With the NHS and private hospitals triggering the de-escalation clause to allow some private work and NHS elective surgery, we take a look to the future from a financial perspective of how private practice can survive during the pandemic.
Income for all practitioners has taken a huge hit in the last couple of months and will continue over the coming weeks.
New protocols to deal with patient consultations, investigations and procedures will mean less patients can be seen, investigated and operated on within the time span compared to pre COVID 19.
This means less income unless fees are reassessed upwards.
The private hospitals by way of the NHS block booking of their facilities effectively received a subsidy to assist them over the 3 month period that in most cases saw little use of their facilities.
The private hospitals will be acutely aware of the huge list of NHS patients needing treatment and will no doubt seek contracts to treat them for the NHS. This will provide an opportunity for additional private work but at what rates?
Insured v Self Pay
There will be a surge of patients wishing to use your services. In the past the health insurers wielded great power in restricting the level of fees that consultants could charge for consultations and procedures.
In the COVID 19 era their power to restrict fees may be somewhat less as their insured members are less attractive to both the private hospitals and consultants. The amount they are willing to pay will not reflect the supply and demand generated by COVID 19 and the additional cost of both theatre and consultants time.
Certainly, relatively new consultants that had to, for recognition purposes, limit fees will wish to look towards self-pay patients.
The insurers business model and subscription charges for members will have to change.
Competition Amongst Consultants
You will be keen to start up again in private practice and hopefully attain similar levels of activity pre COVID 19. This may be difficult due to new protocols and as stated above fees may have to be reassessed upwards as a consequence.
Pressure will be placed on space for waiting areas and investigative equipment to be cleaned after use each time with theatres similarly requiring cleaning particularly for aerosol generating procedures.
Everyone will be keen to kick start their private practices but space and time will be rationed to begin with. This may be acutely felt if the hospital has contracted to deal with the backlog of NHS patients so you may have to discuss these practicalities with colleagues and hospital management.
You may find that you are encouraged to discuss pricing with fellow colleagues and hospital management but be careful not to fall foul of the Competition and Markets Authority (CMA) who penalise practices that are deemed to be non-competitive.
The largest expenses of any practice are staff, indemnity and premises. The government have extended the furlough scheme to the end of October 2020 with the option to bringing staff back on a part time basis. If needed, use this support.
The indemnity insurers need to be contacted to determine if there is any scope for reduced subscriptions. Be careful of changing to any new provider driven by cost as you must ensure that the policies are comparable. Check out first their excesses, roll on cover, what happens if there is a claim and the level and experience of their team to assist you. You do not want in this post COVID 19 period to find that for reduced subscriptions you have access to the most junior person at the indemnity provider or their advisors for support. Check what happens to subscription levels if a claim is made and rollover cover should you decide to cease private practice.
Premises and its suitability to consult with patients will need to be reviewed and if need be altered to meet distancing protocols. The cost will be tax deductible.
The patient pathway from consultation through to recovery will alter drastically. Hospital protocols together with your own will be needed to ensure safety as far as possible for the patient, your staff and you.
You will need to check and follow the patient pathway from beginning to end noting any areas of concern and indeed any area that may cause anxiety for patients themselves. It would do no harm to have a lay person, family or friend test run the pathway.
Dental practitioners offer an opportunity to review what they have in place and provides a good base to see in practice their protocols and any issues faced.
A review of consenting and follow up procedures will be needed and there is an abundance of guidance from your professional bodies.
It is likely that Insurers will look to exclude COVID 19 from claims by patients and therefore you will need to review consent procedures to ensure that it is included within the risks of a procedure taking place in this new world we find ourselves in. No doubt the private hospitals will be working in this and will communicate their policies but it is important that you review your own procedures in this area.
Staff & Administrative Systems
Most consultant’s secretaries either work within the private hospitals or remotely. Some will have been furloughed and you will need to check how they are upon returning. They will be ‘rusty’ to begin with, getting up to speed from where they left off.
What will be important is a review of your administrative systems to ensure that they are capable of working in the new environment.
In an ideal world you would want a package that deals with the patient pathway, all stages, acts as a database of contact details and templates, allows remote access and remote consultations, allows the patient to interact say with booking an appointment and deals with all the financial side, say taking payment remotely in advance.
All under one roof.
Some packages have this, others require some bolt on.
Financial accounts and tax at some time will still have to be prepared and paid.
There are various tax planning opportunities to help cash flow and assist in going forward.
These will be the subject of a future post as you will still be concentrating on getting your practices up and running again.