Category Archives: Cardiac care

Medical Travel for Americans is Alive and Well

Many of you have probably thought that going abroad for medical care after passage of ACA was a thing of the past, or that the idea that workers injured on the job would go abroad was a “stupid, ridiculous idea and a non-starter”, have forgotten that medical care in the US is the most expensive in the world.

But the simple, undeniable fact is that we spend too much on medical care and get very poor results and outcomes, while other countries spend far less and get better outcomes.

Why are we so stubborn? And why hasn’t the workers’ comp world realized that they are fighting an uphill battle to lower costs every time they come out with some new strategy or cost containment measure that never lives up to its promise industry-wide?

Sure, there are individual cases where these companies save money for a particular client, but overall, the cost of medical care for workers’ comp still rises, even if that rise is slow at times, or appears to have shrunk, only to rise once again the next year, as seen in the NCCI State of the Line reports.

An article yesterday in said that traveling abroad for medical care simply makes more sense — even regular teeth cleaning is four times more expensive in the US than it is in Mexico.

One of the first procedures mentioned in the article involves a Minnesota couple who went out of the country for an in-vitro fertilization (IVF) procedure. On her fourth trip to the Czech Republic, it finally worked, and she got pregnant. The procedure in the US would have cost them between $12,000 and $15,000.

While IVF is not something that workers’ comp would cover, the fact remains that procedures cost far too much in the US, and in the case of IVF, only have a 29% success rate, according to a CNBC report cited in the article.

An estimated 1.7 million Americans traveled abroad for care in 2017, according the Josef Woodman, CEO of Patients Beyond Borders, and author of the same titled book. In my seven years of studying medical travel, Josef Woodman’s name has figured prominently in many articles and forums of discussion on the subject.

The article goes on to say that that is 10 times more than the 2008 estimate from Time magazine.

Some of the top destinations for medical care are: India, Israel (always go to a Jewish doctor first), Malaysia, Thailand, Taiwan, South Korea (unless that little twerp up north gets an itchy trigger finger), and Turkey.

However, there are other, more accessible destinations closer to home like Mexico, Costa Rica, Panama, etc.

Typical operations are orthopedic or spine surgery (are you listening work comp world?), reproductive operations, cardiovascular and eye surgery.

For example, a coronary artery bypass graft (CABG) in the US costs an estimated $92,000 (you could buy a couple of nice cars for that amount), whereas in India, the same operation would cost $9,800.

A total knee replacement (are you still listening ,workers’ compsters?) cost around $31,000 in the good ole US of A, but in Thailand, costs around $13,000. Tell me how you can save that much on a knee replacement using any of your so-called cost saving schemes?

These same operations in Costa Rica would cost 45 to 65% less than in the US, and would not require such long flights from most parts of the US. What are you waiting for? Save some money, I guarantee your insureds will love you for it.

Malaysia would be 60 to 80% less, but why go there when you can go to Costa Rica?

According to Woodman, medical tourism (travel) is a Band-Aid for the country’s dysfunctional health care system.

Woodman told Salon, “I don’t think you can penetrate this with philanthropy. It’s gonna be baby steps all the way. But in the meantime, medical tourism is a really important option.”

Woodman also said he did not like the term “medical tourism” because it is not a vacation. You may have noticed that I use the term “medical travel” instead. It is travel for medical purposes, and if there is tourism component to it, it is incidental to the reason for going in the first place.

Patients who cannot afford dental work, IVF or orthopedic surgery in the US, Woodman said, should consider travelling abroad. If their operation or treatment is expected to cost them $6,000 out of pocket, they will save money — even with the plane ticket.

Oh, by the way, that Minnesota couple spent, get this, only $235 for the IVF, not including flights. With such reasonable cost savings, it would be a no-brainer for workers’ comp to do the same.

But some people are stupid, ridiculous, and non-starters in my book.


Global Medical Tourism Industry Market Analysis

Note: The following is a re-print from U.S. Domestic Medical, one of two publications from CPR Strategic Marketing Communications. They also publish Medical Travel, and both publications have re-printed several of my posts on both of their newsletters, so I am returning the favor, which they have paid me many times over. I do not vouch for the accuracy of the data in the article, so please address any comments to the author.

Here is the article:

Global Medical Tourism Market By Treatment Type and by Region – Industry Analysis, Size, Share, Growth Trends and Forecasts (2016 – 2021)

The global medical tourism market has been estimated to be valued at USD 14,278 million, and it is anticipated to reach a market value of USD 21,380 million by the end of 2021 at a projected CAGR of 8.41% during the forecast period, 2016 to 2021.

Medical tourism involves travelling to another country for obtaining medical treatment. It is a high-growth industry driven by globalization and rising healthcare costs in the developed countries. A study shows that in United States, about 750,000 residents travel abroad for healthcare each year. A range of governments across the globe has taken up various initiatives to stimulate and improve the medical tourism in the respective countries in order to improve patient care and help expand the market. Many countries could see potential for significant economic development in the emergent field of medical tourism. Cosmetic surgery, dental care, elective surgery, fertility treatments, cardiovascular surgery and genetic disorder treatments are the most preferred healthcare treatments in this sector.

High cost of medical treatment in the developed countries and availability of those treatments at a lower cost in other countries have fueled the development of medical tourism. In addition, the availability of latest medical technologies and a growing compliance on international quality standards drive this market. The use of English as the main working language solves the problem of communication and patient satisfaction, adding to the growth of this market. Enhanced patient care, health insurance portability, advertising and marketing help the medical tourism industry to grow at a fast rate. On the other hand, infection outbreaks during or after travel, issues in following up with the patients before returning to their own country, and medical record transfer issues are the factors restraining the growth of the tourism industry. However, the unavailability of certain treatments at a lower cost hampers this market more than any other factors.

The global market for the medical tourism industry is segmented based on treatment type (cosmetic treatment, dental treatment, cardiovascular treatment, orthopedics treatment, bariatric surgery, fertility treatment, eye surgery and general treatment) and geographical regions. Cosmetic treatments hold the largest market share, as cosmetic surgeries are not covered by insurance.

Based on geography, the market is segmented into North America, Europe and Asia-Pacific. APAC holds the largest market share, followed by Europe. Thailand and Malaysia are strong markets with prospect for significant growth, followed by Korea.

The key players in the global medical tourism market are Bangkok Hospital Medical Center, Asian Heart Institute, Apollo Hospitals Enterprise Ltd., Bumrungrad International Hospital, Fortis Healthcare Ltd., Min-Sheng General Hospital, Raffles Medical Group, Prince Court Medical Center, KPJ Healthcare Berhad, and Samitivej Sukhumvit.

For more information please click on:

Models, Models, Have We Got Models! today reported that CMS (those lovely folks with all them rules), launched three new policies Tuesday that continue the push toward value-based care, rewarding hospitals that work with physicians and other providers to avoid complications, prevent readmissions and speed recovery.

The newly finalized policies are meant to improve cardiac and orthopedic care, and also create an accountable care organization (ACO) track for small practices, according to the report.

There will be three new cardiac care payment models for hospitals and clinicians who treat patients  for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery.

Federal officials said that the cost of their care…varied by 50% across hospitals and the share of patients readmitted to the hospital within 30 days also varied by 50%. Medicare, the article points out, spent more than $6 billion in 2014 for care provided to 200,000 Medicare patients who were hospitalized for heart attack treatment or underwent bypass surgery.

As for orthopedic care, the new payment model is for physicians and hospitals that provide care to patients who receive surgery after a hip fracture, other than hip replacement.

They also finalized updates to the Comprehensive Care for Joint Replacement Model, which began earlier this year.

So far, that’s three models. But wait, there are more where those came from.

There’s the new Medicare ACO Track 1+ Model, that has a more limited downside risk than other tracks in the Medicare Shared Savings Program (another model I discussed a while back in the post, “Shared Savings ACO Program reaps the most for Primary-care Physicians“).

These new five-year models provide clinicians with other ways to qualify for a 5% incentive payment through the Advanced Alternative Payment Model (APM) path under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. (three more models — so many, in fact, I am losing count)

Why am I pointing out the problem with the release of new payment models?

I’ll tell you why. When I began my MHA (Masters in Health Administration) degree program, I took an online elective on Healthcare Quality. The textbook we read discussed how CMS over a period of several decades, created and instituted so many models and programs, that it made me wonder why our health care system was so complex, expensive and so out of whack compared to health care systems of other industrialized countries.

The answer was simple. Too many models, programs, rules, and so on that only gum up the works and make real reform not only impossible, but even more remote a possibility as more of these inane models are added to what is already a broken system.

Winston Churchill said that you can always count on Americans to do the right thing, after all the other things were tried. We are still on the trying part, and I am afraid we will never get to where Sir Winston said we would.