BMI pull out of BUPA’s Ophthalmology Network

The UK’s largest private hospital group, BMI, has refused to be part of the launch of BUPA’s much heralded Ophthalmology Network. Any BUPA member wanting cataract surgery after 1 August will have to pay for themselves if they want to use one of BMI’s 49 Hospitals across the country.

The new Network is in line with BUPA’s declared strategy of channelling members through a limited number of providers selected on a combination of price and quality. While previous roll-outs for providers of breast and bowel cancer treatment and for MRI scans went through relatively smoothly, Ophthalmology has been dogged with trouble from the outset.

BUPA had wanted to include surgeons as well as hospitals in the Network, but quickly encountered bitter resistance from the BMA and the Royal College of Ophthalmologists. This was not surprising when, as we understand it, BUPA had proposed to cut fees for cataract surgery by almost 50%! In the face of such resistance, it seems that they have agreed to pay their customary fees, as long as the surgeons use a Network Hospital. This is despite general acknowledgement in the industry that fees for cataract surgery are very high in comparison to procedures requiring similar time and expertise.

We believe that BMI’s refusal to take part is due not so much to disagreement over prices as a lack of confidence in the quality criteria that BUPA have established. For their part, BUPA declare themselves confident of reaching agreement in due course.

Meanwhile, the Network as now declared includes most of the hospitals that one would expect to see, although several Central London hospitals appear with a “pending signature of a formal agreement” qualification. St Anthony’s hospital in Cheam is also excluded.

It remains to be seen whether the new Network causes serious inconvenience to BUPA members. Past experience suggests that referral patterns tend to adapt to the new Networks such that patients notice no difference.

Perhaps a more interesting question is whether the results of this strategy are worth the cost in terms of management time and damage to BUPA’s relationship with providers. Containing charges from hospitals and surgeons is an objective which most people would respect, even the providers themselves. Positioning itself as the arbiter of quality is more controversial when this role is already being performed by a range of Governmental and professional organisations. This Network launch suggests that the aim of policing quality may be hindering the drive to contain costs.

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