Monthly Archives: April 2013

Looking Back on My First Six Months: Where I’ve been, where I am, and where I am going

Today marks six months since I started my blog on medical tourism and workers’ compensation. The purpose of my blog was to explore the possibility of realizing the implementation of medical tourism into the US workers’ compensation system, which was the subject of my white paper. My other reason for writing the blog was to attract the attention of potential employers and further my career in either industry, or who were willing to pursue the ideas I wrote about.

I have written on many topics related to both workers’ compensation and medical tourism, and have also written on topics specific to each separately. The topics I wrote about ranged from what I learned at the MTA Congress in October 2011 and why it matter to the workers’ compensation industry, employer/employee choice of physicians in workers’ compensation, the barriers to implementation (from my paper), how a self-insured employer could implement medical tourism for their self-insured work comp program, Mexico as a destination for medical tourism for Mexican-born, US workers, rising hospital costs, immigration reforms impact on both medical tourism and workers’ compensation, listing of several hospitals and clinics in Latin America and the Caribbean, and the opioid abuse problem in workers’ compensation, among many others.

The comments I received, have been on the main, positive and even enlightening, and some have been very complimentary of my writing and my mind. But the responses to my invitations to follow the blog, from both the medical tourism and workers’ compensation industries have been less than hoped for. To date, there are only 62 followers of my blog (63, if you count yours truly).

One thing I have learned, though, is that medical tourism is still in its infancy, and is still pretty much a cottage industry with lots of small companies and individuals competing for business. And as in any growing and nascent industry, it is bound to have its many problems and challenges, and medical tourism is no exception.

But I have also connected with a lot of great folks from around the world, in places I would love to visit, and have had many of my posts published on their websites or in online newsletters or blogs. This exposure too has not generated much interest, but I am grateful to all the people who have published my ideas, and count them as friends with a common interest.

I hope that in the next six months, my situation career-wise will change, and that my followers will increase. One of the drawbacks of writing this blog has been lack of revenue being generated from the blog, either in the form of a paycheck, in advertising revenue due to the platform I am using, or in speaking fees and travel expenses, but this too I hope will change.

I hope all of you who have read, followed, commented, or just visited my blog will continue to do so, and will provide me with your insights and ideas for more posts and more topics to explore. I am grateful for your continued support of my blog, and thank you very, very much for being a part of this experience. I have learned a lot about blogging and hope to learn much more in the next six months.

Employees Unprepared for Increased Health Care Costs

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While the duck is recovering from his injuries, Aflac has released a press release and a report on the state of readiness of American workers covered under employer-sponsored, consumer-driven health care plans, according to the Physicians for a National Health Plan “Quote-of-the-Day” newsletter.

The press release mentions a recent Aflac survey that reveals that employees are not prepared for increased costs, and may not want control of their options, and lack education about what is meant by “consumer-driven health care.”

The report finds that employees are not financially prepared, and that:

  • Only 24 percent of workers completely agree or strongly agree they will be financially prepared in the event of an unexpected emergency or serious illness.
  • Further, 46 percent of employees have less than $1,000 to be able to pay for out-of-pocket expenses associated with an unexpected serious illness or accident, and 25 percent of employees have less than $500.
  • Four-in-ten (40 percent) workers would have to borrow from their 401(k), friends and family to pay for out-of-pocket expenses associated with an unexpected serious illness or accident; 28 percent would have to use a credit card.

The report also states that:

  • Nearly three-quarters (72 percent) of the workforce have not heard of the phrase “consumer-driven health care;”
  • More than half (54 percent) of workers would prefer not to have greater control over their insurance options because they don’t have the time or knowledge to effectively manage it;
  • 62 percent of workers believe the medical costs they will be responsible for will increase, while only 23 percent are saving money for potential increases;
  • 75 percent of workers said they think their employer would educate them about changes to their health care coverage as a result of reform, but only 13 percent of employers said educating employees about health care reform was important to their organization.

Lastly, the report found that among consumers of health care plans:

  •  32 percent are not very/not at all knowledgeable about health savings accounts (HSA)
  • Three out of four (76 percent) are not very/not at all knowledgeable about federal and state health care exchanges
  • Almost half (49 percent) are not very/not at all knowledgeable about health reimbursement accounts
  • 25 percent are not very/not at all knowledgeable about flex spending accounts (FSA)

If American workers are unprepared financially to assume a greater portion of their health care spending, and if they are not aware of what “consumer-driven health care” is, nor are they interested in having control, what does this say about the state of the US healthcare system after January 1, 2014?

And more importantly, what does it mean for medical tourism, which is generally consumer-driven, and relies on patients to seek out medical tourism destinations as they would destinations for any other tourism?

For the workers’ compensation industry, this could mean cost-shifting from employer-sponsored health care plans for certain health care issues to workers’ compensation, which has happened from my personal knowledge of a subrogation company that recovers payments made by health care insurers, when the claim was actually covered under workers’ compensation. This would hasten the day medical tourism is implemented into workers’ compensation, so that employers and carriers can take advantage of the lower costs of medical care abroad.

While cost-shifting may happen, it is unlikely as most carriers would deny coverage for many claims that are routinely covered under health care, but would become financially unavailable to most employees because they are unprepared, or because their employer will want the employee to share the cost.

Whatever happens, medical tourism could see a sharp increase in business in the next few years.

New Technology, New Workers’ Compensation Issues: Can Medical Tourism Help?

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The Industrial Revolution brought with it many new wonders and many new problems, chief among them, numerous industrial accidents that occurred in factories, mills, mines, plants and other workplaces in the 20th century. The workers’ compensation industry was created to meet the challenges of workplace accidents and provide remedy to injured workers.

Now a new industrial revolution, a revolution in nanotechnology, will  usher in new problems and new issues for the workers’ compensation industry in the 21st century and beyond, according to an article in the online magazine of the website, MedicalSea.org.

The article, Health risks associated with manufacturing and using nanomaterials discusses what research the National Institute for Occupational Safety and Health (NIOSH), a part of the Centers for Disease Control and Prevention (CDC) is doing in the area of nanotechnology and its impact on the health and safety of workers in this new and growing industry.

NIOSH has identified ten critical topics to address knowledge gaps, develops strategies, and provides recommendations.

The topics are:

Toxicity and Internal Dose

Risk Assessment

Epidemiology & Surveillance

Engineering Controls and PPE

Measurement Methods

Exposure Assessment

Fire and Explosion Safety

Recommendations & Guidance

Communication & Information

Applications

They have also created a field research team to assess workplace processes, materials, and control technologies associated with nanotechnology, so that research laboratories, producers and manufacturers working with engineered nanomaterials will have the opportunity to participate in a cost-free, on-site assessment.

For the workers’ compensation industry, this research will be crucial to understanding how to handle future workplace accidents and better manage the risks involved with the manufacture and use of these new materials.

For the medical tourism industry, it offers a chance to get away from being strictly concerned with the looks of well-heeled tourists and getting involved with a facet of medical care that has yet to be created: the treatment of injuries from and exposure to potentially dangerous technology like nanotechnology. It can become a cutting edge area of health care that can propel many nations into the forefront of advanced medicine.

Ensuring Patient Safety: Making Sure Medical Tourism Puts Its Money Where Its Mouth Is

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The medical tourism industry prides itself on the better quality of care found in hospitals in medical tourism destinations, but questions about just how good American hospitals are remain.

Insurance Thought Leadership.com published an article today called “The Most Dangerous Place In The World”, written by Leah Binder, President & CEO of The Leapfrog Group (Leapfrog), a national organization based in Washington, DC, representing employer purchasers of health care and calling for improvements in the safety and quality of the nation’s hospitals.

Her article describes the hospital stay of the father of a Harvard professor Ms. Binder knows in an American hospital that was anything but routine.

Here are some of the key takeaways from the article, and should give the medical tourism industry some solace, and some reason to make sure that their hospitals are better than those in the US:

    • American hospitals are “the most dangerous place in the world.”
    • The safety problem is an open secret among people in the health care industry. The statistics are staggering. Each year, one in four people admitted to a hospital suffer some form of harm, and more than 500 patients per day die.
    • We must have a better approach for tracking harm in the hospital, hospitals need to feel the financial consequences of providing unsafe care, and accountability for patient safety must be created.
    • Last year, The Leapfrog Group initiated an effort to rate the safety of 2,600 hospitals. The Hospital Safety Score is available to the public for free on a website and as an app.
    • A recent AARP Magazine article notes features used in safer hospitals that all of us should look for in our own hospital.

If the medical tourism industry is to remain viable and grow larger around the world, it is imperative that hospital administrators, patient advocates, providers, medical tourism facilitators, ministries of Health and other relevant government entities insist on not only reaching quality measures in the US, but beating them, and beating them by an overwhelming margin that makes medical tourism a sound alternative, not only for individual  or group health insurance patients, but for patients injured on the job and covered under workers’ compensation.

An Algorithm a Day, May Keep the Pain Doctor Away

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As previously discussed on this blog, prescription pain medication abuse is a big problem in workers’ compensation, (see Opioid Abuse in Workers’ Compensation: What the Medical Tourism Industry Needs to Know).

There has been a lot of writing on the subject, and a great deal of meetings, webinars, and conferences, with very little solutions being offered, or action taken besides passage of legislation and the creation of state-run databases, as in Kansas and California.

But recently, as reported last week in the Wall Street Journal article, “When Your M.D. Is An Algorithm” by Timothy W. Martin (April 11,2013), a summit was held in Orlando, Florida that brought together patient advocates, policy makers, and law-enforcement officers, as well as representatives of a new cottage industry: companies that are taking a data-driven approach to deal with the drug-abuse problem.

The National Rx Dug Abuse Summit showcased companies that are combining medical research and guidelines with computer analysis to guide doctors about what drugs should be administered, in what doses, or if at all.

These companies, mainly insurers and medical-bill review consultants for companies paying workers’ compensation claims said they are filling an unmet need: that of providing research-driven clinical advice and guidelines to doctors who have not been thoroughly trained on how to treat pain.

There are some doctors, who are skeptical of these programs that have names such as “Opioid Defense Manager” and “VantageComp”. They do not believe that these programs play any role in medical treatment, especially when they are used by companies looking to lower drug costs and medical spending.

One of the 40 analytic companies that attended the conference was Rising Medical Solutions, Inc. Their in-house algorithms, assesses whether an individual is a low, medium or high risk. This is based on a 30-question survey that asks about an injured worker’s optimism about their recovery, their previous injury history and whether they smoke, along with other signs that measure their vulnerability to painkiller addiction.

Rising Medical CEO, Jason F. Beans said that the company had determined that being on painkillers any longer than two weeks, could be an indicator of addiction. Beans also went on to say that, “We enact interventions to prevent the small lower-back claim from becoming a lifelong addiction.”

PMSI’s proprietary Risk Intelligence System, has 18 criteria it says could signal fraud or abuse. According to Ishita Sengupta, director of workers’ compensation at the National Academy of Social Insurance, a nonprofit research group that tracks workers’ compensation benefits and costs, the analytics-driven industry has grown to more than three dozen companies from just a handful a decade ago.

Insurance companies such as AIG, Liberty Mutual and Travelers have added analytical or predictive modeling abilities to their workers’ compensation divisions.

Pharmacy-benefit managers such as Modern Medical Inc.  and consulting firms such as Prium, a Georgia firm that consults to workers’ compensation payers, are also involved with analytics. Michael Gavin, chief strategy office at Prium, said “Your doctor’s approach to pain care may lead you to become addicted—but that is not the case with high cholesterol or high blood pressure.”

All this growth in a nascent industry such as analytics comes about because workers’ compensation spending is soaring. As Martin points out in his article, and as I have pointed out in my white paper, Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation, the average medical cost for lost time claims was $28,000 in 2011, which was nearly double the cost in 2001, when the cost was $15,900.

Both Martin’s article and my white paper cite data from the National Council on Compensation Insurance (NCCI), an industry-created company that tracks workers’ comp spending and the overall health of the industry.

So as the medical tourism grows, and the idea to implement medical tourism into workers’ compensation becomes a reality, medical tourism facilitators and medical tourism providers will be able to know beforehand if a surgical patient who was injured on the job and receiving medical treatment abroad, is already a painkiller abuser or could become one. The provider will have the benefit of the knowledge provided by analytics to determine risk of addiction so that patient addiction can be halted or avoided altogether.

This in turn, will also help the wider medical tourism industry because the very analytics used to determine risk of addiction for injured workers can be used for non-occupational injury patients receiving the same surgery. And that will give the medical tourism industry more credence with the healthcare community at large.

Adjuster Selection Process for Self-Insured Employers: What Medical Tourism Facilitators Should Be Aware Of

You may recall back in November of last year, I wrote a fictional case study about how a self-insured employer who is self-insured for both group health and workers’ compensation, could implement medical tourism into their workers’ compensation program after talking to the benefits manager. Well, for those medical tourism professionals who are interested in working with self-insured employers to implement medical tourism for their injured workers, this week’s article post will give you a little idea of what goes into the process of handling workers’ compensation claims from the employer’s point of view.

Rebecca Shafer, an attorney and expert in workers compensation cost containment, wrote blog piece in Workers’ Compensation.com about how an employer can go about selecting the right kind of claims adjuster to handle their workers’ compensation claims.

Shafer said, that self-insured employers with successful workers’ compensation claim management programs know one key fact – the better the adjuster, the lower the claim cost. Whether the self-insured employer has dedicated and/or designated adjusters at the third party administrator, or utilize their own in-house adjusters, the selection of the best adjusters can be tricky.

She also stated that there are four primary attributes the self-insured employer should look for in the adjuster selection process. These are:

Communication

Documentation

Proactive

Courteous

Communication, Shafer says, should be open…between the adjuster and the employer…Open communications allows for the exchange of information about the claim and ideas on how to assist the injured employee while moving the claim forward. Open communications with the adjuster is not for the employer to micro manage the claims, but to facilitate collaboration and claim progress.

Documentation means that the best adjusters thoroughly document their files. Each phone call, e-mail, medical bill, medical report, attorney letter, state filing, etc., should be documented either in the file notes, the documents section of the file, or both.

Proactivity means that the proactive adjuster will coordinate and manage the medical care either directly or through a nurse case manager. The proactive adjuster will arrange for the employee to return to work light duty. And, the proactive adjuster will coordinate all other aspects of the claim before there is a need for action.

Courtesy extends not just to the employer, but to the employee as well. Other attributes an employer should be aware of, Shafer states, are the following:

Negotiation skills

Organizational skills

Time management skills

Customer service skills (customer being both the self-insured employer and the injured employee)

Work ethic

Ability to prioritize competing demands

Compliance with Best Practices

Technical expertise

As these are attributes that a self-insured employer needs to look for in a claims adjuster, it is not necessary for the medical tourism facilitator company to get so involved with the process of adjuster selection, only to be aware of what the employer will do to find the right individual to handle their workers’ compensation claims. In the event that medical tourism becomes more involved in workers’ compensation, and it is necessary for the facilitator to guarantee that the injured worker will be treated appropriately, it is incumbent upon the facilitator to understand the process of adjuster selection so that no misunderstandings or confusion over who is who, and what role they play in treating and caring for the patient. Knowing what it took to select the adjuster who may need to consult with the facilitator or the medical provider will make the medical tourism experience beneficial for all concerned.

Do “Free Trade” Agreements Help or Hinder Medical Tourism and its Implementation into Workers’ Compensation?

Earlier this week, the UK Ministry of Health released new rules for “Health Tourism”, which may have a chilling impact on foreigners seeking medical care in the UK. And last week, I was engaged in a running commentary with an individual who seemed to know a lot about obscure parts of the ACA, the Canadian health system (particularly the provincial system in British Columbia), and trade issues that were way above my head. I must point out that as an undergrad, I studied international relations and foreign policy as part of my Political Science major, and studied what was then called Global Politics way before anyone ever heard the word, “Globalization”, but as far as what this person was saying, it was beyond my ken.

This individual also threw out a lot of acronyms that I was not aware of such as COOP, SHOP and GATS (which I later realized stands for General Agreement on Trade in Services). Some acronyms like ACA and WTO I did know. COOP: Consumer Operated & Oriented Plan (COOP)(state-controlled coops on exchanges) http://cciio.cms.gov/programs/coop/ . IRS 501(c)(29) cooperative healthcare insurance organization http://www.irs.gov/Charities-&-Non-Profits/New-Guidance-for-IRC-501(c)(29)-Qualified-Nonprofit-Health-Insurance-Issuers. And finally, SHOP: SHOP is the small biz component of health exchanges and COOP must have their offerings. http://www.healthexchange.ca.gov/Documents/Small%20Employer%20(SHOP)%20Exchange%20Issues.pdf

When he/she responded to my request for a clarification of COOP and Shop, it got me thinking about trade, medical tourism and workers’ compensation, and is the reason for this current post.

This is what this individual said in his/her reply:

The COOP is the 501(c)(29) coop health care insurer under ACA for the state-controlled public option on exchanges. It will compete with private insurance for the Obamacare subsidies. This has small business programs under SHOP. If the self-insured programs could fall under SHOP to qualify for subsidies is undetermined. If HHS regulations will allow any overseas options is also unanswered, too. If not, then there are trade questions for the Mode 2 cross-border users and providers under GATS. There are WTO trade questions on public/private monopolies with designated providers. There are WTO trade questions on public/private monopolies with designated providers. This cozy arrangement is trade protectionism, and WC or Obamacare exchanges are public monopolies with the private sector. If this creates an unreasonable trade barrier to foreign providers, then there are monopolistic characteristics. Obamacare creates a paradigm shift, and GATS will export that across our foreign borders under Mode 2 for both the consumer and providers. With Canadians coming down for care, the Canadian system might be the first to feel the impact from exchange fallout. See Health Tourism by David Reisman on page 22. Medical providers can already cross the 49th parallel for licensing (e.g. doctors), but medical providers might find the patient quota system under the Canadian Health Act is far too protectionist. Does the provincial public/private system create a trade barrier to foreign medical providers? British Columbia might find rationing is market protectionism, and Washington Nobody is really discussing this and I wonder about the MTA marketing machine for WTO trade issues. Their clients are more savy about the WTO than Americans, but they might not know if Mode 2 liberalization will impact their domestic programs. Obamacare is really a potential game changer when the US Trade Representative files a WTO trade complaint against these foreign markets. From British Columbia, the Mode 2 migrations will flow into Australia, Singapore, Hong Kong, and China. BC might be forced into a new version of “exchange programs” under GATS.State providers are deterred from entering the Vancouver market. It is restrictive for consumers, too.

One thing this individual did not understand was that Workers’ Compensation does not have, nor will have exchanges as under the ACA. I tried to tell this person that only ACA requires exchanges. This individual also misconstrued the concept of a “Monopolistic State” as it pertains to Workers’ Compensation.

Will monopolistic arrangements require market exchanges?

If there was a state monopoly like the provincial system in British Columbia, then perhaps yes.

You noted the four monopolistic state systems for work comp. This would mirror the BC health system as I understand it under Canada Health Act which is like ACA. Reisman (Dr. David Reisman, who I met at the MTA Congress in October 2012 is a Professor of Economics at Nanyang Technological University, Singapore and Professor Emeritus of Economics, University of Surrey, UK) suggests that Mode 2 cross-border providers and consumers would be impacted. Washington consumers might cross-borders into BC for a medical provider under Mode 2. The state monopolies might be trade protections because of public/private networks. The providers and consumers are impacted.

I tried to explain that for purposes of Workers’ Compensation insurance, state monopolies are only for the purchase of insurance, not treatment. He seems to think that states like Ohio, North Dakota, Washington and Wyoming, all “monopolisitic states” for the purchase of insurance is somehow involved with the WTO. Notice also that this person lumps WC with ACA and says that WC or ACA exchanges are public monopolies with the private sector.

I might point out here that WA State allows injured workers to get care in other countries by providing a page on their website that allows a worker to choose a doctor in certain countries, as I mentioned in my white paper, Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation. Oregon also allows workers to seek care outside the US, but does not have a page or a list of physicians abroad. Also, my paper discusses how California and Florida view treatment in other countries, so there is no monopoly of care.

As I said, above, I studied international relations, but international trade agreements are a little out of my league. I’ll leave that to the economists, international lawyers, and diplomats to figure out. All I am interested in is seeing that injured American workers get the best care at the lowest cost and with the best quality of care. If that happens here, that’s good. If it happens overseas, that’s even better because it will afford the injured worker a chance to recuperate in a relaxed environment, and maybe even in familiar cultural surroundings if they are of Hispanic or Caribbean descent and receive treatment in a hospital in Latin America or the Caribbean, as I discussed in my blog, No Back Alleys Here.

I don’t know much about the WTO, trade barriers, trade protectionism and so on, but it makes me think that medical tourism in general, and more specifically, medical tourism being implemented into workers’ compensation is going to engender a great deal of trade issues that neither I, nor perhaps many small medical tourism facilitators have understood. Add to that what the Ministry of Health in the UK did this week, and it would seem that what sounds like a great idea, may actually be a nightmare in waiting.

I thought that as we get closer together as a world community, that one day it would be possible to travel from one part of the world to another in less time than currently available by jet aircraft, and therefore would make medical tourism much more feasible if distance was not an obstacle.

Such transportation systems found in science fiction like the sub-orbital plane (Land of the Giants), which has been worked on for some time, or the subterranean shuttle (Genesis II and Planet Earth, both Gene Roddenberry pilots for failed series), and of course, Star Trek’s Transporter (scientists have transported a molecule from one place to another, but that is a far cry from actually doing it with humans), may one day make trade barriers and protectionism a thing of the past. If you can dematerialize in one city and materialize in another a minute later, why would there be a need to have borders, and all the hassles that come with them.

So what we need to do if we are truly interested in realizing medical tourism in this century and with our current level of technology, is to figure out how to break down barriers of trade and to eliminate all forms of protectionism.