Consultants who have been treating too many fee-paying patients face sanctions as deadline set by HSE draws near, writes MARTIN WALL
WITH THE deadline set by the HSE for the removal of private practice rights from consultants who have allegedly been treating too many fee-paying patients now only days away, new reviews of the practice profiles of a number of doctors at the centre of the row are taking place around the State.
Highly placed sources say there was evidence from reviews carried out in the south of the country over the past week that some doctors have reduced the number of private patients they have been seeing to bring them into line with official limits. However, it remains to be seen whether all consultants will be found to be compliant.
Any move to remove the private practice rights from individual consultants would almost certainly add to tensions between the HSE and medical organisations, which are already facing some difficulties over proposals to increase the working hours of senior doctors without additional pay and to curb historic rest-day entitlements.
The Irish Hospital Consultants Association has for some time challenged the methodology used by the HSE in calculating the level of private practice. It has said the system adopted by management in the health service is “fundamentally flawed”.
Any move by the HSE to put in place bans on private practice could lead to possible legal challenges.
It is unclear as to whether the HSE plans to publicly identify any consultants from whom it removes private practice rights. In some ways, it is difficult to see how it could avoid doing so.
However, it is understood that management has signalled that any consultants who lose private practice rights could continue to treat private patients in HSE hospitals as long as they did not charge them.
The row over how private practice levels are calculated – and whether some doctors have been in breach of official limits – has been raging virtually since the new contract for hospital consultants was drawn up in 2008.
However, the dispute appears set to come to a head this week with the HSE having set a deadline of this Friday for about 20 consultants, who it considered to have been seeing too many private patients, to pay an effective financial penalty or lose their rights to treat fee-paying patients in public hospitals.
The HSE had maintained that more than 50 per cent of those treated by the consultants concerned, a significant number of whom are believed to be based in the southern half of the country, were fee-paying patients.
It is understood that over the past week or so, a number of these doctors have met senior managers and clinical directors in hospitals to carry out a further review of their practices using the most recent data provided under the Hospital Inpatient Enquiry System.
Management has also been applying new rules drawn up last year to assess private practice levels, which effectively seek to deal with cases such as where there are low volumes of practice or where fee-paying patients are dealt with by teams of consultants.
It is understood that these reviews have whittled down the number of consultants considered to have excessively high levels of private practice.
However, some sources said that in addition to the reduced levels of private practice, which have emerged technically from the use of the most recent data and the new rules, it was evident that some senior doctors had cut down on the number of fee-paying patients.
Further reviews of the practice profiles of other consultants at the centre of the dispute with the HSE are currently under way in different hospitals. However, it is likely to be later in the week before definitive numbers are available as to how many, if any, senior doctors are considered to remain non-compliant with the HSE’s official limits on private practice.
Talks on the private practice issue took place between the Irish Hospital Consultants Association and senior HSE management last Thursday and sources close to the process said some progress had been made, although there was no over-arching deal on the issue.
It is understood that the management side has signalled that if consultants come into compliance with official limits, the outstanding financial penalties could effectively be “parked” for a period.
If the consultants concerned maintained their practices in keeping with the limits for a number of years, the financial penalties could, in effect, be written off.
While such arrangements are being considered, it is understood that as of yet there is no overall deal in relation to such issues.
The question of private practice rights for hospital consultants dogged the negotiation of the 2008 consultant contract, which went on for more than five years.
When the contract was concluded, arguments emerged soon afterwards that the terms which had eventually been agreed were not being adhered to in some cases.
Depending on their type of contract, consultants working in public hospitals with private practice rights can either see a maximum of 20 or 30 per cent of fee-paying patients.
Over the past year or so, the HSE argued that a number of consultants were not in compliance with the terms of the public-private mix in their new contracts.
Last August, the HSE signalled it planned to issue official warnings to consultants that they could face sanctions.
The contract allows for financial penalties to be levied on consultants who are consistently in breach of the public-private practice mix. This money would not go to the HSE but rather into a special research fund.
In June, it said that if the money was not paid by September 15th, the consultants concerned would lose private practice rights in public hospitals.