Monthly Archives: June 2013

Surgical Shenanigans: How Workers’ Compensation is being ripped off

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Now that I’ve cleared the air, and professed the faith of my conviction, I would like to get back to the subject at hand, which is implementing medical tourism into workers’ compensation. In my last post, I asked the following question:

Is there something different about patients who can afford to pay for medical treatment abroad or who have private health plans that do, from those who get injured on the job and have their treatment paid for by an employer or insurance carrier under workers’ comp?

In that same post, I also asked this question as well:

What difference is there if a person injures their hip or knee by engaging in some sort of physical activity outside of their employment, or if the person gets hurt on the job? Are the surgical procedures for these types of surgeries different for a working person than those for a middle-class or upper-middle-class person?

Well, according to a recent study just released by the Workers’ Compensation Research Institute (WCRI), and reported this week by WorkersCompensation.com, there is something different in what hospitals were paid for shoulder surgeries in workers’ compensation and what hospitals were paid by private or group health insurance for the very same surgeries.

The article, Hospitals Were Paid At Least $2,000 More For Common Surgeries For Injured Workers Than The Typical Patient, stated that in half of the study states, hospital outpatient payments for shoulder surgeries in workers’ compensation were at least $2,000 (or 43 %) higher than group health insurance.

The study, entitled Comparing Workers’ Compensation and Group Health Hospital Outpatient Payments, is the first, WorkersCompensation.com says, that compares hospital payments for the same surgical procedure when paid for by group health versus workers’ compensation.

According to Richard Victor, the executive director of the WCRI, “These are large differences in costs in many states. Policymakers looking to contain medical costs in these states may want to ask if the difference is necessary to induce hospital outpatient departments to treat injured workers”.

The WCRI study also found that workers’ compensation payments exceeded group health payments by the most in states where the price regulations were based on a percentage of the hospital’s charges, or had no price regulation.

The study compared outpatient payments made by workers’ compensation and group health insurers for treatment of common surgical cases in 16 large states, which represents 60% of the workers’ compensation benefits paid in the US, and covers outpatient services delivered in 2008.

So apparently, there is a difference between workers’ compensation and group health insurance after all. The only problem is it does not have to do with the treatment received by patients covered under each type of insurance, but rather on how much workers’ compensation carriers paid hospitals for outpatient surgeries. Silly me, all this time I thought it had to do with the type of patient, now I see it has to do with the kind of insurance he is covered under.

So now, my question to the workers’ compensation industry is this:

How long are you going to put up with overpaying for the same surgical procedure for your workers’ compensation claimants, than what group health insurance pays for its patients for the same procedure under their plans?

And my question to the medical tourism industry is this:

If you claim that medical tourism destination hospitals offer lower cost health care than what is available in the US, then why are you not actively pursuing the workers’ compensation market, instead of just pursuing the private or group health care market? Do breast augmentations/reductions, plastic surgery and other common medical tourism procedures make more profit than that of the US workers’ compensation industry, or is it a lack of vision thing?

Do I have to spell it out every time I write an article? The American health care system (and that includes workers’ compensation) is too expensive. Yes, I know there are regulatory differences between health care and workers’ compensation. Yes, I know that in certain cases, there may be different processes involved with the same type of surgery for different patients. And yes, I realize that there are risk and complications; but really, what difference does it make if the patient was injured on the job and needs shoulder surgery, or if the patient was a weekend warrior playing hoops, football, baseball, or a myriad other sports and activities and needs  the same type of surgery? Not much.

The only difference is who pays, and how much, and based on this latest study, it seems the workers’ compensation industry is being hosed, big time. Time to wake up and explore the alternatives to high cost medical care for injured workers. Time to wake up and realize that the rest of the world is catching up to the “good ole’ USA” and providing better quality health care at lower cost.

I am not saying that it will be easy to implement medical tourism, so no one should think reading this that this is what I am advocating. And I am not saying that every destination is up to the task of providing such services. Far from it, but those that can, should be explored. Those that would like to in the future should be encouraged to seek out workers’ compensation carriers, third party administrators and case management firms here in the US for their advice and guidance.

The workers’ compensation industry can take the next step and seriously consider medical tourism, or it can continue to pay at least $2,000 more for the same surgery a group health plan pays. It’s your choice.

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Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation

“The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were.”

John F. Kennedy

“Some men see things as they are and say why. I dream things that never were and say why not.”

Robert F. Kennedy

“It is not because things are difficult that we do not dare, it is because we do not dare that things are difficult.”

Seneca

In the past few weeks, I have received some criticism of the ideas I have expressed in this blog in regards to implementing medical tourism into workers’ compensation. Simply stated, I have been accused of offering “simplistic solutions” to medical tourism and workers’ compensation by inferring that all it takes is a plane ticket. I have also been accused of “throwing pixie dust” on the issue and have been made to feel that I don’t understand the complexity of the issues involved, and therefore should not even bother to tackle the subject.

Well, if that was the case, no one would ever attempt to explore new areas of knowledge or publish new ideas because they were not fully knowledgeable about a particular subject. That is what writing and expressing one’s ideas are all about, learning what you did not know before you started to write. I have also been accused of making it sound easy to get injured workers to go abroad for treatment, and that the ones who would be making that difficult and arduous decision are clerical persons in HR departments. Nothing could be further from the truth.

At no time in the seven months of blogging have I ever said that implementing medical tourism into workers’ compensation was going to be easy. As those of you who have read my white paper, “Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation”, a copy of which can be seen here,  have learned, I lay out a number of legal barriers to implementation of medical tourism into workers’ compensation, some related to workers’ compensation, and some related to only medical tourism and health care.

Because the original paper was written for a class in Health Law, and not for a class in medicine, I did not focus on the medical barriers to such an implementation. And by not doing so, that does not mean that I believe that there are no such barriers or difficulties associated with traveling abroad for medical care. No, I don’t believe that. In fact, I believe that the same barriers or difficulties that exist for private insurance patients also exist for patients covered under workers’ compensation insurance. Is there something different about patients who can afford to pay for medical treatment abroad or who have private health plans that do, from those who get injured on the job and have their treatment paid for by an employer or insurance carrier under workers’ comp?

I have been getting the sense that those who advocate medical tourism for those who can pay or who have private insurance are engaging in class warfare against the working class by somehow painting the treatment of workers injured on the job as somehow different from patients seeking such surgeries as hip or knee replacement, or back surgery, for example. As I have stated before in a few of my blog posts, what difference is there if a person injures their hip or knee by engaging in some sort of physical activity outside of their employment, or if the person gets hurt on the job? Are the surgical procedures for these types of surgeries different for a working person than those for a middle-class or upper-middle-class person? Or is this just bourgeois nonsense of the kind heard on Fox News?

Are the risks and complications of long-distance travel different for a construction worker who goes to a country where he or his family originally came from for medical treatment for an on-the-job injury, or do white, middle-class people have some immunity from risks and complications from surgery for such procedures as getting one’s face lifted, breasts enlarged or reduced, or other medical tourism procedures? I know full well that if one person has complications, so too can others. Economic status and employment status are not risk factors.

What I have been advocating for the past seven months of blogging, is that medical tourism should get over its class bias, and treat all patients, rich or poor equally. As the three gentlemen above have said so eloquently, we need people of vision, we need people who are willing to dare and to ask the tough questions, “Can this be done?”, “Can we provide all patients cheaper, better quality health care, no matter what their bank account, or economic resources are?”, “Can we provide the best health care available to injured workers and save their employers or insurance carriers money, even if they, the patient does not pay for the treatment directly?”

In my lifetime, and many of yours as well, we have seen the dreamers and idealists murdered in cold blood, only to be replaced by people whose vision looks backwards, not forwards, whose motivations are designed around making those with money richer, while making those without a lot of money, even poorer. Our elections have pitted rich men against the people, as the last presidential election showed, and some of the men who have occupied that high office since 1980, have been men who lacked the vision of two of the modern men cited above, but who have convinced us that we don’t need or can’t afford “that vision thing”.

More than the life of a man was taken on November 22, 1963, April 4, 1968, and on June 6, 1968, our vision of the future was taken away, our dreams were taken away, and our hopes for a better future for all human beings were taken away, only to be replaced by greed, avarice, ignorance, stupidity, hatred, fear, and a sense that nothing can be done, so why do anything. The future of medical tourism must include workers’ compensation, or else it is just another means to getting rich from tourism and making the wealthy feel better about being wealthy.

Steel Drums and Medical Tourism Too: Trinidad as a Rising Star in Medical Tourism

Trinidad-physical-mapBack in January, when I wrote my article, No Back Alleys Here: Medical Tourism Hospitals, Clinics and Networks in Latin America and the Caribbean, I left out one of the newest of the new “rising stars” of medical tourism in the region, Trinidad and Tobago. Since then, I have connected with a medical student from Trinidad and Tobago by the name of Kedella T.J. Issac. I asked Kedella if she could write up a little something on what hospitals are on the island of Trinidad and what the medical tourism outlook looks like there, as she has an interest in medical tourism.

Through numerous emails over the course of the past several months, Kedella has graciously provided me with a brief synopsis of the medical tourism picture in her home country. Rather than re-writing what she wrote, I thought I’d let her words speak for herself, so the following text is Kedella Issac’s view of medical tourism in Trinidad.

Trinidad and Tobago is well on its way towards establishing itself as a strong Medical Tourism capital, with high hopes of standing strong against established neighboring countries. With a population of 1.346 million and occupying 5,128 square kilometers, this twin island estate yields a gross national income of 22.48 billion US dollars mainly from its rich source of natural gas and petrochemicals. Bending towards sustainability, the budding phenomenon of medical travel is of great interest. There are three main hospitals that are already involved in Medical Tourism.

The West Shore Medical Private Hospital began operations in 2004. It is located just outside of the capital city, Port-of-Spain. This hospital offers services to both national and international clients. They offer a wide range of services ranging from Accident and Emergency, Orthopedics, Pulmonology, Maternity, Cardiac Surgery, Gynecological surgery, Gastric-Bypass surgery, Neurosurgery, Laparoscopic surgery and Plastic surgery. The hospital’s website aids persons in finding quotations for accommodation and tips for places for shopping and sightseeing.  They offer air ambulance services to clients as well. Their strategic location on the coastline offers scenic and therapeutic recovery.

Medical Associates located North of Trinidad in St. Joseph, was established in 1979. There are four operating rooms. This hospital has bragging rights of being well established in the Caribbean and being the first in the region to perform the following:

  1. Retroperitoneal Aortic Surgery (for aneurysms)
  2. In situ vein bypass for lower limb salvage
  3. Infrapopliteal vein bypass for lower limb salvage
  4. Kidney transplantation
  5. Myocutaneous flaps to cover soft tissue defects
  6. Phaecoemulsification for cataract extraction
  7. Retinol Fluoroscein Angiography (to visualize blood vessels in the eye)
  8. Minilaparotomy Cholecystectomy (gall Bladder Removal)
  9. Minilaparotomy Ureteric lithotomy (kidney Stone Removal)
  10. Extra corporeal shock wave lithotripsy (for shattering kidney stones)

They offer specialties in Cardiology, Endocrinology, General surgery, Neurology and Orthopedics, Ophthalmology, Rheumatology, Obstetrics and Gynecology, Urology, Pediatrics, Plastic surgery, Ear, Nose, Throat. They offer packages and offer in and out patient services.

St. Augustine Private hospital was established in 1988. Located in the East of Trinidad, they have a vision of being the first choice of health care in the Caribbean. With a staff of 120 medical and non-medical personnel, this small hospital provides  a few private rooms, private suites, semi-private rooms and shared rooms and the following services:

  • Cardiology
  • General Practice
  • General Surgery
  • Laser Vein Clinic
  • Nephrology
  • Neurology
  • Obstetrics & Gynaecology
  • Orthopaedics & Sports Medicine
  • Pediatrics
  • Psychiatry
  • Urology
  • Pain Management
  • Thoracic Surgery
  • Plastic surgery

And many more

http://westshoreprivatehospital.com/home.html

http://www.medicalassociatestt.info/index.html

http://www.saphtt.com/doctors.aspx

http://www.medicaltourismmag.com/newsletter/74/cabinet-agrees-to-specialized-medical-centers-in-trinidad-and-tobago.html

I want to thank Kedella for her hard work and I know she will become an excellent doctor her family and friends, and her island nation can be proud of. I am grateful for her assistance in getting the word out about medical tourism in Trinidad and Tobago

Opt-out as a way in: Implementing Medical Tourism into Workers’ Compensation

 

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Last December, in my post, The Stars Aligned, I mentioned a study released at that time that looked at the Texas model of an opt-out program for workers’ compensation, and the proposal that failed in the Oklahoma legislature last year.  My LinkedIn connection, Peter Rousmaniere recently released a new study on the Oklahoma opt-out program that was recently enacted by the Oklahoma legislature and signed by the governor, and what he reported about it has significant implications for implementing medical tourism into workers’ compensation.

The report was published today by Sedgwick CMS, and in his email on RiskList, a group I belong to on Yahoo Groups, Peter stated that opt-out right now is rapidly transitioning from a marginal, obscure concept to a viable, legitimate product in the employee benefits family with a compelling value proposition for every state.

Peter further defined the value proposition as follows:  The value proposition is that it by conforming work injury benefits to established employee benefit practices, and thus releasing it from the traditional statutory model, worker benefits can increase and employer premiums can significantly decline.

When I contacted Peter earlier today to clarify what this means, and whether this means that medical tourism could be implemented into workers’ comp as an employee benefit, his response to me was that it makes medical tourism viable for work injury benefits, as employer has largely unfettered discretion over selection of medical provider.

What this means for medical tourism and workers’ comp is this, as more states enact opt-out programs for employers in their states, the likelihood that an employer would chose to send their employees abroad for medical treatment increases. Considering what I have already said in earlier posts about the changing demographics of the US labor force and the rise of medical tourism destinations in Latin America and the Caribbean, this possibility is closer to becoming a reality because more states will have given their employers a choice to stay in the statutory system with its complexity and its legal barriers to implementing medical tourism, or to allow them to add workers’ compensation medical care as another employee benefit which they control and for which they can offer medical tourism as an option since they would no longer be subjected to state rules and regulations concerning medical care for injured workers.

Some information on Medical Tourism in the Caribbean

This is what the future of medical tourism and workers’ compensation looks like: http://www.imtj.com/news/?entryid82=420236&utm_source=IMTJ_News&utm_medium=Email&utm_campaign=IMTJ_News_130531&utm_content=TextLink