BUPA Stance on knee surgery

Bupa has changed the way it deals with knee arthroscopy (keyhole surgery to treat the knee joint) in future.

Background

According to BUPA there is published medical evidence which shows that there is a lack of patient benefit from knee arthroscopy for certain conditions, such as chronic knee pain due to osteoarthritis. 

As with many medical conditions, people with the same conditions and symptoms sometimes receive different treatments based on the preference of the treating doctor rather than good clinical evidence or the patient’s own preferences. This is known as unwarranted variation and has been widely documented in medical practice. 

One of Bupa’s key priorities is to address unwarranted variation so that our customers do not have unnecessary surgery or pay for ineffective treatment through their premiums.

BUPA review of knee arthroscopy amongst its customers found that it is more than double the rate of NHS patients. While BUPA fully expect there to be some variation for clinical reasons, they have also found that some surgeons are three times more likely to perform a knee arthroscopy on BUPA customers than others and clearly, they need to understand the reasons for this.

Medical review process

BUPA want to work with doctors to review all knee arthroscopies performed on Bupa customers so that they can understand the clinical rationale for them and ensure its members are receiving the most appropriate treatment. 

As a result, all knee arthroscopies performed on Bupa customers from 23 May 2011 must go through the new medical review process to confirm eligibility for funding. 

In most cases, BUPA will confirm funding the next working day. Where a knee arthroscopy appears to fall outside published evidence-based guidelines, BUPA will seek a second opinion from one of its expert clinical advisers, who are independent UK-based consultant knee specialists, to ensure that it is medically necessary and therefore covered by Bupa as eligible treatment.

BUPA have written to its recognised orthopaedic consultants advising them that all knee arthroscopies need to be medically reviewed before treatment starts. BUPA will also let its customers know about the medical review process for knee arthroscopy when they call to pre-authorise treatment. 

BUPA believe this is a good example of them helping its customers obtain the best treatment, ensuring they receive high standards of care and that their healthcare spend has a positive impact on their health.

Should you have any concerns regarding this article please contact our offices on 01384-456-345.

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