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Fee publication fiasco

By Robin Stride

A new age of transparency for consultants’ private fees was ushered in this month amid concerns over its accuracy and practicality.

Some specialists also have fears about the workload and possible confusion the Competition and Markets Authority’s (CMA’s) demands will cause their administrative teams.

And there are suspicions that some consultants, especially solo practitioners in specialties with fewer regular links to private hospitals, will be unaware of the new requirements until they read this story.

What consultants must do, under Article 22.2 of the CMA Order, arising from its long-running inquiry into private healthcare, is to send patients written fee information before outpatient consultation (operative by 31 December 2017) and prior to further tests or treatment – by the end of last month.

Letters need CMA approval, but to make it easier for doctors and providers, a team – led by BMI general counsel and company secretary Catherine Vickery – drew up a series of template letters covering the costs of a patient’s care following on from a consultation.

Endorsed by watchdog

These have been endorsed by the competition watchdog and late last month they were put onto the Private Healthcare Inform­ation Network (PHIN) website.

Providers are required to ensure their consultants’ fee information is always given by a letter from the specialist.

This must also signpost a patient to PHIN’s website to find what the CMA hopes will ultimately be useful information on the quality of hospitals’ and consultants’ performance.

Hospitals may use these template letters or their own version, so long as they have been signed off by the authority.

Some have disregarded the template letters and produced their own, meaning a consultant with practising privileges in several hospitals in London, for example, must use a variety of letters depending on where the patient is seen.

The template letters comprise initial consultation; post-consultation – all patients, further tests; post-consultation for non-private medically insured patients’ treatment; post-consultation for insured patients’ treatment; plus, a signposting text for those creating their own fee letters.

‘Greater transparency’

A PHIN spokesperson said: ‘We welcome this as a positive step in improving transparency in private healthcare.

‘The letters sent out from the end of February help bring greater transparency in pricing and also direct patients to PHIN’s website, enabling them to find information about the hospital providing their care and compare with other hospitals in the local area.’

A CMA spokesperson told Indep­endent Practitioner Today: ‘It is great that the Private Healthcare Inform­ation Network has made these letter templates available for hospitals.

‘These new templates will ensure that patients are able to make decisions confidently, with full knowledge of their treatment and its cost. This should mean fewer disputes over charges, as patients should be clearer about the total cost of treatment.’

It advised any consultant whose hospital group has not provided them with an approved template to ask it to do so ‘straight away’.

Sympathy for secretaries

Rosemary Hittinger

Rosemary Hittinger

Independent healthcare management consultant Rosemary Hittinger, an associate adviser to the Federation of Independent Practitioner Organisations (FIPO), commented: ‘Do I have sympathy for PAs. I can see everybody going mad, making sure they’ve sent the right letter for the right hospital.’

She said this was one of the issues FIPO had raised, as it was ‘very concerned’ the fees clarity drive would make things increasingly complex for consultants and patients.

Ms Hittinger said: ‘FIPO fully supports the concept of giving clear fee estimates, but it wants to continue to uphold professional integrity and standards so that each individual patient that comes to see a consultant receives the most appropriate care for their particular situation.

‘Overall, the transparency move is a good one, but the practicalities of implementing it in blanket fashion is going to raise all sorts of issues. But we are doing the best we can and trying to make sure everyone knows what their resp­on­sibilities are.’

She said issues included:

  • Monitoring consultants’ compliance when patient pathways were far from straightforward;
  • Differing ways of working in different practices could alter how and when a patient might be able to get a fee estimate that was unambiguous and could inform their choice;
  • Consultants’ fees formed only a comparatively small part of the bill for inpatient care, so it would be difficult to give patients the full information. That could lead to mistrust and disillusion;
  • Private insurance policies vary in terms of excess and what they do and do not cover. FIPO believes insurers ‘need to be as transparent as consultants’.

Part of FIPO’s work has been informing its member organisations about the fee letter requirement, but there was ‘probably some lack of knowledge about this requirement’ on the ground. But she added: ‘This is a beginning, it’s not a slam dunk completion.’

PHIN starts publishing consultants’ fees on its website next year. It is talking with hospitals and stakeholders on the implementation. A spokesperson said: ‘We are working with all these groups to make sure the system works.’

Templates are available on the website portal.phin.org.uk.

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