Current Issues for Radiologists in the Private Sector

Radiology - Organisation and Recognition in the Independent Sector

Although there are a number of consultant financed and led totally independent radiological units outside private hospitals (particularly in large cities) the majority of private radiological investigations are performed in the Radiology departments of private hospitals. Radiologists are to some extent dependent on patient flows generated within hospitals although many, if not the vast majority, have specialist interests and are sought out by their colleagues for their specialised skills.

Insurance companies have in recent years have been reluctant to recognise the specialist skills and independence of radiologists, preferring instead to reimburse the hospital for radiological investigations with a fee which is agreed between hospital provider and insurer. The fact that consultant radiologists are fighting for recognition means at the moment that their fees are bundled into hospital charges. As a consequence tensions may sometimes arise in some units between the hospital and consultants over the apportioning of fees.

The situation of fee charging in complicated by the fact that interventional procedures are listed by the insurers with codes and reimbursement maxima.

The difficulty for radiologists is that, by and large, they do not have the infrastructure (secretarial, computerisation etc) to separately invoice patients even though they may wish to do so.

It is AIR's view that if fees are bundled the fee structure and bill to the patient must be transparent and patients must know what proportion of fee is hospital or consultant based

AIR, like the LCA, and FIPO (Federation of Independent Practitioner Organisations - of which AIR is a member) does not condone excessive or unreasonable charges but nevertheless sees increasing difficulties if the current situation persists.

Some consultant radiologists have reacted to this problem by forming legal groupings amongst themselves around the country (chambers, partnerships or incorporation) and this will allow improved consultant organisation for clinical, administrative and financial reasons. If you are in a chambers, partnership or company arrangement or are thinking to establishing one please visit:

www.consultantchambers.com

Insurance Issues – update January 2008

As part of its new strategy of managed care BUPA Insurance has tried to implement certain specialty “carve outs”. This began with MRI and as most radiologists will know a number of independent hospitals were initially excluded from BUPA recognition. Whilst many of these have now regained recognition the insurance objective was to some extent achieved in that MRI prices were lowered.

Following this and over a year ago BUPA Insurance attempted to package price ophthalmic surgery (in particular cataracts) but this attempt was largely rebutted by the profession with each consultant making his own decision. The BUPA ophthalmic network has now virtually collapsed and it may be said that this strategy was largely unsuccessful.

However, PPP is attempting a similar strategy by a different route namely by altering the details in the insurance policy that it has with its subscribers. This means that patients needing cataract surgery will be directed to a limited number of PPP “approved” hospitals where package pricing is being developed. There are few such hospitals and certainly in London only two small facilities are currently recognised.

Orthopaedics is being approached in a slightly different fashion by BUPA Insurance with attempts to engage small groups of consultants in various localities with care plans and limited package deals. For more information on this topic please see the FIPO website at www.fipo.org

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This page has been re-printed from the web site of the london consultants' association. Updates and further information on the subjects discussed may be available from www.london-consutants.org