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BUPA ophthalmology initiative

10 August 2007

Dear Colleague

You have probably received a letter from Mr Pink (19 July), Head of Provider Relations and Procurement at BUPA, setting out yet another approach to its network which shows that BUPA has reversed its decision to terminate the BUPA consultant partnership arrangements for ophthalmologists. This was the mechanism that first alerted the BMA to BUPA’s attempts at imposing restrictions over the profession. From 1 August the Scheme would continue but with the change in one of the partnership requirements relating to cataract procedure.

The BMA is concerned that BUPA, through its new grading of reimbursement for cataract procedures, may be driving ophthalmologists to use only certain hospitals (100% reimbursement for treatment in ‘approved’ hospitals, 50% or 0% for treatment in ‘non-approved’ hospitals). It is important to realise that it is the patients, their subscribers, who are most at risk of being disadvantaged by such action. The patient is responsible for paying the fee whether insured or not.

It is important to recognise that our greatest asset is our relationships with our patients. It is imperative that such relationships be protected via increased patient awareness of the pitfalls of the various BUPA managed care initiatives in the pipeline, which could potentially compromise patient care and choice. The BMA is looking to address the concerns over BUPA’s managed care initiatives by encouraging close involvement with patients.

You may have noted in Mr Pink’s letter that corporate clients will only receive 50% reimbursement in a non-approved hospital. This may be of particular concern to patients who are executives of BUPA-insured companies. Clearly, raising awareness of any BUPA initiatives that may be detrimental to patients/policy-holders, is key.

Where approached by patients receiving a less than full reimbursement, the BMA has produced an explanatory notice to assist patients, which is attached to this letter. This document may be viewed as part of your ongoing client relationship/care. Where clients are unhappy with the changes implemented by BUPA, they are invited to contact BUPA directly.

Should you require further support in relation to the issues raised in this letter please do not have any hesitation to contact us directly.

Yours sincerely,

Derek Machin
Chairman
Private Practice Committee

Rhod Daniel
Chairman
Ophthalmic Group Committee

BUPA ophthalmology initiatives

Dear Patient,

This letter is aimed at helping you understand the issues surrounding BUPA Insurance and cataract surgery. BUPA has endeavoured to introduce an Ophthalmology Network, which would have severely restricted patient choice, both of consultant and hospital. This initiative has come under considerable scrutiny by both doctors and hospital groups.

The initiative was originally proposed as a ‘quality initiative’. In its latest reincarnation, the quality of patient care has not necessarily been improved.

The only ophthalmological procedure involved is cataract surgery, which is by far the most frequently performed procedure, but not the most complex.

Hospitals which have agreed to BUPA Insurance Ltd’s conditions are ‘approved’ and all other hospitals are ‘non-approved’. Your reimbursement for the surgical benefit is now uniquely dependant upon your type of membership and the hospital where the treatment is to be carried out – only Personal Scale A & B BUPA subscribers get full reimbursement in a non-approved hospital. Business Scale A, B and C and Personal Scale C members get approximately 50% reimbursement and all Network Members receive no reimbursement at all. This means that 93% of BUPA subscribers will only receive between 0% and 52% of the normal BUPA reimbursement for the surgery and will be personally responsible for paying the shortfall.

The BMA’s concern is that through the BUPA initiative we feel that surgeons are being placed under pressure to use only ‘approved’ hospitals. However, it is very important for patient safety that consultants work regularly with the same team and by moving to an unfamiliar hospital, to satisfy BUPA’s financial requirements, patient care may be seriously compromised.

Patient choice is also compromised by your potentially reduced choice of hospital.

We would suggest that if having discussed the issue with your surgeon, you are unhappy with the situation, you consider writing directly to BUPA Insurance Ltd to express your concerns. To this end, BUPA’s postal address has been annexed to this letter.

Yours sincerely,

Derek G Machin
Chairman
BMA Private Practice Committee

Rhod Daniel
Chairman
BMA Ophthalmic Group Committee

Should you wish to write to BUPA please address your letter to:

Val Gooding
Chief Executive
BUPA
BUPA House
15-19 Bloomsbury Way
London
WC1A 2BA