Monthly Archives: April 2014

Opt-out as a way in: An Update

In June of last year, I wrote an article entitled, “Opt-out as a way in: Implementing Medical Tourism into Workers’ Compensation“. In that article. I discussed how the state of Oklahoma has enacted an opt-out program for workers’ compensation. David De Paolo wrote last week that employers in Oklahoma are excited about policies being offered by three (soon to be four) insurance companies that meet the minimum standards the Oklahoma opt-out law requires. David said that this is a very exciting time in the evolution of workers’ compensation. We have a system that is over 100 years old and has been morphing, particularly in the last 20 years, to cope with changes in work and the economy, and many feel those changes have been negative. He goes on to add that the Oklahoma experiment is bold. Whether it is the beginning of a trend remains to be seen – but it is clear that the early sentiment reflects a sizable appetite for something new. As I concluded in my previous post on the subject:

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.

If employers are really looking for something even more bolder than opt-out programs, they might want to consider lobbying their legislators to change the statutes to allow them to offer medical tourism as an option to their employees. What they will get in return, is lower cost health care at the same or better quality, and if their workforce is increasingly Latino, they will benefit from receiving care in the best facilities in their home or similar countries. That would really be a bold move.

Court Rules Obesity a Disability: What It Means for Medical Tourism and Workers’ Compensation

The Wall Street Journal reported yesterday that a Federal district court had ruled last week that obesity, by itself, may be a disability, separate from an underlying physiological condition. This confirmed an earlier article in the Wall Street Journal last month that discussed the rising risk of lawsuits on grounds of obesity discrimination.

In an article written by Gregory J. Millman, a senior columnist for Risk & Compliance Journal, and the author of last month’s article, Judge Stephen N. Limbaugh, Jr. (wonder if he’s related to you-know-who), a judge in the U.S. District Court, plaintiff Joseph Whittaker sued his employer on the grounds that his employer had “terminated his employment because of his disability and in retaliation for the charge of discrimination, threatened to terminate business with other entities if those entities employ plaintiff.”

Attorneys for the employer moved to dismiss the case, citing that obesity was not a disability under the Americans with Disabilities ACT (ADA), and they cited language from the Equal Employment Opportunity Commission (EEOC), that “except in rare circumstances, obesity is not considered a disabling impairment.”

Judge Limbaugh rejected that argument, and noted that it rested on case law that applied before the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), which “rejected the unduly restrictive approach” to determining whether a plaintiff suffered from a disability. Judge Limbaugh also pointed out that the EEOC’s language had been “omitted following the ADAAA.”

The case is still in litigation, but an attorney who represents employers in labor and employment cases said that “I think we will see a lot more cases like this over the next few years.” The attorney also said “that employers should probably assume that obesity, at least severe obesity, constitutes a disability regardless of whether there is an underlying physiological condition involved, and seek a reasonable accommodation if the disability interferes with job performance.”

Corporate Wellness is one of the hottest areas of health care today, given the alarming increase in obesity among the American population. Related diseases such as High Blood Pressure, Diabetes, and Kidney Disease are something all employers need to address if some of their employees are obese.

This case, and many others like it, would suggest that rather than terminating an obese employee, employers would be better served if they kept the employee working and tried to get them appropriate medical care from a corporate wellness program. This would have a tremendous effect on the company’s health care costs, and on the employee’s self-esteem, knowing that his or her employer is looking out for their health, rather than firing them for having a disability.

In my White Paper, I discussed a case in California, in which an obese employee of a convalescent home, who fell while working as a cook, went to the Duke University clinic to lose weight. A friend had suggested he go there after his doctor and two of the employer’s doctors recommended that he lose weight. But as the employer did not direct the employee to a specific weight-loss program, the employee was free to choose he wanted to go. The Supreme Court of CA ruled in favor of the employee. (For a discussion on choice of medical provider see my posts, Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers’ Compensation  and Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation).

What does this mean for Medical Tourism?

The case in Missouri described in Gregory Millman’s article, and many others that will undoubtedly follow, presents a great opportunity for the medical tourism to capitalize on the corporate wellness programs employers might consider offering their obese employees as an alternative to expensive lawsuits stemming from wrongful termination because of a disability.

This was apparent to me when I attended the Medical Tourism Association’s 5th World Medical Tourism & Global Healthcare Congress in October of 2012. Executives from American Express and Google conducted a fireside chat on the topic of innovations in global benefits and employee wellness. Other companies such as Colgate-Palmolive, Cigna, and Disney made presentations there.

Weight-loss surgeries such as gastric bypass surgery and gastric sleeve surgery are areas where medical tourism can be of tremendous value to employers with obese employees. If those employees are part of a corporate wellness program, and have been unsuccessful in losing weight through diet and exercise, may be willing to undergo surgery to lose weight.

Ruling obesity a disability will mean more of these surgeries will be performed, and with more Americans getting health care through the ACA, medical tourism destinations will be one way in which those surgeries can be obtained by employers willing to pay for their employees to have surgery. The lower cost and higher quality of care in many destinations in the Western Hemisphere region will be a further enticement to employers looking to retain these employees and avoiding lawsuits over discrimination.

What this means for Workers’ Compensation?

That a Federal judge has made a preliminary ruling in a case of employment discrimination will have serious repercussions for the workers’ compensation industry, because if this case decides that obesity is a disability, many obese workers’ compensation claimants will file claims for workers’ compensation benefits citing their work environment as a contributing cause of their obesity. That would add significant costs to the initial claim, whether from a slip and fall or some other cause of injury.

While this may take many years to work its way through the courts and through workers’ compensation boards and other entities, employers would be wise to be proactive and incorporate a wellness program in their companies, so that obese employees can lose weight through diet and exercise, or baring that course of action, get surgery to lose the weight. Workers’ compensation carriers should also consider corporate wellness as a means to prevent workers’ compensation claims from expanding beyond the initial cause of injury,

The same constraints to getting surgery mentioned above would also apply to workers’ compensation claims, if obesity is considered a compensable medical condition. Anyone worried about what effect obesity as a disability will have on workers’ compensation claims, should be willing to consider alternatives to long, drawn-out lawsuits, workers’ compensation hearings and court cases, and charges of wrongful termination because of obesity. Medical tourism could be a viable option.

The Price is Wrong: Why the high price of medical care in the US cannot be maintained.

Thanks to Philip Eide for bring the following post to my attention. It’s been discussed before in many other blogs and newsletters, but needs to be repeated often enough so that it sinks in…we have the most expensive health care “system” in the world, and for workers’ comp, that’s not good, especially as Joe Paduda reported earlier this week with regard to consolidation in the workers’ comp services sector.

Also, a shout-out to Megan Hanley, Executive Vice President, Business Development at Ascential Care Partners for re-posting Joe’s post and thus allowing me to tie the two articles together.

Here is the article by Kathryn Mayer, of BenefitsPro:

If prices don’t come down, and if the cost of workers’ comp services goes up as a result of consolidation of the workers’ comp services providers, then some other alternative to high prices has to be found.

I stand by my belief that medical tourism could be such an alternative, but it is up to you to decide whether it is better to pay through the nose (pun definitely intended), or to find a lower cost alternative that is not a rip-off and is able to provide the same or better quality than what is available in the US.

But this is also a challenge to the medical tourism industry, not just the facilitators, but the medical providers, hospitals and clinics, and businesses that wish to attract American business, whether it is for individual patients, group health patients, or workers’ comp patients, to be transparent in terms of pricing, quality outcomes, efficiency of facilities, skills, understanding of English and American cultural norms, etc.

In my earlier post, Of ‘Aged Statutes and Old Case Law’ — Why Workers’ Comp Must Change, I discussed a bio-psycho-social theory of development calledSpiral Dynamics“. I also mentioned a book I am currently reading called ” MEMEnomics” which explains why the US and the global economy is in a mess, and discusses what needs to happen for the world to progress to the next level of human existence, which is a difficult and painful process because it involves leaving behind all of the old, unhealthy value systems of the past, so that the planet and the human race can sustain itself for the future. Such a leap from the “Existence” tier we now exist in, to the “Being” tier we are emerging into will move the entire human race up the spiral to a brighter and more prosperous future.

To deny this or to try to prevent this will only lead to more dysfunction and chaos, and will probably be the end of all life on Earth as we know it, so anyone whose interests lie in keeping the status quo, is only harming the rest of us.

Globalization is not just about moving businesses offshore, or getting connected with people on the Internet. It is about creating a healthy and prosperous future for all humanity, and all aspects of human culture will be changed because of it.

For those celebrating Easter, have a happy holiday.





Telehealth’s impact on Workers’ Comp

The following post from Kimberly George, SVP, Senior Healthcare Advisor for Sedgwick, and one of my LinkedIn connections, echoes the post I wrote last year called,  The Doctor will see you now….Online.


Statutes are not Statues ― Why Workers’ Comp Must Open up and Be Flexible

“None so blind as those that will not see.”  Matthew Henry (1662-1714)

“Every man takes the limits of his field of vision for the limits of the world” Arthur Schopenhauer


Last week, in my post, Why Medical Tourism for Workers’ Comp is an idea whose time has come, I mentioned that there are some people who believe that medical tourism in workers’ comp can’t happen under current state statutes. I agree with them, and that is why the title of today’s post is called “Statutes are not Statues”.

When workers’ compensation was first enacted one hundred years ago, it was conceived as a remedy for the lawsuits filed by injured workers. It was supposed to be a no-fault system whereby the employer would pay for the medical benefits and the loss of wages, and the employee would give up their right to sue the employer. But that has not always been the case. It has become more litigious than ever imagined by those who proposed the first workers’ compensation laws.

And yet, there are people who have made a fetish of some of the workers’ compensation statutes, in much the same way religious people have made a fetish of the Ten Commandments, which many have suggested should rightly be called “The Ten Suggestions”, because so many people have broken Commandments 6, 7, 8, 9, and 10. The workers’ comp statutes are regarded by these people as written in stone, sacred and inviable.

However, the statutes have been amended down through the years, and are not written in stone. Much of what the various state statutes in workers’ comp are concerned with has to do with how insurance companies conduct business in a particular state, how the state workers’ compensation system operates, as well as other necessary and important rules and regulations. Those statutes are not what I am referring to, and I have no quarrel with them at all.

The statutes I am referring to, and that these individuals claim prevents medical tourism from being implemented into workers’ compensation, pertain mostly to the medical care an injured worker receives, from whom they receive it, the licensing of the treating physician, and who gets to choose the treating doctor, as well as how far the treating doctor can be from the patient’s home. All of these issues I mentioned in previous posts or in my White Paper.

On page 15 of my White Paper, I stated the following with regard to the issue of licensing of physicians:

“One of the most obvious legal barriers to implementing medical tourism into workers’ compensation are the provisions of State workers’ compensation laws that establish who can provide medical care to injured workers. In four of the largest workers’ compensation states, California, Florida, New York and Texas, medical providers must be licensed by the state to practice medicine.  Florida’s statutes have a provision to allow certain foreign-trained physicians to practice in the state, but do not mention treatment outside of the state.”

It is logical and reasonable to have physicians licensed to practice medicine, as no one wants to be treated by someone who does not have a license to practice medicine. Do these statutes mean that a patient from one state cannot be treated by a physician in another state? Suppose an employee who lives in northeast Pennsylvania, south of the New York State line (Matamoras), is injured in New York where he works, does that mean that the physician who treated him Port Jervis and is licensed only in New York, cannot treat him? Supposed a patient goes to the Mayo Clinic in Minnesota, but lives in Arkansas, does that mean that the surgeon at the Mayo Clinic must be licensed in Arkansas as well as in Minnesota, or does reciprocity kick in? The statutes are not very clear on that, so again, how sacred and inviable are they?

In the paragraph that follows the one quoted above, I mentioned that Washington State and Oregon have statutes or rules that allow workers to choose an attending doctor or physician in another country. And Oregon’s labor code states, “…The worker also may choose an attending doctor or physician in another country or in any other state or territory or possession of the United States with the prior approval of the insurer or self-insured employer.”

Washington State’s workers’ comp agency “has a page on their website that allows workers to find an attending practitioner in the U.S., Canada, Mexico and Other Countries. The webpage allows the worker to search for a U.S. physician by entering a zip code, miles, doctor or provider type, and specialty.  Workers seeking physicians in Canada, Mexico and Other Countries, such as England, Germany, Honduras, New Zealand, the Philippines, Spain, Thailand and Ukraine are directed to .pdf files that list selected doctors and their specialties and contact information.” This is on page 16 of my White Paper.

So, here again, statutes are not statues, and not written in stone. And lastly, as discussed on page 28, I mentioned the Court of Appeal ruling in the Florida case, AMS Staff Leasing v. Arreola, where the court “ruled that state law did not preclude the foreign physician’s treatment of the claimant in Mexico…” The Court went on to say that “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.”

Knowing that Washington State, Oregon have statutes or rules allowing workers to go out of state, knowing that Florida law allows the worker to leave the country for care, and knowing that California companies are already providing workers’ comp benefits to injured workers in Mexico, it would seem that workers’ comp statutes can be flexible, if only there is a will to make them so.

Why that is not the case in all other states is the real question. I also addressed that in my White Paper on pages 16 and 17 when I said the following:

“Among some of the other barriers to medical tourism is the result of entrenched interest groups wishing to avoid competition with low-cost providers. Also, outdated federal and state laws intended to protect consumers, but only increase costs and reduce convenience. Additionally, state and federal regulations restrict public providers from outsourcing certain expensive medical procedures. Federal laws inhibit collaboration and state licensing laws prevent certain medical tasks being performed by providers in other countries. Foreign physicians lack the authority to order tests, initiate therapies and to prescribe drugs that U.S. pharmacies are able to dispense.”

In the above quote, there is reference to “entrenched interest groups”. One author I cited in my White Paper, Devon Herrick cited The American Society of Plastic Surgeons as coming out against medical tourism, and another author, Toro Longe cited Herrick’s citation in a Master’s thesis in Health Law. But there are other “entrenched interests” besides plastic surgeons.

Doctors who specialize in occupational medicine, hospitals, lawyers (both plaintiff and defense), workers’ compensation services providers, and state legislators who rely on campaign contributions from these interest groups also would be against medical tourism in workers’ comp, and therefore would be against changing any of the statutes that pertain to how an injured worker receives medical care and from whom.

However, if the workers’ compensation system is to survive the next one hundred years, given the globalization of the economy, the increase in foreign-born labor in the American workforce, and the globalization of health care in general, it would be prudent for the workers’ compensation system to become more open and flexible. That California, Florida, Oregon and Washington State have shown some flexibility in their laws and statutes; it may be possible that the other 46 states can do as well.

In order for that to happen, it may require some outside pressure in the form of employers, insurers, and the medical tourism industry itself to pry open the doors of the workers’ comp system to an alternative that can offer lower costs and better quality. It is certainly clear that as long as there are those who do not see, as long as there are people who take the limits of their field of vision for the limits of the world, this will not happen.

I am not making it my mission to do anything but opening up people’s eyes to other possibilities. But to dismiss it out of hand is to be blind and lacking vision. It may not happen today, it may not happen tomorrow, but it will happen someday. Nothing is immune to change, not even workers’ comp.

Why Medical Tourism for Workers’ Comp is an idea whose time has come

There are some people in the workers’ comp world whose mission it is to keep the status quo going for the benefit of plaintiff lawyers, defense lawyers, doctors, hospitals and workers’ comp services providers, as well as for the state legislators and regulators of workers’ comp systems in all fifty states who write the laws and oversee that the rules and regulations are adhered to.

They like to argue that the claimant’s lawyers would object, but it is the very lawyers, both plaintiff and defense, that have made workers’ comp claims so expensive and so dysfunctional. Then there are the myriad service providers who claim to be able to lower costs, but only add more expenses to the claims. Add to that what the physicians charge, what hospitals charge and by the end of the claim, the medical costs have outstripped the indemnity payments to the claimant. There is something wrong with that.

And because these people are invested with keeping the status quo, they feel it is their right to shoot down any idea that would change the status quo. One such individual has called my idea to implement medical tourism into workers’ compensation a “ridiculous idea” and “a non-starter”.

Yet, I have been published in several medical tourism blogs and newsletters published in this country and elsewhere, and have been singled out as one of the “many smart, loud, and committed folks talking and writing about what needs to happen [to improve workers’ comp] and why.” by a well-respected fellow blogger in the managed care/workers’ comp arena. This blogger also told me that I am “far in front of the crowd” on this issue, and I wrote a post with that very title.

And, I have been invited to speak at a medical tourism summit in Mexico in November because of my writing on the subject of medical tourism and workers’ comp. So obviously, my idea is not as far-fetched or ridiculous as some would have you believe.

What most of these individuals do not know is that cross-border health care is already happening. And it’s been happening for years, as I’ve written in my post, Cross-border Workers’ Compensation a Reality in California, and I also wrote about a company in North Carolina that is paying for their employees to go to India or Costa Rica, mainly for work-related back injuries.

They are under the delusion that workers’ compensation, unlike other industries, is somehow immune to the forces of globalization, and that by doing the same things over and over again, to lower costs, and to get better quality outcomes, they are going to get different results. You know what that is called, right?

What most of these people are afraid of is that these innovative and new ideas will actually work to help bring down costs and provide better quality outcomes for workers’ comp claims. They know that if employers and insurers actually save money by sending injured workers to places like Costa Rica, Mexico and other Latin American countries where they speak the same language as the claimant and have the same or nearly the same culture as the one the injured worker came from originally, that other injured workers will do the same.

And that would mean that the American surgeons and hospitals that charge thousands of dollars for surgeries common to workers comp could lose market share. Well, isn’t that what capitalism is all about? Getting the same good or service at the same or better quality, but at a lower price? Why should workers’ comp be any different than buying a car in another state where the price of the car is lower than what is available at a nearby dealer?

But there is another reason why these people do not like the idea of medical tourism in workers’ compensation. It’s called “American exceptionalism”. It is a meme carried over from our colonial past whereby the original settlers believed that America was a shining city on a hill, and therefore anything Americans do is the best. Well if that is true, then why is America’s health care system so bad? I wrote an article not that long ago called “We’re No. 1!”, NOT! — Why the US Health Care System is Not the Best in the World and Why Implementing Medical Tourism into Workers’ Comp Could Improve Outcomes that proves that we don’t have the best health care system in the world.

But what’s more, these people actually believe that non-Americans cannot be as good as Americans, as if being from another country somehow means that they are less qualified or less skilled, even when the physicians are trained in the US or in Western Europe. Have any of these people ever seen how many foreign-born doctors are working in our hospitals? Where do you think they go once they stop working in this country?

Yet again, these people believe that it is okay to subject injured workers to this broken, dysfunctional system, and insist that if we only do this, or do that, or try something else that has no chance of lowering costs to a reasonable level, they will get different outcomes. Saying that you can negotiate lower costs or use a fee schedule to bring down costs, when even that negotiated cost or fee schedule cost is higher than what is available outside the US, is not a real solution to high-cost medical care. It only makes matters worse. What good is getting surgical costs down to $25,000 from $30,000, when the same surgery can be less than $20,000, with airfare and accommodations for two people in a first-class medical tourism facility?

I know there are barriers and obstacles to implementing medical tourism into workers’ comp. I wrote a White Paper on it, and have written many times that it won’t be easy, nor is it a “pipe dream”. They even say that it can’t happen under the current workers’ comp statutes. I know, that is why I said they have to change the statutes to do so. And they also said that no judge would order medical tourism. No judge has to order this, it has to be done before it goes before a judge, but since they mentioned it, I will say that the District Court of Appeal in Florida has ruled that a worker can return to their home country for care under Florida law (see AMS Staff Leasing v Arreola).

But somehow, medical tourism for workers’ compensation is harder to do than flying in the air, or going into space and walking on the moon. Tell that to the millions of people around the world who fly in airplanes every single day. Tell that to the men and women, from many countries, not just our American astronauts and Russian cosmonauts who have flown in space, and tell that to the men who have walked on the moon. Is medical tourism in workers’ comp harder and more difficult than those achievements? Hardly. The only thing that stops us is our lack of imagination and lack of will.

I leave it to others to figure out how to get employers, insurers, lawyers, doctors, and most of all, employees to choose medical tourism as an option for medical care. It’s not for everyone, but for those who do chose it, it could be better than the sub-standard care they are getting now in our broken and dysfunctional health care system. And they just might find that the world is really truly getting smaller and that borders are no longer the barriers they once were for all kinds of goods and services.

The world is globalizing. Health care is globalizing, and workers’ comp medical care must and will globalize. If not, it will fail as a system to provide the best care possible at the lowest cost possible. There is nothing anyone in the workers’ comp industry can do to stop globalization, so you might as well get on-board with it and stop fighting it. You’ll feel better when you do.

No April Fool’s Joke ― ACA to Federalize Work Comp

At first, when I read Joe Paduda’s post this morning on my smartphone, I thought it had to be some kind of April Fool’s joke.

But when I clicked on the links Joe provided in his article, I found out he wasn’t joking. His brilliant article, Obamacare exchanges to be used for work comp enrollment, caught me and a few commenters by surprise.

It caught me by surprise because back in the summer of 2011, I took an online elective course on the PPACA as part of my MHA degree program. The term paper I wrote, PPACA: The End of Workers’ Compensation?, mentioned that:

“In 1972, the National Commission on State Workmen’s Compensation Laws issued a report that took the position that it would be unwise and unnecessary for any national health insurance program to assume medical costs of workers’ compensation. The Commission stated that to fold workers’ compensation medical costs into a national health insurance program would be inconsistent with the central tenet of workers’ compensation and that the costs of work-related injuries and diseases should be allocated to the responsible source.”

I went on to write in my paper that in the 1990’s, the Clinton Administration favored the merging of the medical component of workers’ compensation into a federal health care system as part of their health reform proposals. The Administration backed off of this proposal after strong opposition from business owners who said it would not produce any real savings, would have pre-empted state “choice of provider” laws and empower employees to select providers from any federally approved health plan.

Yet, I found that any talk of federalizing workers’ compensation was speculative, since one bill introduced into the House of Representatives was stalled in committee, and when the PPACA was being drafted, the issue of workers’ compensation was not a minor focus of the legislation, and as I quoted:

“there is no language in the law that would directly and explicitly affect workers’ compensation. From the beginning of bill-drafting in both the House and Senate, it was clear that workers’ compensation was not an area that should get mixed into the reform process”.

Well, from reading Joe’s article this morning, it would seem that the Obama Administration has picked where the Clinton Administration left off, and even went further because they ignored the report of the National Commission on State Workmen’s Compensation Laws, and went ahead with a plan to federalize part of the workers’ compensation system.

According to Joe, the reason why the small employer mandate has been delayed is because the “Feds are incorporating a national “single payer” work comp program” that is not ready to be introduced.

This program is called POWER (Protecting Our Workers and Ensuring Reemployment). It is to be administered by the Office of Workers’ Compensation Programs.

Without going into any great detail about the program, here are the key takeaways from Joe’s article:

  • POWER was not part of the original healthcare reform bill; it was initiate as part of a Presidential directive (boy, this is really going to get the Tea Party angry) shortly after PPACA was passed and signed into law. ( July 19, 2010)
  • Detailed in the POWER initiative, the program will measure employers; performance across eight metrics, with those employers failing to demonstrate improvement targeted for additional Federal oversight (another thing that will launch the Tea Party into orbit)
  • Implementation date is June 1st; small employers (26-99 employees) will be required to sign up as their current workers’ comp policies expire
  • Employers WILL be allowed to “opt out”
  • POWER will utilize OSHA reporting system to cross-index claims reporting
  • Employers will avoid reporting claims to reduce the risk of the dreaded “additional Federal oversight.”
  • The federal fee schedule will likely be used for medical treatment, and
  • OSHA will have to revamp their reporting process

It is Joe’s opinion that now that the health exchange “glitches” are mostly fixed, the workers’ comp program will move very quickly, and it will be much less complicated, as there will be a single payer, a single payment system, and universal benefits and coverage specifications.

What does this mean for medical tourism and workers’ compensation?

My guess is that depends on how you view a federal role in workers’ compensation in the first place. Some may like that idea and some may hate it. It could be a boon for medical tourism because now there will be federal coverage for workers’ compensation for employers with less than 100 employees, and as many people have already commented on social media and in medical tourism forums, the ACA may bring more patients to medical tourism destinations.

But it could also be a hindrance because we don’t know how flexible federal workers’ comp rules and regulations are regarding the location of treating physicians, the licensing of physicians, liability and malpractice laws, and whether federal law recognizes the right of choice of physician to the employee or his employer.

In addition, the federal fee schedule for medical procedures may or may not be lower than the fee schedules in states that have fee schedules, or lower in those states that do not have fee schedules. If the federal fee schedule is lower, the question then becomes, can medical tourism physicians and facilities quote lower costs than even the federal fee schedule? (airfare and accommodations included in the cost of going abroad).

Finally, medical tourism facilitators, providers and facilities will have to adhere to OSHA rules under the POWER program. Will facilitators and providers and facilities be able to comply with and understand OSHA rules? That and the other points I mentioned is what will ultimately determine if this program will be a boon for medical tourism. I really don’t know. Only time will tell. It’s up to the medical tourism industry to decide if it is worth going after.

Happy April Fool’s Day everyone! It really was a joke on Joe’s part! 🙂