to all after May 15th what actually happened!
I would hope that when this has settled we would all continue to meet as local groups and all work towards the same aim of high quality treatments at a reasonable cost, but in meeting face to face so we can tell who's behaving honestly and who's not.
We should also lobby the CSP and PF more to act a better on our behalf - as a neutral party they are in the best position to do this - but this whole incident shows that they only start to act when pushed - I guess this means reading and responding more to what's in the journals (but sometimes it's sooo hard to get the plastic cover off!)
I know PF are very disapointed in the lack of feedback for the data collection survey ( which if collated would give us much more power to our elbow) - but to do it is a very longwinded and time consuming process that many of us don't have time for - has anyone gone back to them to see if it can be made easier?

[physiobob]

It's interesting to look at the results of the PhysioFirst survey.

http://www.surveymonkey.com

Looks from those results that a lot of people who responded were people who did fill out the tender process, at least in part. This should not be taken as actually filing an official tender as we know of many who did it and did not expect to get a result as they asked for what we are worth.

I suppose the results are a bit off in a few respects, or at least one should consider them in relation to:

This is a sub group who bothered to take part in both the tender and the survey. (That said it is a good number)

The London numbers responding to this survey are low. The results on the (also perhaps biased) Physio Forum and Physiosvoice showed similarly that about 80% of London based physios did NOT tender.

The split in the tender fee was about 50:50 for those who tendered at the BUPA suggested fee and those that tendered above. This is rather interesting as the fees are perhaps OK for people outside of the main cities. So the large number who tendered above the suggested fee actually suggests that the BUPA fee is not enough no matter where you are and therefore a London and Non-London pricing structure might not have been a sufficient differential.

48% more respondants indicated that set their fees for treatment above the BUPA benchmark. (35% at BUPA price vs 52.7% above BUPA suggested price)

More than half did not agree to their 2.5% increase after 2 yrs.

As you can see one should be careful in interpreting the simple display of these results.

The stats also does not include non-members of physiofirst who work in the private practice sector who might have been asked to tender.

[hockeyphys]

Interesting stats - different bias from the physio voice polls.
Having difficulty accessing this pol to regiter my response - how do you do it?
Seems to me that the demographic of who tendered does not register where the 'non tender' group are based, as if you didn't tender, you go straight to 'done'
As such I presume this is not a true reflective pole.
However, it is disapointing to see the proportion who tendered at or below the BUPA benchmark, and affectivly capitulated. Those voices have been very quiet on thsese sites - seems to me that there have been 2 voices - don't tender, or tender at your normal fees - seems that there's a whole group out there doing something else who should feel ashamed of themselves.

[physiobob]

Seems to me that the demographic of who tendered does not register where the 'non tender' group are based, as if you didn't tender, you go straight to 'done'
As such I presume this is not a true reflective pole.

Good point. PhysioFirst really should make some comment when they present some stats. Without that stats are likely to be misread.

[physiobob]

Saw this on the BUPA website today. Interesting. Seems they are trying to get enough from their existing relationships. Then if that doesn't hold they'll open it up further down the chain. The chain I believe that for the past 4-5 years they have felt not sufficiently qualified to treat their clients. Seems when there's a need and a financial incentive any physio is OK to treat their clients. Maybe this is a question the OFT should be asking them of their 5yr+ minimum requirement.

We have decided to put on hold the recognition of new physiotherapists during this period but we will be able to get back to you after 1 October 2009 to update you on possible changes to the recognition process.

[physiosteo]

I tendered at a price above my normal price.
Just received this email from Bupa:

“As part of the second phase of implementation we will be contacting additional providers, including yourself, who we feel are able to enhance the network for the benefit of our members. We would like to better understand your current position and discuss your application further”

I guess that's a "no" for now, then?!