SBP: Hospital Consultants break contract terms with no concequences

[seabhcan]

So the new consultant contracts were supposed to ensure consultants did the job they were paid for at least 80% of the time. The remain 20% could be spend on private nixers - get paid extra during company time and using company facilities, equipment and branding. Personally, I'd love a contact like that - you'd think they'd be happy.

But no - its not enough for them. They recently got pay increments to €270k, despite there being no efficiency improvements. Additionally, they spend up to 52% of their working day treating private patients - getting paid twice for the same work.

In Tallaght, private work has gone from 16% on the old contract, to 38% today. Consultants are apparently defrauding the state out of 40%-50% of their wages. In any other profession, they'd be sacked for gross misconduct.

My solution would be to take a page from Reagan - fire them all. The HSE can then pay for their services on a case by case basis, while they should pay rent and fees back to the hospital to pay for the facilities they use.

[damus]

So the new consultant contracts were supposed to ensure consultants did the job they were paid for at least 80% of the time. The remain 20% could be spend on private nixers - get paid extra during company time and using company facilities, equipment and branding. Personally, I'd love a contact like that - you'd think they'd be happy.

But no - its not enough for them. They recently got pay increments to €270k, despite there being no efficiency improvements. Additionally, they spend up to 52% of their working day treating private patients - getting paid twice for the same work.

In Tallaght, private work has gone from 16% on the old contract, to 38% today. Consultants are apparently defrauding the state out of 40%-50% of their wages. In any other profession, they'd be sacked for gross misconduct.

My solution would be to take a page from Regan - fire them all. The HSE can then pay for their services on a case by case basis, while they should pay rent and fees back to the hospital to pay for the facilities they use.

Even before that new contract....private activity was at the 30% mark in public hospitals. What that article also failed to mention was the Brennan report also noted similar problems with private activity in public hospitals, in addition to the fact that consultants were refusing to fill in the necessary documentation so that hospital accounts could recoup from the PHI companies the costs of providing care to private patients and that was without any sanction being imposed on them from either hospital managers, the HSE or the DOHC. This problem still exists, and that's why the DOHC is now seeking to introduce systems that would totally by-pass consultants for billing purposes.

[seabhcan]

Even before that new contract....private activity was at the 30% mark in public hospitals. What that article also failed to mention was the Brennan report also noted similar problems with private activity in public hospitals, in addition to the fact that consultants were refusing to fill in the necessary documentation so that hospital accounts could recoup from the PHI companies the costs of providing care to private patients and that was without any sanction being imposed on them from either hospital managers, the HSE or the DOHC. This problem still exists, and that's why the DOHC is now seeking to introduce systems that would totally by-pass consultants for billing purposes.

An easy solution to that would be to withhold payment to the consultants until they did their job. Not rocket science.

Its high time the gov called bluff on these chancers. Sack them all.

[Éireann go Brách]

brilliant sketch from The Savage Eye team on consultants

[Nemesiscorporation]

So the new consultant contracts were supposed to ensure consultants did the job they were paid for at least 80% of the time. The remain 20% could be spend on private nixers - get paid extra during company time and using company facilities, equipment and branding. Personally, I'd love a contact like that - you'd think they'd be happy.

But no - its not enough for them. They recently got pay increments to €270k, despite there being no efficiency improvements. Additionally, they spend up to 52% of their working day treating private patients - getting paid twice for the same work.

In Tallaght, private work has gone from 16% on the old contract, to 38% today. Consultants are apparently defrauding the state out of 40%-50% of their wages. In any other profession, they'd be sacked for gross misconduct.

My solution would be to take a page from Reagan - fire them all. The HSE can then pay for their services on a case by case basis, while they should pay rent and fees back to the hospital to pay for the facilities they use.

I don't understand why the consultants and anyone else taking part in this fraudulent activity, are not arrested and jailed for fraud.

[seabhcan]

I don't understand why the consultants and anyone else taking part in this fraudulent activity, are not arrested and jailed for fraud.

Maybe some concerned citizen should make a complain to the Gardai? Wasn't that what was done with a certain Clontarf-based senator?

[damus]

An easy solution to that would be to withhold payment to the consultants until they did their job. Not rocket science.

Its high time the gov called bluff on these chancers. Sack them all.

They kicked up a stink when somebody had the audacity to propose that they would start using a clocking-in system many a year ago when the Brennan report was first published. Now they are in dispute about how their private activity is being calculated. But the white elephant in the room seems to disregard the fact that the vast preponderance of private activity in public hospitals is delegated to NCHD's....which is at the public expense. To me its simple, do away with all private activity in public hospitals, and if consultants want to engage in off-site private activity, a clocking-in system should be used to ensure that they are actually fulfilling their public contracted hours....simple.

[Merovingian]

There are a number of erroneous assertions in the post and in Damus's reply:

1. No Hospital Consultant is on 270K. Starting salary is around 150K. Great salary but far short of the 270 pie in the sky number in the post. If you have a specific exmaple I'd be happy to change my opinion. Median salary for Consultant in UK is now 130K sterling.
2. As for Damus's assertion that Consultant's were refusing to fill in the PHI forms. Well in that case neither the Consultant nor the hospital gets paid. The reason forms don't get filled on time is typically because direct patient care trumps filling out forms in the list of things to be done.
3. In most State Hospitals the overwhelming majority of cases (80%-90%+) come in through A&E or are cancer cases. The Consultant has no say in whether the patient decides to use their health insurance or not. 50% of the population still carry PHI and are likely to use it when admitted to a State hospital.

There is a major push on now to enhance hospital revenue. The is no such thing as a 'Public Hospital' in Ireland. There are State funded Hospitals which are a mix of publically funded care suplemented by private health insurance to as much as 20% of their budget. Therefore public hospital managers are actively encouraging the use of PHI in State Hospitals to make good the reduction in the annual hospital capitation grant. Actively discouraging private patients using their insurance when admitted to State Hospitals which perform the overwhelming bulk of the complex care in this state makes no sense. Rather than say you must stay below 20 or 30% a rational Health Planner would have said: 'Surgeon A we want X number of public surgical procedures, Y number of public OPD attendances and Z amount of public administrative support; after that you can work away to your heart's content. In the current situation a surgeon doing 100 public procedures and 21 private is in breach of contract, whereas a surgeon doing 50 public and 10 private is to be commended. Daft!.

[seabhcan]

There are a number of erroneous assertions in the post and in Damus's reply:

1. No Hospital Consultant is on 270K. Starting salary is around 150K. Great salary but far short of the 270 pie in the sky number in the post. If you have a specific exmaple I'd be happy to change my opinion. Median salary for Consultant in UK is now 130K sterling.
2. As for Damus's assertion that Consultant's were refusing to fill in the PHI forms. Well in that case neither the Consultant nor the hospital gets paid. The reason forms don't get filled on time is typically because direct patient care trumps filling out forms in the list of things to be done.
3. In most State Hospitals the overwhelming majority of cases (80%-90%+) come in through A&E or are cancer cases. The Consultant has no say in whether the patient decides to use their health insurance or not. 50% of the population still carry PHI and are likely to use it when admitted to a State hospital.

There is a major push on now to enhance hospital revenue. The is no such thing as a 'Public Hospital' in Ireland. There are State funded Hospitals which are a mix of publically funded care suplemented by private health insurance to as much as 20% of their budget. Therefore public hospital managers are actively encouraging the use of PHI in State Hospitals to make good the reduction in the annual hospital capitation grant. Actively discouraging private patients using their insurance when admitted to State Hospitals which perform the overwhelming bulk of the complex care in this state makes no sense. Rather than say you must stay below 20 or 30% a rational Health Planner would have said: 'Surgeon A we want X number of public surgical procedures, Y number of public OPD attendances and Z amount of public administrative support; after that you can work away to your heart's content. In the current situation a surgeon doing 100 public procedures and 21 private is in breach of contract, whereas a surgeon doing 50 public and 10 private is to be commended. Daft!.

1. SBP states "salaries now range from €150k to €220k, with additional €50k entitlement for clinical directors" = up to €270

2. Given that they are taking in several 100k in private fees, you would think they could employ some kind of clerical assistant, no?

3. The contracts have a built in solution to the scenario you describe. If the consultant finds him/herself in breach of the 20% rule, they are supposed to pay excess fees earned to the hospital. SBP says no-one has ever done this.

[damus]

Merovingian, what I said can be backed up by the findings of the C&AG and the Brennan report, and the problem is still ongoing which is the main reason why the DOHC is now considering measures that would by-pass consultants for the billing process.

Problem 4 on the Non-Imposition of Charges stated;

"The Comptroller and Auditor General has reported a number of instances where charges have not been properly imposed or collected (Table 2.7). The most significant cases relate to the failure to charge for tests relating to the private activity of Consultants in the public hospital system (i.e. the taxpayer has met the costs which should have been charged to the private practice of certain Consultants). In addition, there was a case where a failure by Consultants to provide information about their private patients to hospital management resulted in more than €1 million not being billed to private health insurers" (Pg 35).

http://www.healthreform.ie/pdf/brennan.pdf