Monthly Archives: October 2012

What I Learned at the 5th World Medical Tourism & Global Healthcare Congress, and Why It Matters to the Workers’ Compensation Industry.

HEALTHCARE is globalizing, and Workers’ Compensation should be a part of that. There. I’ve said it, and I will explain why. When I attended the 5th World Medical Tourism & Global Healthcare Congress, last week at the Westin Diplomat Resort & Spa in Hollywood, Florida, sponsored by the Medical Tourism Association (MTA), I found just how big this growing industry is getting, and how many countries are getting on the bandwagon to provide lower cost healthcare at the same or better quality than U.S. hospitals are offering, with doctors trained in the U.S. or in other Western countries; the latest technology and medical equipment, and accreditation from the Joint Commission International (JCI), the International Organization for Standardization (ISO), as well as the U.S. Centers for Medicare and Medicaid Services (CMS).

I was invited by the MTA to attend the Congress after they published a White Paper I wrote originally as a term paper for my Master’s in Health Administration (MHA) degree program’s ‘Health Law’ class.

In the paper, I discussed what medical tourism is, how it is being implemented into health care plans, the cost savings of medical tourism, as well as the issue of quality, which is equal to or better in many of these hospitals than most American hospitals provide. I then discussed the state of workers’ compensation medical costs, and finally, the legal barriers medical tourism faces, as well as the legal barriers to implementing medical tourism into medical provider networks for workers’ compensation, using three legal cases pertaining to medical tourism and workers’ compensation claims.

The first one, was in California, and was a case of domestic medical tourism. A cook at a convalescent hospital slipped and fell and injured his right elbow and back. Due to his weight, the treating physician, and his employer’s physicians recommended he lose weight, but since they did not tell him which weight loss clinic to go to, the claimant chose to go to a clinic three thousand miles from his home. The case wound up in the CA Supreme Court, which ruled in his favor, granting him temporary disability for the ten months he was at the Duke University clinic, and for all future costs of medical treatment.

The second case was also in California, and concerned a Mexican worker who fell off of a ladder. He was treated by the State Compensation Insurance Fund and a provider in his hometown of Tijuana. The medical reports were prepared by both the treating physician and another doctor. The Workers’ Compensation Appeals Board made an award to the claimant, the State Fund petitioned for reconsideration, on the grounds that both physicians were not licensed under California law. The Court of Appeals ruled in the claimant’s favor in this case as well.

The last case happened in Florida, and also involved a Mexican worker who was injured when a vehicle struck him as he was unloading trash in the right leg.  He was hospitalized for a long period of time and had twelve surgeries to repair the fracture. He was seen by an orthopedist in Dallas, who recommended additional surgery. He never got the surgery in the US, as he returned to Mexico and did not have legal documents to return to the US. This case went to the Florida Court of Appeal which ruled that state law did not preclude the foreign physician’s treatment of the claimant in Mexico. They stated that Florida workers’ compensation law contemplates coverage for non-citizens, and they cited an earlier case in which the court held that undocumented workers were entitled to workers’ compensation coverage in Florida, and two later cases that held that “to construe the section 440.13(2)(a) in a manner that would limit authorized treatment for a claimant injured in Florida to a physician licensed in the State, or anywhere else in the US, would preclude workers (including illegal aliens) who return to their home country from receiving authorized remedial care for clearly compensable injuries.”

The Court of Appeal also stated that Florida law indicates that an injured worker is not prohibited from moving from his pre-injury residence in the state, and receiving treatment outside of the state. As the claimant was no longer living in Florida, the court held that this case was different from three other cases that the defendants cited, in that the claimant was already living in Mexico when he requested medical treatment. Therefore, the trial court did not err in directing the employer/carrier to authorize treatment by a Mexican physician, and the trial court’s decision was affirmed by the court.

These cases are by far not the last ones that will arise in regard to medical tourism and workers’ compensation, and with a growing working class population in the U.S. that is foreign born, there will most certainly be others in the future. And as such, getting these workers treated in their home countries where issues of language, culture, cuisine, family and friends supporting them are not a problem, it will become necessary for employers, workers’ compensation carriers, unions, and the claimant’s themselves to have the same options for treatment that they may be getting from their employer’s health care plan.

What is the difference if a knee or hip replacement is performed on a patient who is injured on the job, or crossing the street and gets hit by a car? There is none, so why should workers’ compensation be any different than health care plans already being implemented, or are being planned for in the future as the medical tourism industry grows, and more businesses arise to facilitate such tourism and more hospitals get in on the game around the world.

Among the nations represented at the Congress were many countries in Central and Latin America such as Mexico, Guatemala, Costa Rica, Nicaragua, Panama, Colombia, Chile, Brazil and Argentina as well as Caribbean countries such as the Bahamas, Barbados and Puerto Rico. Other nations represented there were Poland, Lithuania, Turkey, Thailand, Malaysia and Japan. With many workers comp cases involving both legal and undocumented workers from these countries and many others, using the medical tourism option will make sense because the claimant can get the best treatment available in his home country at reasonable costs in surroundings that will benefit his recovery and healing, which will allow him to return to work more quickly because being with family during a medical event has proven to be the reason why Latinos have better health outcomes than African-Americans.

By chance, on the third day of the Congress, I met a woman from Guatemala who is working with her American partner on developing medical tourism for self-funded health plans in Latin America. I discussed my paper with her and gave her my business card for her and her partner. They are partnering with Meritain Health/Aetna on creating these plans, and I mentioned to her that Aetna recently purchased Coventry Health Care. I told her it is possible that Aetna could use the work comp services side of Coventry to expand in that direction. Earlier in the day, also by chance, I met a woman from Canada who advises a subsidiary of Blue Cross and Blue Shield of Florida about workers compensation and medical tourism. I gave her my card as well, and sent her my resume and paper by email for her to pass on to her client.

Whether or not any of these two possibilities pan out for me is not really the point I am trying to make. As more and more health care companies implement medical tourism into their plans as options for individuals and groups, and as more and more employers, both self-funded, as well as those who get their health care through the commercial market, the pressure on both insurers and employers to  lower the cost of health care as costs keep rising, will no doubt lead them to seek lower medical costs for their workers’ compensation policies as well. What is good for the goose is good for the gander.

But what it will take from the workers’ compensation side is much more difficult than what is already happening among such companies as Google and American Express, both of whom had representatives speak at the Congress about what they are doing with medical tourism for their employee’s health care, as is a company from Michigan who is also using medical tourism for their employee’s health care. With regard to workers’ comp, my paper outlines some of the legal barriers to implementing medical tourism into workers’ comp. Those laws will have to be replaced or amended to open up the workers’ comp arena to medical tourism.

Among some of the issues not covered in my paper, but that present both a problem and an opportunity, are the laws about distance from a claimant’s home a provider can be in order for the claimant to reasonably get to the doctor’s office. This would not be a problem for medical tourism, as the best way it could be utilized would be on a secondary care level. The next problem would be the Employee/Employer choice of doctor requirements states have in their workers’ compensation laws. Here too, this could also be good for medical tourism, if the employer or carrier realizes that local secondary treatment would be extremely costly to both, then finding a lower cost option domestically, or internationally, would allow medical tourism to benefit the workers’ compensation claimant.

Even if a state has laws stating that employees have a choice, like Washington State and Oregon has, then the claimant could choose from a list of providers the state has pre-selected to provide treatment abroad. Washington State already does that with a page on their website that takes you to pdf files that have lists of pre-selected doctors in certain countries. For this to be realized in other states, insurance companies, employers, business groups, unions and even workers’ rights organizations must get involved and lobby their state legislatures to change or amend their laws.

Medical tourism, once the purview of the wealthiest, has become more affordable to more people, as well as to those who are under-insured or uninsured. Self-funded plans and commercial insurance companies are choosing this as an option. For these employers to do so for their health care coverage, and not for their workers’ compensation coverage is like buying homeowners insurance, but not flood insurance or auto insurance. A house is certainly not a car, but neither is it always going to be flooded, but on the off-chance that it is, and it is situated in a flood zone, then it makes sense to buy both auto and flood insurance along with homeowners insurance. Workers’ Compensation should be no exception.