Fees fight goes on

By Robin Stride

The Competition and Markets Authority (CMA) has announced its planned timetable for implementing publication of consultants’ fees following the profession’s failed challenge to the appeal court.

Independent doctors’ bodies, given only a few weeks’ notice to react to the ‘consultation’, were working on submitting responses as Independent Practitioner Today went to press.

The Federation of Independent Practitioner Organisations (FIPO), which lost an appeal court challenge on the issue over the summer, said it did not object in principle to the CMA’s ‘fee remedy’.

CMA datelineBut chairman Mr Geoffrey Glazer warned it would take ‘some time’ to implement and needed to operate ‘within a genuine and open competitive process, where fees are not controlled or distorted by the insurers’.

Since the appeal rejection, FIPO has informed the CMA of a material change of circumstances following the competition watchdog’s 2014 report.

It said on its website: ‘These are well known to consultants and patients and involve control of fees by the insurer for new and many established consultants and various other restrictions and diversions of patients to alternative consultants, treatments and hospitals.

‘This trend has been increasing since the CMA issued its report and it is on this basis that FIPO has asked for a further review of this matter.’

Independent Doctors Federation (IDF) specialists committee chairman Dr Brian O’Connor told a LaingBuisson private healthcare conference that FIPO’s argument had been: ‘What’s the point in publishing fees if private medical insurers set them?’

As a FIPO board member, he sympathised with that view, although the IDF thought the publication of fees ‘won’t make much difference’ in the short term.

But, in the long term, it could increase fees through patients judging highest fees as evidence of best treatment, he said.

Writing in this issue of Ind­ep­endent Practitioner Today, Dr O’Connor says, on the face of it, the CMA remedy appears 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.’

However, he argues the CMA has not taken account of changing circumstances for private specialists and says the IDF feels the watchdog does not fully understand healthcare and its various nuances.

The IDF would, he writes, strongly endorse the principle of transparency in all doctors’ activities in the independent sector. Therefore, fees publication, cost estimates of procedures and treatments as well as publicity on outcomes, performance and measures of quality delivery are all to be encouraged.

But he warns doctors of an imminent 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.

‘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.’

Dr O’Connor adds: ‘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.’