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.

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This entry was posted in Cross-border Health Care, Health Care, Health Care Costs, Legal Barriers, Medical Tourism, Quality, Workers' Compensation and tagged , , , , , , on by .

About Transforming Workers' Comp

Have worked in the Insurance and Risk Management industry for more than thirty years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. Have experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. Received my Master of Arts (MA) degree in American History from New York University, and received my Bachelor of Arts (BA) degree in Liberal Arts (Political Science/History/Social Sciences) from SUNY Brockport. I have studied World History, Global Politics, and have a strong interest in the future of human civilization in all aspects; economic, political and social. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. LinkedIn Profile: http://www.linkedin.com/in/richardkrasner Resume: https://www.box.com/s/z8rxcks6ix41m3ocvvep

4 thoughts on “Why Medical Tourism for Workers’ Comp is an idea whose time has come

  1. Frank Kowalski

    There is no evidence, even in the sources you cite, that HSM is using medical tourism for workers’ compensation cases. They are only using it as a voluntary option as part of their health plan benefits. Why do you continually misrepresent the company’s position on this? Where are the specific cited sources showing HSM uses medical tourism to treat their work related injuries?

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    1. Transforming Workers' Comp Post author

      Frank,

      I know that they are doing this as a voluntary option, and I contacted Tim Isenhower to ask him some questions and to get him to answer a list of other questions I wanted to send him so that I could write it as an interview. When I spoke to Tim Isenhower, he tried to convince me that Joanne Wojcik of Business Insurance magazine had misrepresented what he told her, so I contacted Joanne, who went over her notes. She told me specifically that the employer, HSM went to their employees at their 50 locations and offered this as an option. Isenhower tried to make me think that the employees came to them. Not true. As most of the injuries were back injuries, and HSM is a furniture manufacturer, those injuries could not have been caused by anything other than their work activities. As Joanne pointed out in her article, Self-insured firms offer medical tourism option to cut health care costs http://www.businessinsurance.com/article/20131215/NEWS05/312159991, Isenhower estimated that over a six year period, HSM saved $9.5 million, and that some of the savings were starting to acrue in their workers’ com program.

      Of course it did. They used their group health plan to avoid paying for these surgeries under comp, which is charged more than general health care. See my post, Surgical Shenanigans: How Workers’ Compensation is being ripped off http://wp.me/p2QJfz-hm, and my follow-up post, The Rip-off Continues http://wp.me/p2QJfz-hz.

      Isenhower did tell me that he received a call from a local hospital after this initially broke in the media and they complained to him that they did not overcharge him. He pulled out his bills and showed them that they had. But I got the impression when I mentioned work comp, that he was scared of something or someone, and he alluded to that when he mentioned to me something about state disability ratings.

      The bottom-line is, HSM cost shifted work-related back injuries (they did not get these injuries playing football) to their self-insured, group health plan. My only contribution to this was to see through the obvious deception. If that is the way HSM is portraying it, so be it. I stand by what I said. Something is fishy, and it ain’t me.

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  2. Frank Kowalski

    Thanks for the info. Although, as a person who has an injured back from a home repair, I am not sure I agree with the philosophy that all back injuries are work related.

    Do you have an example of a big company using medical tourism legally, and not violating the law? It would seem more credible if you could sight one that was doing it as part of their official comp program.

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    1. Transforming Workers' Comp Post author

      I never said all back injuries were work-related. I just said that it would be logical for a furniture manufacturer to have back injuries that required surgery, and in the case of HSM, if the employees knew that spinal fusion was the standard treatment, any option presented to them to have alternative treatment would be welcomed, as was the case with the 250 employees HSM sent abroad. Naturally, not all of these were back cases. The two featured on ABC Nightline were gastric bypass and knee surgery, and there are other surgeries that the company paid for.

      The reason why there is not much said about medical tourism for comp is that any company, large or small that does so, would be open to criticism from competitors or from state regulators. However, having said that, there is an insurance company in CA, Insurance Company of the West (ICW) that is writing comp policies for their clients in the San Diego/Imperial Valley area. Check out my post, Cross-border Workers’ Compensation A Reality in California. I am told that there are other insurance plans in CA that have had success with cross-border health care, including with comp, so while it has not been out in the open, it is happening.

      Lastly, you must realize that some of the work comp statutes, which were first adopted around one hundred years ago, or more recently, have been written to protect physicians and lawyers whose business is workers’ comp. These statutes have had the unintended consequence of imprisoning injured workers in a three-ring circus between employers, insurers, and doctors, lawyers and service providers, all the while ignoring the needs of the injured worker. These statutes were supposed to protect the worker, but have been gamed to benefit those who rip the system off.

      I worked in NY both as a Claims Examiner and as a Claims Administrator for a Wrap-up program, and the shenanigans that I saw and heard about, vis-a-vis the handling of claims, leads one to believe that we have a broken and dysfunctional system. So opening it up to medical tourism may help bring back the focus of what work comp is all about…taking care of the injured worker.

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