London Consultants Association

What do Insurers want from the Profession - -Cut Price or Quality?

was held on
Wednesday 4th June 2008
at The King's Fund

This LCA meeting was held at the King’s Fund on the 4th June 2008. There were two speakers from the profession and four speakers from different private medical insurance companies. Clinical governance, quality, fraud and future liaisons between the insurers and the profession were the gist of the meeting.

Dr. Duncan Dymond, Consultant Cardiologist and LCA Board member spoke about local governance, MAC functions and the way in which the profession is bench marking and looking at various audits within the acute hospital sector. Mr. Richard Packard, Consultant Ophthalmologist and FIPO Board member spoke about some of the difficulties of measuring outcomes preferring rather to use process measurements as a guide to good practice.

Sandwiched between the two professional speakers were four speakers from insurance companies. Dr Douglas Wright, Head of Clinical Governance at Norwich Union spoke about a need for good clinical governance and the ways in which the insurance companies were looking at value for money.

This message was echoed by David Mezher, Chief Operating Officer at PruHealth who also stressed his company’s views about encouraging healthy life styles as a means of reducing claims for treatment.

Standard Life Healthcare was represented by Jayne Evans, Head of Commercial Contracts and WPA by Julian Stainton, Chief Executive Officer of WPA. Both outlined their concepts of private medical insurance

Whilst all companies adopt a slightly different approach to the question of quality and value for money, there was general agreement amongst the insurers about the ways in which consultant performance is monitored. Mostly this was related to billing irregularities but in the event of clinical issues there was a feeling that these should be referred to appropriate medical expert(s). The anomalies in coding were noted and there was clearly a need, identified during the discussion, for a Forum in which various issues can be discussed between insurers and the profession.

There were some questions raised during the discussion period about fraud and PPP’s approach to this in particular. As PPP were not represented at this meeting this matter was not pursued in depth but it was pointed out that there have been only a very small number of cases successfully prosecuted through the GMC for fraud. This did not mean that there were no underlying problems in billing procedures but these insurers felt this was not of great magnitude. They did ask if some clear guidance on unbundling of procedures could be issued and the 50 consultants at this meeting agreed with this in principle. This would be a topic that could be tackled in the new Forum between the profession and the insurers and the audience felt that some of the coding anomalies should also be addressed. It was felt that some agreed guiding principles should be developed in this Forum and this matter will be taken forward as soon as possible under the aegis of FIPO.


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