Monthly Archives: November 2015

An Open Letter to the Latin American Medical Tourism Community

Today marks the one-year anniversary of the creation of FutureComp Consulting, and this past October 29th was the three-year anniversary of the creation of my blog, Transforming Workers’ Comp.

In the three years that I have been writing my blog, I have attended three medical tourism conferences, two in Florida, and one in Mexico in November of 2014, where I gave a presentation entitled, “Barriers, Obstacles, Opportunities and Pitfalls of Implementing Medical Tourism into Workers’ Compensation.”

At these conferences I have met many people from Latin America and have told them of my idea for transforming workers’ compensation in the US by sending patients to countries in the region.

To date, not one person I met at these conferences, nor anyone who has read my blog and is from that region has contacted me to offer their support and services to make this idea a reality.

And when I discuss the issue with Americans, especially those in the workers’ compensation industry, their response has been to call it a stupid and ridiculous idea, and a non-starter.

They have also suggested that medical care in your region is not up to American standards, despite the fact that I have pointed out to them that outcomes here are not guaranteed, and that mistakes can happen in local hospitals as well.

Here is a sample of a typical response from someone in the workers’ comp industry:

“Honestly, medical tourism for injured employees will not work. We are already challenged daily when injured employees leave the country and we have to provide them with care outside of the US. I hear you but it’s a stretch. We can’t get good outcomes here I hate to think what would happen when we send them somewhere else. The laws are much too complicated to garner the intended result.”

Early in my blogging, I wrote the following article based on some comments made on social media that I included in a virtual dialogue, “Point/CounterPoint: A Virtual Dialogue on the Merits of Implementing Medical Tourism into Workers’ Compensation”.

In the presentation I gave in Reynosa, I said that there is a lack of knowledge about the quality of medical care abroad (so-called “Third World medicine”) and that American harbored negative attitudes towards medical care abroad, as well as the conceit known as “American Exceptionalism” whereby only American doctors know how to practice medicine and only American hospitals are qualified to offer care.

However, not all Americans are like that; in fact, one lawyer representing injured workers had knee surgery in Costa Rica, and had such a great experience, he wants his clients to have that too.

In my presentation, I laid out six major barriers and obstacles to implementation, but in writing this letter now, I want to say to the Latin American medical tourism community, that there is a seventh barrier and obstacle, and that is your inability to market and defend your medical services to the American insurance industry, and most specifically, to the workers’ comp community.

That has been one reason why I have been writing about this for so long. In many of my articles, I implore you to do something about this. I even said this in Mexico when I said that you had to go after the market; the market will not come to you.

Just so you don’t think I am some crazy gringo, Norte Americano, here are some of the articles I have written that does exactly that:

The Stars Aligned: Mexico as a medical tourism destination for Mexican-born, US workers under Workers’ Compensation

Lower Cost, High Quality Health Care is Nearby

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

Far in Front of the Crowd

Muy por delante de la multitud

E PLURIBUS UNUM: Latin American and Caribbean Immigration, Workers’ Compensation and Medical Tourism

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

Questions, Questions — How Medical Tourism Can Become a Real Alternative in Health Care and What it Means for Workers’ Compensation

More Questions, Questions: A Call for Answers from the Medical Tourism Industry

Más preguntas, preguntas: Una llamada para obtener respuestas de la industria del turismo médico

Finally, next week was supposed to be when I was going to give a second presentation in Mexico, this time in Puerto Vallarta, but for personal reasons, I had to back out.

This is the presentation I was going to give that outlines the challenges facing workers’ compensation, and what the medical tourism industry needs to do.

So my challenge is to you, Latin and Central America. Are you going to market your services to this industry, and will you defend your medical care as equal to, or better than the care we get in the US?

What about price and transparency? Will you share data with industry leaders skeptical of your better medical care, or are you going to allow them to call you “carnival barkers”?

I am willing to work with you. You know how to reach me.

The Miasma of Fraud

One last post before you celebrate Thanksgiving.

Business Insurance’s Stephanie Goldberg reported today, that five people have been charged  with workers’ comp insurance fraud in California, and that the insurance commissioner called it, “one of the largest workers’ compensation insurance fraud cases we have ever seen.”

In July, 2014, I wrote two articles about fraud in California, “The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System” and “The Stench of Fraud, Continued.”

Charged in the case was the former CFO of Pacific Hospital, James L. Canedo, two orthopedic surgeons, a chiropractor, and Paul Richard Randall, a health care marketer.

They were charged with illegally referring more than 4,000 patients for spinal surgeries, and generated more that $580 million in fraudulent bills during an eight-year period, according to the US Department of Justice, in a statement released yesterday.

Many of the claims were paid by the California work comp system, the rest by the federal government.

Canedo and Randall have pled guilty, and the other three have agreed to plead guilty, and under the terms of their plea agreements, each defendant could face prison terms and be required to pay restitution to their victims.

The US Attorney’s office for the Central District of California said in a statement that Canedo faces 10 years in prison and at least $20 million in restitution.

The scheme consisted of kickbacks of $15,000 for each lumbar fusion surgery, and $10,000 for each cervical fusion surgery, according to the US Attorney’s statement.

The ongoing investigation, dubbed “Operation Spinal Cap”, discovered that some of the patients lived hundreds of miles away from Pacific Hospital, and closer to other qualified facilities, the patients were not informed that medical professionals were offered kickbacks for referrals, and that insurers had paid the hospital more than $226 million for the surgeries.

Once again, we see that workers’ comp, especially in California, but also in other states, is like a fetid pool of rotting vegetation and other foul matter, so that what was once called a stench, is now a miasma that hangs over the surface of the system.

It does not have to be like that. It can be better. You can find an alternative to expensive surgeries and illegal payoffs, if only you would consider new ideas and new possibilities.

Or you can continue to breathe in the foul air. The choice is yours.

 

 

 

Survey Says, Employers Shifting Health Care Costs to Workers: Will Workers Shift to Work Comp?

In September, Jay Hancock wrote an article for Kaiser Health News, that reported that premiums for employment-based medical insurance rose moderately, to 4% in 2015, but that employers continued to shift in expenses to workers, according to a new survey.

According to Mr. Hancock, the average premium for single coverage rose to $6,251 while the average premium for a family plan increased to $17,545, according to a survey published by the Kaiser Family Foundation and the Health Research & Educational Trust.

Deductibles have been rising substantially faster than total health costs, according to Hancock, and 46% of covered workers have a deductible of at least $1,000 this year for single coverage as employers shift to “consumer-directed” plans that give members incentives to seek less-costly care.

Deductibles are more than $2,000 for single coverage for almost a fifth of covered workers.

Drew Altman, KFF’s CEO said in the article, “The so-called great slowdown in health care costs has been all but invisible to consumers because deductibles have been going up so much faster than their wages.”

The following chart illustrates this shift from 1999 to 2015.

kff-image-1

Other takeaways from the survey of nearly 2,000 large and small employers are as follows:

  • In the face of measures from the 2010 health law that took effect this year to encourage coverage, some employers expanded insurance while a small percentage shifted jobs to part-time to avoid the obligation to offer a plan.
  • One in five companies with at least 200 employees expects its most popular plan to be liable for the “Cadillac tax” on high-value coverage that takes effect in 2018. Employer efforts to avoid the tax will probably shift new costs to workers, analysts said.
  •  It’s not only workers’ deductibles that are rising. The portion of premiums they pay has gone up, too. Employee premium costs have increased 83 percent since 2005 while the total cost of a policy went up 61 percent.
  • Worker wellness programs continue to surge, with nearly a third of large firms offering employees financial incentives to take health-risk screening tests.

A prior article I wrote stated that the Affordable Care Act (ACA) may shift claims into workers’ compensation.

If employers continue to shift costs to their employers, their employees may shift the cost of their health care to workers’ comp. Case in point, another article I wrote in 2013 said 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.”

So it is not too far out of the realm of possibility that some workers whose employers have shifted the cost of medical insurance on them, will turn around and shift it to their employer’s work comp carrier.

If that happens, and they require expensive surgeries, unique alternatives may need to be implemented, even if it is outside the box, and outside the border.

Original article by Jay Hancock, September 22, 2015, Kaiser Health News

 

 

What Legalized Pot Will Cost Employers

Last May, I wrote a short piece, “California is Going to Pot“. It discussed the issue of whether medical marijuana will be allowed in workers’ comp.

Caroline McDonald, Senior Editor of the Risk Management Monitor and Risk Management magazine, wrote an article today about the cost to employers should more states legalize pot.

Ms. McDonald cited a White Paper from Quest Diagnostics that suggested that employers will face potentially costly litigation, as case law develops, and will face challenges to protect employees from injury and to comply with drug-free workplace requirements.

Quest reported that legalization has led to the production of pot-infused foods and gadgets, such as vape pens, and that these two modes of consumption will make it more difficult, if not impossible, to tell when employees are using on the job.

Ms. McDonald writes that as use of pot increases, so will injuries, accidents, mistakes, and illnesses, which will escalate the cost of the company’s liability, workers’ compensation, and health insurance.

She outlines five steps employers can take to protect themselves:

  1. Stay up-to-date with the changing legal landscape and adjust workplace policies accordingly.
  2. Remember that marijuana is still illegal under federal law.
  3. Join other employes to monitor state legislation and take action with legislators to ensure workplace protections are included in any marijuana laws.
  4. Educate your workforce about the danger it poses to children, families and the workplace.
  5. Challenge the notion that marijuana is medicine, or risk paying for it in your health insurance. No marijuana medicines being sold in states that legalized them have been approved by the FDA as pure, safe, or effective. Doctors cannot prescribe them and pharmacies cannot sell them.

Number five is not one that I would subscribe to, as I believe that it does help those with serious illnesses such as cancer and other rare and debilitating diseases.

So long as pot remains illegal under federal law, the FDA will not approve the use of it as a medicine, but that is what needs to change.

Yet, risk management personnel need to be mindful of the other steps, and generally, people who are using marijuana as medicine are not engaged in dangerous or harmful employment, to themselves or others. When you are that sick, working is one of the last things you are concerned with.

And advocates for legalized pot should be aware of the risks it poses not only on the workplace, but for the employee as well. Failing a drug test can get you denied work comp benefits, unemployment insurance, especially if they are terminated for cause being under the influence, and not to mention the legal hassles the employee will face.

 

 

 

 

 

California Work Comp: What a Mess!

Kevin Tremblay, V.P., National Accounts for SMS National Solutions in Altamonte Springs, Florida, and a connection of mine on LinkedIn, penned the following article about California work comp and liens.

Normally, I shy away from articles involving California work comp, but on one or two occasions have written articles about it that I feel fit the subject of this blog. This article is one of those, but is more about the mismanagement of one state’s work comp system, rather than the state of affairs of the entire system nationwide.

Here is Kevin’s article in full:

California Workers Compensation System – Liens, Waste and Medical Provider Billed Charges

The California workers’ compensation system is unique like no other state in the country. There are two distinct sides of the equation in California workers’ compensation, Applicant and Defense.

Applicant-The party, usually the claimant that opens a case at the local Workers Compensation Appeals Board (WCAB) office by filing an application for adjudication of claim.

Defense-The party, usually the employer or its insurance company opposing the claimant in a dispute over services and benefits.

Lien-A right or claim for payment against a workers’ compensation case. A lien claimant, such as a medical provider, can file a form with the local Workers Compensation Appeals Board to request payments of money owed in a workers’ compensation case.

OMFS-The official medical fee schedule is promulgated by the DWC, Department of workers Compensation administrative director under labor code section 5307.1 and can be found in section 9789.10 of title 8, California code of regulations. It is used for payment of medical services required to treat work related injuries and illnesses. The California Official Medical Fee Schedule is considered prima facie evidence of reasonableness.

A lien claimant has the burden of proving that any amount charged is reasonable, and a lien claimant must prove that there are “extraordinary circumstances” that justify a fee that exceeds the Official Medical Fee Schedule.

According to some recent reports, an expected 500,000 liens will be filed by treating medical providers in the California Workers Compensation system in 2015, costing employers and insurers an estimated $200 million dollars in loss adjustment expenses and delaying claims adjudication.

Some of these liens forces some employers or insurance companies to settle liens they may not be legally obligated to pay simply to settle and close the claim to avoid paying additional disability, administrative and legal costs. Emphasis here on, ‘forces

Some additional statistical findings reported by the DWC are:

  • Medical treatment liens account for more than 60 percent of the liens filed, and 80 percent of the dollars in dispute.
  • $1.5 billion per year is claimed in medical lien disputes after adjusting for amended lien files.
  • One-third of medical liens involve disputes over the application of the Official Medical Fee Schedule.
  • Authorization for treatment was in dispute in seven out of 10 medical liens surveyed.
  • Reasons treatment was not authorized were: 37 percent provider not authorized to treat (mostly out-of-network); 7 percent denied claims; 6 percent medical necessity of treatment rejected by utilization review; 1 percent contested body parts; 20 percent authorization status unknown or not stated.
  • The volume of liens filings is sensitive to procedural changes, such as the adoption or repeal of a $100 filing fee and the adoption of new filing procedures.
  • Up to 30 percent of medical liens are prematurely submitted before the time has elapsed for the claims administrator to pay or object to the provider’s bill.
  • Ten percent of medical liens are submitted on the date the service is provided.
  • Nearly one quarter of medical liens are filed more than two years after the last date of services for which payment is claimed, including 6 percent that are filed five or more years after the last date of services.

The report was based on information provided by the Division of Workers’ Compensation, and was an attempt to characterize the problem so policymakers can propose solutions to the lien problem.

Source: CHSWC/InsuranceJournal.com

The Lien System Game:

Bill ($5,000) – Paid ($1,000)-in accordance with OMFS

Fee to file the lien the claim in court by medical provider $150.00

Lien balance $4000

Demand: $3800

Offer: $2000

Negotiation continues

Collector says $3200 is the bottom line for him

Adjuster forced to pay and settle to avoid additional claim cost agreement at $3200

So while the DWC and legislators continue to sort over of resolve the issues of the lien process, what can adjuster’s implement to mitigate the process and reduce claims costs? The following strategies are a good place to start:

  • How much is the lien?
  • How much is the OMFS or reasonable value of the lien?
  • What are your lien defenses?
    • AOE/COE
    • MPN
    • OMFS or other fee schedules / IBR
    • Reasonableness & Necessity
    • UR / IMR
    • Other technical issues
  • What evidence do you have to support your position? Objection letters? MPN Notices?
  • Did you serve your evidence on the lien claimants and/or your counsel?
  • What are the probable economics of your decision to settle or fight?
  • How much are you willing to pay to settle or resolve the lien?
  • We paid per OMFS & DOS is after 1/1/13
  • You failed to request 2nd review within 90 days (LC 4603.2(e)(2))
  • You failed to request IBR within 30 days from 2nd review (LC 4603.6(a)
  • You are done. The Code says: “the bill shall be deemed satisfied and neither the employer nor the employee shall be liable for any further payments.”
  • Any appearance at the board on your lien will result in a petition for costs & sanctions! [LC 5811 & Valdez decision (en banc) (77 CCC 1113)]

The State of California has taken recent measures with the advent of SB863 and labor codes 9792.5.12 and 4903.1(b) regarding independent bill review process and tighter lien submission rules. California legislators need to continue to act and close the loop holes in existing laws to mitigate and eventually eliminate the magnitude of waste and abuse by certain medical providers that is currently taking place and plaguing the workers’ compensation system.

The lien process is certainly unique to the rest of the country’s state by state workers’ compensation system. So what is it? Unethical gaming of the system and adding tremendous unnecessary costs and clogging the California courts and workers’ compensation system, no question. Anything more, you decide…..

Final Rule for Bundled Hip and Knee Replacements Published

Four months ago today, I wrote a piece called, “CMS to Require Bundling of Reimbursements for Hip and Knee Surgery”, that said the Centers for Medicare & Medicaid Services (CMS) will require the bundling of reimbursements for hip and knee surgeries.

Today, Health Affairs blog published an article reporting that CMS has recently published the final rule for the Comprehensive Care for Joint Replacement (CJR) model, which is a mandatory bundled payment model for lower extremity joint replacement (LEJR) services in certain geographic areas.

The article, by Patrick H. Conway, Rahul Rajkuma, Amy Bassano, Matthew Press, Claire Schreiber and Gabriel Scott, said that hip and knee replacements are the most common inpatient surgery procedures for Medicare beneficiaries, and can require long recovery and rehab periods.

The authors said that in 2014, more than 400,000 beneficiaries received hip or knee replacement, which cost more than $7 billion just for hospitalization.

They also reported that the quality and cost of care for these surgeries varied significantly by region and by hospital, and was true for both the care received in the hospital and for post-acute care outside.

The variation, they said, is due to the way Medicare pays for this care today, spread among multiple providers, with no single entity accountable for the total patient experience.

Care can be fragmented, they wrote, which leads to adverse outcomes.

Here are the key takeaways from the final rule:

  • the CJR model seeks to incentivize Medicare providers and suppliers to work together to improve the quality and reduce the costs of care for patients undergoing lower extremity joint replacement
  • the acute hospital where the procedure occurs will be accountable for aggregate Medicare expenditures and the overall quality of related care
  • the model will include participant hospitals located in 67 Metropolitan Statistical Areas (MSAs) throughout the country
  • acute hospitals paid under the Inpatient Prospective Payment System (IPPS) and located in the selected MSAs will be included in the model, with the exception of hospitals currently participating in Model 1 or Models 2 or 4 of the Bundled Payments for Care Improvement (BPCI) initiative
  • depending on the hospital’s quality and aggregate spending performance, the hospital may receive an additional payment from Medicare, or need to repay Medicare in the second year if spending exceeds targets
  • hospitals will need to work with physicians and post-acute care providers, such as home health agencies and skilled nursing facilities, to ensure patients get the care they need

This is in contrast to what I reported on in July, when I said that a former CMS official was cited in the Freeman article as saying that mandatory bundled payments for hip and knee surgeries would shutter one in four skilled nursing facilities and trigger “demand destruction in areas such as diagnostic testing, hospital stays, and avoidable readmissions.”

Whether or not this final rule will do what the authors of the Health Affairs article says it will do remains to be seen, but judging by past CMS programs to affect quality and costs, this may be wishful thinking on the part of the authors.

The insistence that one more new initiative, or more incentives, or one more new model or new rule will change the way health care is being provided in the US, just goes to show that until we adopt a single-payer, “Medicare for All” system with less rules and less incentives, some people will continue to game the system, then we will see a radical change in the American health care system.

And if workers’ compensation follows changes in health care under Medicare, especially how it determines reimbursements for hip and knee surgeries, which are also common to workers’ comp, we can expect to see issues in workers’ comp.

Alternatives must be considered to an ever expensive and poor quality of health care for workers’ comp. That alternative is medical travel.

Challenges Facing Work Comp

In three weeks, members of the medical tourism industry will gather in Puerto Vallarta, Mexico to attend the 6th Mexico Medical Tourism Congress.

You may recall that I was invited and attended the Congress last year, and was invited again this year. However, due to personal and financial reasons, I am not attending this year.

I am however, posting my PowerPoint presentation below for your viewing, with narration by yours truly. I hope you find it interesting and informative.

Challenges Facing Workers’ Comp (PowerPoint)

Challenges Facing Workers’ Comp (video)

 

SPOTLIGHT Interview – October 31, 2013

This is the original interview published on October 31, 2013 by Medical Travel Today.com.

Medical Travel Today (MTT): Tell us your position in the medical tourism industry, as well as your thoughts on integrating medical tourism into workers’ compensation cases in the U.S.

Richard Krasner (RK): Currently, I am a blogger, blogging about the implementation of medical tourism into workers’ compensation.

I first began looking into integrating medical tourism into workers’ compensation when I needed a topic for a paper in my Health Law class as part of my M.H.A. degree program in March of 2011. A lawyer who was working for a medical tourism facilitator company at that time, and who had written an article in a law journal about medical tourism, gave me the idea after my first topic did not pan out. She thought that the legal barriers to implementing international medical providers into workers’ compensation through medical provider networks was a good idea, and since I had a small interest in the subject of medical tourism, I submitted that as my topic to the instructor.

He gave me his approval and, as I started to do my research, I found many articles on medical tourism and nothing on medical tourism and workers’ compensation, so I knew my task was a difficult one. But as the point of the paper was to write about a legal issue and persuade people one way or the other, I felt that I could mention the lack of literature on the subject and perhaps open up dialogue in that area. I then found a roundtable discussion from the January/February 2008 issue of the journal Telemedicine and e-health.

In the discussion, I found something that I had been looking for, but had not expected in a medical journal: a validation from four of the participants for my idea to implement medical tourism into workers’ compensation. I made their discussion the centerpiece of my paper, and thus my argument in favor of implementation. They said essentially that they thought that medical tourism could work for non-emergent, i.e., non-emergencies or long-range issues, such as knee or hip replacement, chronic back injury and repetitive action injuries, and that it would not be a leading offering. That is when the light bulb went on, and I realized that it could be accomplished as an option for the injured worker to consider.

Initially, my research consisted of finding articles that discussed medical tourism in destinations, such as India, Singapore and Thailand, and my thought then was that it might be a stretch to send injured workers that far away, but that maybe it could be done. Later on, as I got more involved in medical tourism through my attendance at the 5th World Medical Tourism and Global Healthcare Congress in October 2012, and through conversations online with another lawyer, I realized that the best chance for this to happen was in Latin America and the Caribbean, and that given the rise of the Latino population in the U.S., sending patients home to their home countries for treatment would present no language or cultural barriers, and would allow friends and family in those countries to visit them during recovery, which will improve their self-esteem and improve their recovery time.

I have since come to believe that all injured workers could be offered this as an option, not just those of Latin or Caribbean origin.

MTT: How will the integration benefit individuals, health insurance companies, and the entire medical community, both domestically and internationally?

RK: I believe first and foremost that medical tourism will have its most important benefit on the individual because of some of the things I mentioned above, namely little or no cultural or language barriers to overcome between Spanish or English in most cases, or between Portuguese or other languages in the region. Also, as I said, their friends and families back home can visit, which would make their recovery more relaxing, more pleasant and would show them that the patient is not sitting at home just collecting a check. It would also give the patient greater self-esteem and speed recovery. Finally, by being treated in the better hospitals in the home country, a patient’s friends and family will see that their loved one is being cared for by the best doctors and at the best facility in their country.

I think the benefit for the health insurance company or, in this case, the workers’ compensation carrier would be that they will not have to pay for expensive procedures, such as hip or knee repair/replacement, shoulder surgery, spinal fusion surgery or carpal tunnel surgery. This is despite the fact that many states have fee schedules for workers’ compensation, which tells providers how much to charge the carrier for each procedure, and which may be less than the normal fees charged. Nonetheless, as the recent New York Times article indicates, the U.S. has the highest cost for healthcare, and it is not slowing down, nor has the average medical cost for lost-time workers’ compensation claims, as I have written about in my white paper and my blog.

I think for the entire medical community domestically and internationally, it will have several benefits, the first of which will be the realization that healthcare is globalizing and that it is no longer possible to consider that quality medical care is available only in the developed world. Second, it will lead to the development of international accreditation standards, quality standards and other standards that up to now have hampered medical tourism’s expansion and growth.

These standards will take time to be adopted and will be expensive to implement for the medical tourism facilities involved, as it has already been for the implementation of other standards and forms of accreditation, such as from the Joint Commission International.

Thirdly, it will have the benefit of bringing American patients to medical providers in other countries, those who otherwise would never be seen by foreign doctors except for those who have gone to foreign-born doctors practicing here in the U.S., whether in private practice or in a hospital setting. Fourth, and this is more of an issue with workers’ compensation cases, doctors abroad will be able to get broad experience treating work-related injuries that they have never seen, thus adding to their medical experience, and providing their fellow citizens with that experience should they ever require it.

Medical tourism will open up global healthcare to all inhabitants of this planet, not just those looking for cosmetic surgery, or procedures that are too expensive or unavailable in their home countries. It will certainly open it up to those who otherwise could not afford to travel out of their country for treatment.

MTT: What would you say are the steps necessary to take in order for medical tourism to be integrated into workers’ compensation effectively?

RK: First, there has to be a removal of all or many of the legal barriers that I mentioned in my white paper, as well as many others that I could not or did not mention. Also, there has to be some understanding on how the legal issues surrounding medical tourism can be solved such as malpractice, legal liability, privacy issues, medical records transfers, etc.

There are financial steps that need to be addressed, such as which currency the payments will be made in, any incentives to injured workers, referring physicians, treating physicians, destination hospitals, as well as travel insurance coverage for things not covered under workers’ compensation. And lastly there has to be a willingness on the part of employers and insurance companies, third party administrators, and lawyers to accept medical tourism as part of workers’ compensation. I have discussed this with several people recently through emails, and in the past six months since beginning my blog, and have written about this as well.

As the Chinese say, a journey of a thousand miles begins with the first step. An industry like the workers’ compensation industry in the U.S., which is concerned with issues, such as pain medication abuse, physician dispensing of drugs and dealing with cost-curbing strategies that have failed, must come to the realization that the journey for them must begin now — before costs skyrocket any further.

MTT: What can you see being potential deterrents in integrating medical travel benefits into workers compensation?

RK: First of all, let me say that I don’t have all the answers, and I cannot foresee all contingencies and problems associated with traveling abroad for care. But I do want to make this clear so that your readers will not think that I don’t know what I am talking about, or that they will think that integrating medical tourism into workers’ compensation will be easy and not fraught with difficulties and complications.

It will not be easy, there are and will be complications from flying after undergoing surgery abroad, just as there are if the patient was treated at the local hospital. I am not a medical person, so my knowledge of how patients will tolerate air travel after surgery or what complications will arise is beyond my experience. But I can say this: I don’t see a difference between a patient who traveled abroad for medical care as a private patient for cosmetic, body improvement or other forms of surgery usually associated with medical tourism and a patient who is traveling abroad for surgery as a result of an on-the-job injury. Yes, there are differences in the process of treatment and aftercare and recovery, but if the private patient can develop complications, so too can the workers’ compensation patient.

To answer the question then, I think deterrents include a lack of will, fear of lawsuits in countries with laws that do not favor the insurance company or the employer, malpractice insurance and legal liability that does not meet American standards, employee choice to stay at home, and pressure from special interest groups like doctors, hospitals, pain clinics, rehab facilities, trial lawyers, etc.

MTT: During a time of rapid healthcare reform, why do you think medical tourism hasn’t been connected to workers compensation already?

RK: Because there is so much uncertainty over the impact the Affordable Care Act will have, not only on healthcare, but also on workers’ compensation. In my research on that subject, I found that there will be little immediate impact, but down the line there will be, especially as more people get health insurance, and also because of the doctor and nurse shortage, which will affect both healthcare and workers’ compensation.

There are critics of the law who say it will raise costs, and then there are those who say it will lower costs, as some have already pointed out recently. But only time will tell who is right and who is wrong. Finally, I don’t think many in the workers’ compensation industry have ever considered looking abroad, except to plan their next vacation.

MTT: Is there anything else you would like to add at this point that you think is significant in terms of medical tourism, workers’ compensations and/or the integration of the two?

RK: Yes, as I said in my blog post, The Faith of My Conviction, what is needed is the will to do it, the courage to make it happen, the hard work to get it there, and the determination to bring the two industries together. I have had experts tell me that it won’t happen, but I pointed out right away in my post the discussion I found between the four medical professionals, and I believe that as medical professionals they have a better understanding of the issues involved than I do as a layman. I trust their judgment of the issue and defer to them for my belief that it can be done.

So who is right and who is wrong? I don’t know the answer to that, but I do know this: for 20 years, the average medical cost for lost-time claims has gone from around $8,100 to almost $30,000 with no decrease in cost, but with a slowdown in the rate of increase. Is that progress? Is that a sign that all other avenues tried have not succeeded? Perhaps it will take higher costs to wake people up to the reality that medical care, like all other goods and services, always goes to those places where the goods or services can be produced at cheaper cost with better quality.

SPOTLIGHT Interview on Medical Travel Today.com

The following interview was published this morning on Medical Travel Today.com. They have published several of my articles in the past, as well as a prior interview in 2013.

Medical Travel Today (MTT): It’s been awhile since Medical Travel Today has checked in with you. Remind our readers of your position in the medical travel industry, as well as what you have been involved with since we last chatted in 2013.

Richard Krasner (RK): I am the blogger-in-chief of the Transforming Workers’ Comp blog, as well as the CEO and principal consultant of FutureComp Consulting – an as yet not official company dedicated to bringing the medical travel industry into the workers’ comp industry.

Since 2013, I have continued my blogging, and in November 2014, I spoke at the 5th Mexico Health & Wellness Travel Show in Reynosa, Mexico. I was invited to speak again at the 6th Mexico Health & Wellness Travel Show in December, in Puerto Vallarta.

MTT: Can you give the readers some background on FutureComp Consulting and its goals?

RK: I came up with the name of the company because I truly believed that the future of workers’ compensation in the U.S. has to be more globally focused, especially since the workforce in the U.S. is increasingly Latino and Asian, as has been reported by those who follow the demographic makeup of the U.S. population as a whole.

The goal of FutureComp Consulting is to transform the workers’ compensation industry by freeing employers and injured workers from the high cost of surgery for work-related injuries common to workers’ compensation claims, such as back, hip, knee, shoulder, and carpal tunnel.

MTT: Do you work directly with the patient, employer and/or both?

RK: As FutureComp Consulting is at the very early stage as a startup company, there are no patients or employers that I am working with, however, there is one health plan that has expressed an interest to expand what their members’ employees are already doing in northern Mexico with regard to general healthcare, and not workers’ comp.

My vision for the company would involve employers and insurance companies seeking to lower the cost of surgeries for work-related injuries, with the injured workers agreeing to go out of the country when the option is presented to them. They would not be under any obligation or pressure to go abroad for medical care, and should they decline to do so, they would be free to get treated here in the U.S., as if the option was never offered. I think that with the large and growing Hispanic workforce in the U.S., that if presented correctly, they would choose to go to their home country, or similar country for surgery. This would help them overcome any language or cultural barriers, and assure their friends and relatives in that country that they are getting the best care possible, in the best facility their country has to offer. For non-Latino workers, it would be a chance to see another region of the world, and to learn about other cultures. Naturally, in both cases, spouses and even children, would be allowed to travel with them to make the worker feel more comfortable with going abroad.

MTT: Will FutureComp Consulting help connect medical travel patients to specific locations?

RK: I would like to see injured workers travel to Latin America and the Caribbean, because the travel time from the U.S. mainland would be less than four hours, and less of a strain on their injury and recovery from surgery.

MTT:Medical travel provides patients with the opportunity for high-quality, cost-effective healthcare, so in 2015, why do you think there is still pushback?

RK: For one, I think because of media reports about the negative outcomes and serious injuries that have occurred, even a few deaths, here and there. Second, I think too many Americans are under the impression that medical care in other countries outside of North America and Western Europe is so-called “third-world medicine,” and therefore not as good as medical care at home. Third, the concept of “American exceptionalism,” of which I have written about in the past, is too strong in the mindset of most Americans, especially those who have never traveled abroad or to those regions where medical travel is currently offered. I have written about the issue of “third-world medicine” as well, and one domestic critic of mine insists that I want to send patients to Bangladesh or some other country that does not have first-world medical care, as they would define it. I don’t want to disparage Bangladesh or any other country, but that is the perception, and that is why there is pushback, at least in terms of what I am trying to do.

The workers’ comp industry is too conservative, and too stuck in their ways to look outside the box and outside the border of the U.S. to find solutions to the problems plaguing workers’ comp. In other words, they have not caught on that the world, healthcare and workers’ comp are all globalizing.

MTT: Where do you see the future of healthcare headed, domestic and international?

RK: As far as workers’ comp is concerned, I think that the future of medical care is uncertain, because there are forces both internal and external that are challenging the original intent of the system. International medical travel for workers’ comp is years away in much the same way that sub-orbital, commercial flights between one and four hours travel time is — something that may happen by mid-century.

However, domestic medical travel in workers’ comp is occurring due to differences in medical and surgery costs from state to state.

With regard to general healthcare, the enactment of the Affordable Care Act (ACA) has not yet been felt as either hurting or helping medical travel, because the timeframe is too short at this point. Not enough information about the impact of the law has been developed, although there are some conflicting opinions about aspects of the law, which I have recently written about in regard to Accountable Care Organizations (ACOs).

I am not sure if the ACA is driving some people to look abroad, but those who are now covered, and who were not covered before, are more likely than not to stay home, unless it gets too expensive or they lose it because opposition politicians get their way.

MTT: At this point, is there anything else you would like to share with our readers?

RK: Yes, there is. The end of October 2015 will mark three years since I began writing my blog, and one of the biggest disappointments I have encountered has been the number of individuals and organizations that are not behaving in an ethical or professional manner. This has been brought to my attention by several individuals I have had contact with over the past three years. I believe that it is time for this behavior to stop. We must treat each other ethically and professionally. Standards should be established for how to conduct business with each other, between our partners, and with the patients themselves, as well as for how to practice medicine, and relate to foreign patients in terms of learning to speak their language, and providing meals at the proper time and in accordance with their cultural norms, etc. We must also develop organizations to bring the industry together under common laws and procedures for handling problems.

Lastly, I think there is far too much emphasis on conferences and congresses, and not enough on actually going out into the market and getting the business, instead of bringing providers and facilitators together. Also, the industry must, as I said in Reynosa, go after the workers’ comp market; it will not come to you. You must go beyond cosmetic and plastic/reconstructive surgery, dentistry, spas, wellness programs, etc., and market your services for the masses, and not just the rich and affluent. Healthcare should know no class distinctions.

I have been unable to get traction from both the workers’ comp industry and the medical travel industry, but I am willing to partner with anyone who sees what I am trying to do, and wants to be a part of it. I hope this interview will allow me to do so.

The entire interview can be seen here.

A History Lesson: What it Means for the Health Care and Workers’ Comp Industries

Allow me to take off my blogger’s cap, and put away my MHA degree, and write about something I do know a lot about, and that is American history. After all, the MA after my name means “Master of Arts”.

On September 6, 1901, President William McKinley, was shot by Leon Czolgosz, an anarchist, and died on September 14th. McKinley, who had been re-elected the previous November, was succeeded by his second Vice-President, Theodore Roosevelt.

When Roosevelt became the 26th President, the course of American history changed forever, or so it seemed, through most of the twentieth century. The fact that it did not completely change the course of history is the subject of this essay.

You are probably wondering what impact this all has on the American health care system, and workers’ compensation in particular.

The answer to that can be found in a statement made decades later by the anti-tax lobbyist and Bush 43 White House aide, Grover Norquist, who said, “his goal is to bring America back to what it was “up until Teddy Roosevelt, when the socialists took over…

It was Roosevelt who first proposed national health insurance that future presidents, both Republican (Nixon) and Democrats wanted to create. Roosevelt also passed the Pure Food and Drug Act of 1904, which created the FDA, and led to food and drug safety.

For several decades in the late 19th century, progressive reformers had unsuccessfully tried to change things, and not always peacefully, as the various riots and bombings and strikes can attest to.

But after Roosevelt, and after his defeat in the 1912 election, progressives moved closer to the Democratic Party, first under Woodrow Wilson, then twenty years later, under Teddy’s cousin, Franklin.

It was during Taft’s last years in office, and Wilson’s first years, when workers’ comp laws were enacted by states. And in the years to follow, such reforms as direct election of senators, the right to vote for women, end of child labor, the right of unions to strike and bargain collectively were won, and unemployment insurance, social security, welfare, and many other social programs were created.

But some thirty-five years ago, that began to change, when men like Norquist became President, Senators, and Congressmen, and a slow process of destroying the social safety net began.

We are seeing this in the resistance to, and threat of repeal of the ACA, the assault on statutory workers’ comp through the expansion of opt-out, and the corruption of the workers’ compensation system by carriers, employers, judges, lawyers, physicians, and service providers.

To illustrate this point, David De Paolo wrote today about responses to two previous posts he wrote, in which several respondents made threatening remarks towards persons’ unknown, who had heaped further injury on already injured workers.

While I do not advocate personal harm towards any one claims person (I was one myself a long time ago, and was threatened, or so I was told, but never by whom), I have expressed the opinion that those who inflict pain on those already in pain, are inviting trouble. But that is to be directed towards the system, not a person.

In response to an article by Jodi Mathy about the employee experience of claim management, I said that such action should be,

“Not against claims people, but against a system that causes pain to people who are already in pain. WC was supposed to ameliorate the harshness of the laissez-faire, industrial revolution, not redistribute wealth. If that was the case, claims awards would be in millions.”

To further drive home this point, I quoted the following:

Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

Karl Marx

Now before any of you see red stars, or hammers and sickles before your eyes, calm down. I only quoted him because what he said was true when he wrote it, and could be true again in the future, if we allow ourselves to be deluded by those like Norquist who want to go back and party like it’s 1899.

So if you are afraid of socialism, just remember these inconvenient truths, or facts. One, many of us alive today would never have gone to college without socialism. Two, our parents would not have gone to college either, especially those who fought in WWII, Korea, and other conflicts. Three, our parents would not have been able to retire to Florida, Arizona, or anywhere else without Social Security, and would not have gotten medical care after 65 without Medicare, and if they were poor, Medicaid.

Four, all of you no doubt has flown for both business or pleasure. Do you not like the idea that there is a federal agency, the FAA that regulates airlines, and oversees airports? What about interstate highways, railroads, cruise ships, etc.? All of that because of socialism, although a limited form of socialism.

Last week, the GOP elected a new speaker, Paul Ryan. A while back, it occurred to me that since Ryan was a devotee of Ayn Rand, and Rand Paul was running for president, that there was a curious connection between the three of them. If you take Ayn Rand, then Rand Paul, then Paul Ryan, put their names together, you get “AynRandPaulRyan”, and if you take Ryan’s name, drop the “R” and move the “y” after the “a”, you get back to where you started.

It doesn’t mean anything, but it is curious, given their libertarian values.

And getting back to where we started, i.e., in 1789, is no way to run a modern, post-industrial society, so yes, history does matter, and both health care and workers’ comp will be the worse off if we forget it, as per Santayana.