Category Archives: Cross-border Health Care

WA State Considering Telemedicine Legislation for WC

Legislators in Washington State are considering a bill, S. B. 5355, that would require the state’s Department of Labor & Industries to pay for telemedicine sert d require the department to provide access to telemedicine and reimburse providers for health care services provided to injured workers through such services.

The bill defines telemedicine as follows, according to the article, “the use of interactive audio and video technology, permitting real-time communication between the patient and the provider. ” It would exclude audio-only telephone calls (my White Paper mentioned this as a legal barrier to implementing medical travel into workers’ comp), fax messages, or emails.

Should this become legal, telemedicine services provided by hospitals, rural health clinics, physician offices, community mental health centers, and skilled nursing facilities would be covered.

This would have a profound impact on implementing medical travel into workers’ comp in Washington State, as this is one of two states that allows patients to travel outside the state or outside the country for medical treatment.

The Department of Labor & Industries has a page on their website called “Find A Doctor” where they list physicians in both Canada and Mexico, as well as the rest of the US, and when I began my research for my paper back in 2011, had a list of physicians in the following countries:  England, Germany, Honduras, New Zealand, the Philippines, Spain, Thailand and Ukraine.

As more states allow telemedicine services to be covered under workers’ comp, the day will come that getting surgery abroad, especially in the Western Hemisphere countries, will become reality, and will go a long way to lower costs and speed workers back to work, and relieve the stress to the health care system that repeal of the ACA will have on health care in the US.

Trump Esta Loco: What it May Mean for Cross-Border Healthcare

In picking a fight with Mexico over the building of a wall on the US/Mexico border, the current illegitimate occupant of the Oval Office is not only threatening the relationship with our nearest neighbor to the South, but with our number two trading partner, as the following stats point out for 2016:

2016 : U.S. trade in goods with Mexico
Total 2016 Exports: 211,848.7
Imports: 270,647.2
Net: -58,798.6

Source: https://www.census.gov/foreign-trade/balance/c2010.html

By threatening to slap a 20% import tax on goods from Mexico, including his ties, this so-called businessman, will hurt the very farmers who voted for him, as well as the workers who buy their household goods from Walmart and other low-cost outlets, as many parts or food items are made or grown in Mexico. When I spoke at a medical tourism conference in Reynosa in 2014, we drove along the border area where the maquiladoras are located and saw that one of them makes frozen food that is sold across the border. Want to pay 20% more for that frozen TV dinner?

Then there is all that cerveza and tequila and mescal, not to mention avocados and guacamole that will cost more. Stay very thirsty my friends, because it will cost you more to drink with the most interesting man in the world, and all thanks to the least interesting man in the world.

What then does this mean for cross-border medical care?

If Herr Trump gets his way, not only will Mexican goods get more expensive, but if we get into a trade war, look for costs of medical care south of the border to go up as well, or even slow to a crawl or not at all. There is a hospital being built in Tijuana with the assistance of Scripps Health, and as I’ve written about in the past, the Insurance Company of the West already writes workers’ comp policies to include cross-border healthcare for their insured’s whose employees live in Mexico, but work in California.

Since the passage of NAFTA, trade between the US and Mexico has increased, and the towns along the border have benefitted from it. Back then, the talk of building a NAFTA superhighway was met with strong and fierce resistance (I was living in Texas at the time), but I realized that we already had one. It’s called Interstate 35, and runs from the Canadian border to the Mexican border, as does Interstate 5 on the West Coast.

In two earlier posts, I discussed a case in Arizona where the injured worker received two benefits, one from Mexico and one from Arizona (https://richardkrasner.wordpress.com/2014/01/20/nafta-work-comp-and-cross-border-medical-care-a-legal-view/) and (https://richardkrasner.wordpress.com/2015/02/04/nafta-work-comp-and-cross-border-medical-care-a-legal-view-update/).

So before you book that trip to Cancun for your tummy tuck or face lift, check to see if there is a 20% tax imposed on your flight, hotel, food, etc., from either the US or Mexican governments. If so, thank the orange-haired son of an orangutan.

donaldtrump-orangutan

Cut the C**P!

For my 300th article, I want to address the medical travel industry and its failure to rid itself of the crooks, liars, shysters, and phonies who prey upon the desperate.

Case in point, the article last Wednesday in the New York Times by Gail Kolata about one man’s experience getting stem cell therapy through medical travel.

This case is endemic of the industry’s impotence to police itself and get rid of those medical providers and hucksters who use slick promotional material to sell useless and often dangerous treatments or dubious procedures.

But what do you expect from an industry whose major organization is merely a conduit for funneling money into the pockets of the organization’s founders and their friends?

What do you expect from an industry that emphasizes attending conferences and not on standardizing the laws and processes for the provision of medical care across national borders.

When I started this blog over three years ago, I had high hopes that the industry would listen to what I had to say, and to at least consider offering medical travel to injured workers in the US. But as happened with the workers’ comp industry, no one has stepped up and offered to work with me.

I’m not mad at everyone in the industry. Many of you are very nice people and work very hard, but your focus is on such medical care as dentistry, cancer, cosmetic/plastic surgery, and other treatments not available in the US, or too expensive.

But helping those who are injured on the job, and many of whom are from many of the countries in this hemisphere who offer medical travel services, should be something some of you might want to do.

It was my hope that this industry would offer me a chance to change direction, but that has not happened, and now I am not sure if it ever will.  There does not seem to be any financial or employment opportunities here, just a lot of conferences and hyperbole.

Prove me wrong.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

Cross-Border Health Care in California Expands

In my earlier posts on cross-border health care, “Cross-border Workers’ Compensation a Reality in California“, “NAFTA, Work Comp and Cross-Border Medical Care: A Legal View“, “NAFTA, Work Comp and Cross-Border Medical Care: A Legal View: Update“, and “Cross-border Health Care and the ACA“, I discussed the way some Mexican workers living in Mexico, but working in the US or traveling between the US and Mexico, have been able to get health care on both sides of the border.

An article in Fierce Healthcare.com last month,  says that Scripps Health will help run a hospital in Tijuana, along with Sistemas Medicos Nacionales S.A. de C.V. (SIMNSA).

SIMNSA is the medical insurer in Mexico that the Insurance Company of the West (ICW) contracted with some time ago to treat Mexican workers of ICW’s US insureds in the San Diego/Imperial Valley area of CA.

According to the article by Ilene MacDonald, the insurer will design, build and operate the facility, and will seek accreditation from the international arm of the Joint Commission, the Joint Commission International (JCI), and will be an affiliate of the Scripps Health Network.

Those who think that cross-border health care, whether general or work comp-related is not going to happen better think again, because it is, and while this is just now involving the areas along the US-Mexico border, with or without that stupid wall some jerk wants to build and have Mexico pay for, medical travel on this continent is moving forward.

The only thing that is not happening yet is travel further down into Mexico and into the other countries in Central and South America. But that will happen, no matter what you or any putz running for president says.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Blog is now viewed all over the world in 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

‘Turkishmaninacanstan’ Strikes Back

Readers of this blog know that from time to time, I have had to criticize those in the workers’ comp industry for their short-sightedness, narrow-mindedness, excessive American Exceptionalism, “Know-nothingism”,  xenophobia and subtle racism.

But when a well-respected online journal re-posts an article by the chief anti-medical travel opponent in the workers’ comp world, it is high time that the medical travel industry speak up and defend itself.

As a tireless advocate for medical travel in workers’ comp, I am leading the charge that you, my friends around the world must do for yourselves.

You will notice the title of this post. This is what the individual in question calls those countries that provide medical travel services. Also, please note that by using this canard as my title, I am in no way insulting Turkey, or any other nation that markets their medical care to the world.

There is fair criticism of Turkey and many other countries in the medical travel industry, but those criticisms are meant to improve the services and to correct the mistakes of the past, and not to pass judgement on them.

But when someone uses a term such as ‘Turkishmaninacanstan’, it conjures up the worse images of third world poverty and backwardness in all aspects of life of the nations so broadly brushed with that epithet.

The individual who coined that despicable name is a self-styled, right-wing American conservative who lives on the gulf coast of the state of Florida, a region where many individuals like him retire to after their careers have declined to play golf.

While this individual may not be one of those just yet, the fact that he dismisses new ideas, that he insults the millions of men and women around the world who are trying to offer real low cost medical care at equal or better quality, that he insults the very nations who could use those resources they are spending to bring medical travelers to their countries as a way to improve their balance of trade and economic power in the global economy, when they could be used to raise the living standards of their poorest citizens, is something that can no longer go unanswered.

So, I ask all of you, doctors, nurses, travel agents, medical tourism promoters and facilitators who are legitimately trying to provide better medical care at lower cost to all of the world’s citizens, to speak up and tell this individual and those like him, that your countries are not ‘Turkishmaninacanstans’, and that you are developing world-class medical facilities that outshine those in his own country, and mine.

Basically, he is calling you con artists and frauds, and that is something that only you can stop.

 

 

 

 

Texas State House Seeks to Change Rules for Workers’ Comp

As reported this morning by Elena Mejia in the Houston Chronicle, members of a Texas State House committee are calling for major reforms to that state’s workers’ compensation program that would change coverage rules that now leave thousands of workers uninsured.

Yesterday, the House Committee on Business and Industry questioned state Insurance Department officials at length about employers who are now failing to provide coverage and continuing complaints about the state’s designated-doctor program.

Texas was the first and only state to allow employers to opt-out of the statutory workers’ comp system until Oklahoma passed legislation, that has since been ruled unconstitutional by the Oklahoma Workers’ Compensation Commission.

Testimony given before the committee indicated that participation by physicians in the Designated Doctor Program, in which state-approved doctors examine injured workers to decide claims in disputed cases, has dropped precipitously.

According to Stephen Norwood of the Texas Orthopedic Association, participation is down 67 percent, mostly because the state does not reimburse physicians enough for expenses to travel to remote locations.

Mr. Norwood stated that, “All this time away and expense often unexpectedly to remote locations doesn’t make it feasible for physicians to participate,”… “If you allowed proper specialists to evaluate several workers during same travel, you increase access of workers to more appropriate exams and more efficiency to physicians.”

This testimony caught my eye, as generally, I don’t write specifically about one state, but take an overall, big picture view of the issues surrounding workers’ comp and discuss how medical travel can be implemented to relieve those issues.

This would be a perfect scenario for such implementation, so that injured workers in remote parts of Texas can get their treatment in Mexico that may be less expensive to travel to, rather than to have physicians to take the time and expense to travel to those remote locations.

But I suspect that that solution will elude the Texas legislators like so many other issues have eluded them, such as allowing women the right to have abortions, or the right of all workers to be covered under a mandatory state workers’ comp system that is fair to both injured workers and their employers.

But that would be asking too much of them. Sort of like asking the village idiot from Texas to not think about going to war in two countries at the same time.

 

Trouble Ahead for Workers’ Comp

The Denver Business Journal today published an article by Steve Doss, VP of Commercial Lines at CCIG.

Here are the key takeaways from Conning, a Connecticut-based investment management company for the insurance industry:

  • Accident frequency has increased. A stronger U.S. economy has meant more inexperienced workers have joined the workforce, so high-hazard occupations like transportation and construction have seen increases in work-related injuries since 2012. For example, non-fatal work-related construction injuries jumped 9.5 percent from 2012 to 2013. Also, as older employees work longer, the number of accidents among those 65 and older rose 18.5 percent from 2012 to 2013.
  • Accident severity is rising. The Bureau of Labor Statistics reports that construction fatalities rose 5.6 percent from 2013 to 2015, and manufacturing fatalities rose 9.3 percent from 2013 to 2014. In addition, hospital and drug costs – the biggest expenses associated with workers’ compensation claims – are rising faster than inflation.
  • Evidence of cost-shifting. The Affordable Care Act may be driving physicians and hospitals to “leak” group health cases into the workers’ compensation system, where they can charge more for the same services than under a group health contract, according to Conning.

For those of you not familiar with workers’ compensation, and those of you who are, what each of the bullet points mean, in simple terms is this:

  • More accidents,
  • Degree of accident injury increasing and,
  • Cost-shifting is occurring.

Isn’t time to stop and realize that whatever programs are implemented, whatever analytical or predictive modeling techniques are utilized, whatever the so-called “experts” say is the cause of this or that problem, whatever so-called “reform” or work comp alternative is attempted, wouldn’t it be prudent to think outside the box, and outside the borders of your limited minds?

Schopenhauer said the following:

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

Those of you who will not listen to other ideas, no matter how far-fetched they may be, have limited your field of vision and taken them as the limit of the world. The world is globalizing, health care included.

Aerospace technology will very soon allow us to travel to any part of the world in under four hours. Don’t believe me? Ask Boeing why they are running commercials that tout that very same possibility.

Those who cite judges as saying no to medical travel must ask yourselves this question: Do doctors sentence people to death? (By that I mean execution, not natural death from disease or incompetence)

Those who say the laws won’t allow it, should know that laws can be changed, and laws written in the era of the horse and buggy should not dictate to the post-modern, jet-age, and soon-to-be sub-orbital space plane age. Would you like to live under the laws of Caesar or Charlemagne?

And finally, those who say the injured workers won’t go abroad to get better medical care, have you ever asked them, or are you just putting your words in their mouths?

Methinks you all doth protest a bit too much for the sake of injured workers and myself. Look in the mirror and ask yourselves why workers’ comp is failing. The answer is staring right back at you.