Monthly Archives: January 2016

Medical Management Internship Paper, Summer 2011

No doubt, many of my readers have wondered what I learned in my MHA degree program, and why my writing has been of interest to so many of you.

Upon checking my stats for the blog, I noticed that someone had viewed a paper I wrote in the summer of 2011 for my Summer Internship course, as part of my MHA degree program requirements. The school I attended required all students without a health care background to take a one-credit course as an Intern in a health care organization.

The organization I choose was one my school already contracted with, Broadspire. At the end of the course, we were expected to write a paper about our internship for a grade in the course.

The following link will direct the reader to a copy of my paper that I hope the reader will find interesting, and will highlight my skills as a researcher and writer. Speaking engagements as well as research opportunities are most welcome, as are full-time positions and consulting opportunities.

https://www.dropbox.com/s/5573hm8xo074po0/Medical%20Management%20Internship%20Paper.docx?dl=0

As the summer session was very short, only three projects were undertaken, and the last one was truncated due to time constraints and the report presented to Broadspire concentrated on only two states, Florida and California.

Let me know your thoughts.

Pushback on ARAWC’s Attempt to Expand Opt-Out To Tennessee

David Fish wrote an opinion piece last week in The Leaf-Chronicle that stated there is no need to change that state’s workers’ comp program, as had been discussed previously by numerous bloggers, including yours truly, and that ARAWC has been advocating, by actually writing the legislation for Tennessee and South Carolina.

It is such an excellent article, and makes the point so clearly, that I am going to let David Fish speak for himself.

Here is the link:

http://www.theleafchronicle.com/story/opinion/readers/2016/01/22/opinion-no-need-change-workers-comp-program/79164208/

Fine Print Excludes Outpatient Surgeries in Some Work-Based Plans

Kaiser Health News reported today that the fine print in some work-based health plans exclude paying for outpatient surgeries.

As reported by Jay Hancock, Libbi Stovall, who lives in Carrollton, Texas was shocked to learn that her employer’s 2016 health plan provides no coverage for outpatient surgery.

Stovall, who has a history of back problems, looked at the fine print of her company’s health plan, which supposedly met the strictest standards for employer obligations under federal rules.

Inpatient hospital care, office visits and diagnostic imaging are paid for by her insurance, but it provides not coverage for outpatient surgery; surgeries that account for two out of every three operations in the nation.

Yet, being offered such a plan through her employer, she is barred from federal subsidies to buy more comprehensive coverage on the online marketplace by a company called Open Systems Technologies.

According to Hancock, Stovall’s experience illustrates the latest chapter in the story of employers and insurance designers pushing the limits of the ACA.

Last year, Hancock writes, regulators blocked companies with millions of lower-wage workers from claiming that coverage with no inpatient hospital benefits met the ACA’s strictest standard for large employers.

So-called “skinny plans” are no longer allowed, says Hancock, and therefore insurance administrators and many cost-conscious employers are claiming to meet the rules with a new version that excludes outpatient surgery. Hancock goes on to say that the new plans may not survive regulatory scrutiny any more than the old ones did, according to some experts.

Timothy Jost, a law professor at Washington and Lee University said, “I really wonder whether they can do that.” He added, “Refusing to cover any outpatient physician surgical services is arguably a violation.”

Outpatient surgeries such as hernia repairs, knee arthroscopies and repairing bone fractures are typical of those without an overnight hospital stay. They generally cost less than inpatient operations, Hancock writes, but can still be tens of thousands of dollars.

Leaving these procedures out of a plan saves money for the employer, Hancock states, but it leaves the workers with crippling bills.

The article goes on to discuss in length the way the new rules affect lower-wage workers and how their employers are responding to them.

It is not known what Ms. Stovall’s job is, or how she developed back problems, but for millions of lower-wage workers like her, the rules surrounding the implementation of the ACA means that their employers are sacrificing their health to save money on an already expensive health care system, instead of seeking out other alternatives.

These are the very kind of workers, a woman I had a Skype call with this morning, is trying to help with her company, Trip4Care.

Her name is Maria Maldonado, and she told me about a construction worker who needed double knee replacement, but his union-based insurance deductible was $40,000 and he waited five years before he got the surgery at hospital in Colombia that Maria vetted and sent him to.

I have written before about how medical travel can save money, not only under group health, but especially under workers’ compensation. And since many of the outpatient surgeries these work-based health plans have excluded are common in workers’ comp, it would make sense to tear down the walls between the two silos of group health and workers’ comp, and explore these opportunities to save huge amounts of money on medical bills.

But as long as people discount the validity of going abroad, as long as people in certain industries refuse to admit that not only is the cost lower abroad, but the quality too is better, when you go through someone like Maria Maldonado.

It is my intention to work with Maria to do just that. She has some possibilities that may require my expertise in workers’ comp, while she handles the group health side. If you are an employer who wants to save money on health care costs, contact me and we will work with you.

Otherwise, you will leave your workforce to the mercy of these rather draconian and capricious rules and cause pain and suffering to millions of lower-wage workers. ProPublica/NPR has shown this to be true, but it does not have to be so.

Knee Surgery in Latin America under $20,000

As a follow-up to my post, Top 10 Hospitals for Knee Surgery Under $50,000, here is a graphic I submitted recently to a workers’ comp carrier in Florida I am interested in exploring opportunities with.

The hospitals and costs were culled from the Archimedicx website I linked to in the previous post.

Western Hemisphere Hospitals Knee Surgery under $20,000

I am sure there are many more, and there are more that are between $20,000 and $50,000 that were not mentioned in the first article by Archimedicx.

Even if these figures are not completely accurate, why take the chance that they are not at least representative of the cost difference between what is charged by hospitals in the US. And when you add in all the additional fees one finds on a US hospital, these prices are practically a bargain.

But go on and pay through the nose. Or is that the knee? To quote Forrest Gump, “stupid is as stupid does”.

Medical Tourism and Workers’ Comp: What’s Good for the Goose is Good for the Gander

Happy New Year everyone!

For my first post of the year, I want to re-post an article published yesterday by my fellow medical tourism blogger, Maria Maldonado of Trip4Care.

Maria has written an excellent article outlining the benefits of medical tourism for an employer’s health plan, so naturally the same can be said for workers’ comp, especially with regard to self-insured or even opt-out employers.

Here is Maria’s article in its entirety:

Medical Tourism: A Component of Your Health Insurance Plan?

Given that medical tourism is an option chosen by many to get procedures not typically covered by insurance, it may come as a surprise that medical tourism is also something that is growing in popularity as an additional health insurance benefit—especially for self-insured companies. Let’s take a look at the reasons behind this trend.

Why Employers and Health Insurers Are Opting to Add Medical Tourism to their Health Plans

There are actually quite a lot of reasons why employers and health insurers alike are opting to add medical tourism benefits to their health plans. Let’s take a look at some of these:

  • The employer saves money. This is especially true for employers who opt to “self-insure” (i.e. the employer acts as an insurer, and pays the employee medical expenses rather than providing a separate insurance plan).
    • Since many procedures can be completed internationally for a fraction of the cost of the same procedure at home (even including the cost of travel), this is one of the biggest drivers behind the trend, for both self-insured organizations and other insurers.
  • The employees get more options. Giving employees additional benefits like this can be used as a recruiting tool, helping organizations to secure talent.
  • The employees have the choice to travel– possibly at no personal cost – for some treatments, and may be able to take a vacation at the same time. The option for coupling international travel with a medical treatment can be a major benefit for some employees.
  • Technology makes this process easier than in the past. With the wealth of information available at the click of a button today, it’s easier than ever to research the procedures that are available internationally and gain trust. Additionally, there are companies like Trip4Care that can facilitate all aspects of a medical tourism trip, making administration simple for the organization.
  • Employees do not sacrifice health outcomes. Naturally, companies who opt to take this route should take care to ensure to partner with companies offering the highest standard of care. In this way, everyone benefits and costs are kept low.
  • Keeping employer costs low also benefits the employee in the form of low premiums. It stands to reason that if costs are kept low throughout the group, there will be less rationale for premium price hikes. Another win-win.
  • Keeping costs low benefits, the employee through lower shared expenses too. Whether the healthcare plan’s coinsurance is 20%, 30%, or more, it all adds up. Keeping total expenses down for the patient is beneficial for everyone. Besides the obvious cost savings, this can reduce the stress involved for employees who have to seek medical care—reducing the financial burden can relieve some of the anxiety.
  • From an employer cost-savings standpoint, another option is to pass along the travel portion of the cost to the employee. This saves the company money while still keeping costs down overall. (Obviously this is lesser of a benefit for the employee, but the employee will often still come out ahead in terms of total expenditures as compared to having the procedure at home.)
  • Adding medical tourism coverage could make providing dental care more affordable. Dental procedures are a perfect example of a procedure that can often be sought internationally for less money than at home; employers offering dental coverage can take advantage of that.
  • Treatment wait times may be shorter. In cases where an employee may be subject to a lengthy wait list for a treatment at home, medical tourism options may give the flexibility to avoid that wait list and get treatment faster. This is yet another benefit for employees and employers alike.

Self-insured companies have the flexibility to do this right away. While this trend may take some time to take hold, it’s always great news to hear that more options will be available to more patients—allowing individuals to have more choices in their healthcare.

It has been pointed out in the past that doing this for either health care or workers’ comp is too complex and too costly; but as I have said many times before, we went to the moon more than once, and that was infinitely more complex and more dangerous than sending employees to another country for medical care.

I have defended my idea in the following posts:

The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible and is not a Pipe Dream

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

“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

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

Tell Me Again Why Medical Tourism in Workers’ Comp is a Bad Idea?

Nothing is Impossible

Paralysis by Analysis: Or the Only Thing We Have to Fear Is, Fear Itself

So when people tell me this idea is ridiculous and a non-starter, or that I have no credibility, or some other lame excuse why it won’t be considered, I go back to the points made in these seven articles above, and many others I have written that says it is possible. It’s just our lack of vision that makes it so.

The only things preventing it are the complexities of the health care or workers’ comp systems that are harming the systems, making them more expensive than they should be, people defending the status quo so that entrenched interests continue to game their respective systems to the detriment of the patient bases they service, and to those who would like to change them for the better.

We have seen this in our tax code, our politics, and many other facets of life. But it does not have to be that way. We can make things much simpler, but it requires employers, carriers and others to do so. Saying it can’t be done or it is too expensive only makes things worse.

We went to the moon; no one ever said it was too expensive to go, too complex to go, too dangerous to go. We went, and we went many times, but in the end, the naysayers and right-wing penny-pinchers who were really diverting that money into the pockets of the wealthy, shut down our space program, so that now we have to hitch rides on Russian rockets.

That’s what we get for saying it is too complex. That’s why the supercollider is in Europe and not in Texas. We have given up and given in. The world is changing, globalizing. Let’s not blow that too.

In other words, what’s good for the health care goose, should be good for the workers’ comp gander.

Here’s is the link to Maria’s article:

https://www.linkedin.com/pulse/medical-tourism-component-your-health-insurance-plan-maria-maldonado