CMA ‘fee remedy’ fails to fix issues
News viewpoint
By Dr Brian O’Connor, chairman of the Independent Doctors Federation’s specialist committee
Consultants are required by the Competition and Markets Authority’s (CMA) latest remedy to provide information to patients about cost of consultations and procedures – and total cost of care (see ‘Fee fight goes on’).
The Private Healthcare Information Network (PHIN) has been charged with receiving this information from consultants, who are obliged to supply it with all relevant information about fees for all treatment, notably frequently conducted treatment procedures.
A lack of fee transparency, and indeed the lack of readily available published information on treatment outcomes, is deemed by the CMA to lead to an adverse effect on competition in the provision of consultant services.
The CMA, which launched its private healthcare investigation over five years ago, feels that patients would be better able to exercise effective choice if they knew the cost of care and if they also had some information about quality of outcomes.
On the face of it, this CMA remedy would appear to be reasonable.
There is no reason why consultants should not publish and display clearly the cost of their commonly conducted treatment procedures and outpatient fees. Indeed, the vast majority of consultants already provide such information.
The CMA’s fee remedy was unsuccessfully opposed by the Federation of Independent Practitioner Organisations (FIPO), in particular because the basis of the remedy was to improve competition and patient choice.
FIPO’s contention was that the private medical insurance companies, by virtue of their imposition of restricted fees – particularly on younger consultants – have introduced a fixed fee for private patient consultations and treatment, thereby removing market forces from the equation.
Indeed, the non-legal minority view of an economist during the CMA appeal totally concurred with FIPO’s view and felt that the influence of insurers totally distorted any potential for a competitive market place for private practice.
Changed circumstances
Notwithstanding all of this, the CMA has, in my view, not taken account of changing circumstances since the original remedy.
The private sector has altered significantly. Private medical insurance companies are imposing severe fee restrictions on doctors, which are preventing the vast majority of new consultants from entering private practice in the traditional way.
Many observers, including those of us in the Independent Doctors Federation (IDF), are concerned at the lack of presence of young, talented specialists in the independent sector.
An unintended consequence, I suspect, of the CMA remedy is the emergence of a proposal from hospital providers to enter into a contract with doctors, offering them salary packages to deliver practice in hospitals.
This is a new departure for doctors in private practice and, on the face of it, cannot be good for competition or, for that matter, independent medical practice.
A new young consultant, unable to afford the set-up costs of private practice and severely restrained by insurers from charging economic rates for consultations and procedures, may well be encouraged to enter into a contractual relationship with hospital providers.
As a salaried individual, a specialist will effectively have employee status within a provider organisation and may not always act in the best interests of the patient, both clinically and indeed in terms of costs of treatment.
CMA doesn’t understand
These are some of the concerns we have about the remedies. Circumstances have altered. We do not feel that the CMA fully understands healthcare and its various nuances.
But, nonetheless, the IDF would strongly endorse the principle of transparency in all activities undertaken by doctors in the independent sector.
Therefore, publication of fees, estimation of cost of procedures and treatments as well as publication of outcomes, performance and measures of quality delivery are all to be encouraged.
However, there will be a bureaucratic burden. In my own case as an example, as a consultant physician in respiratory medicine and allergy, I could not begin to assess the likely cost of treatment for a patient with cough.
The majority of patients would incur very few costs, both in terms of outpatient attendances and investigations.
Unpredicatble costs
However, a significant minority will have severe disease underlying their cough, such as lung cancer or complex airways disease, and these patients will incur huge and often unpredictable costs over many months.
I have no doubt doctors will rise to the challenge of fulfilling the requirements of the fee remedy. This will mean more transparency on the part of hospitals to inform doctors of the costs of various tests and procedures as well as the costs of inpatient hospital care.
In that regard, patients might reasonably expect that, even when insured, they will receive full disclosure of the costs incurred during their care.
Whether that would be the responsibility of the doctor to provide such information, which is currently not available to doctors – who are actively discouraged from discussing fees with insured patients by their respective insurers – or by the private medical insurers or hospital operators remains to be seen.
Full disclosure means full disclosure and should apply not just to privately-funded patients but also to those patients who are insured and who rightly wish to assess whether they are getting true value for money.