Private practice faces curbs

THE HSE has introduced new regulations – including potential restrictions on private practice – for dealing with hospital consultants deemed to have been treating too many private patients.

Under the terms of the new contract introduced in 2008, consultants who persistently breach the limits on private practice can be required to pay fees earned above the permitted threshold into a research and study fund.

New regulations drawn up by HSE management this month set out how this arrangement will operate.

In a confidential memo to senior managers last week, the HSE’s national director for commercial services and reconfiguration, Brian Gilroy, said it was now clear there were still a number of consultants who were not in compliance with the terms of the public-private mix in their new contracts.

This stipulates that the ratio of public to private patients treated by doctors in public hospitals should range between 70:30 and 80:20, depending on the type of contract held by each doctor.

However, the Irish Hospital Consultants Association has consistently challenged the methodology used by the HSE to calculate private practice rates.

In the new regulations, which were issued separately to Mr Gilroy’s memo, the HSE states: “Once the medical consultant and the employer are agreed regarding total private fee income, an amount of private fee income to the extent to which the medical consultant has exceeded the specified ratio will be identified.

“For example, should the medical consultant have exceeded the specified ratio in a particular segment of practice (inpatient, outpatient, day case or otherwise) (eg engaged in 30 per cent private practice instead of the specified ratio of 20 per cent), the amount of private fee income above the 20 per cent threshold in that segment of practice (inpatient, outpatient, day case or otherwise) will be recouped.”

The regulations state that the medical consultant will be given 30 days to remit the money to the new research and study fund.

However, if the money is not paid over, the medical consultant will be required to cease private practice in that segment where he or she is in excess of the specified ratio pending remittance of outstanding fees to the fund.