Category Archives: ERISA

Fam Tours for Self-Insured Employers

The subject of medical travel for self-insured employers is one that this blog has rarely discussed from the point of view of the medical travel facility.

Previous posts here have discussed a possible scenario for medical travel by self-insured employers under workers’ comp, the experience of one company that did so for its employees under their group health plan, and why self-insured employers are failing to adopt medical travel, as well as other posts that briefly mentioned self-insured employers.

Yet, at no time has this reviewer, in the position of content writer, ever discussed how the medical travel facilities can market their services to potential self-insured customers.

A new book by Maria Todd, her sixteenth in fact, does exactly that. Organizing Medical Tourism Site Inspections for Self-Insured Employers is a well-written manual for medical travel facilities seeking to highlight the services they offer by hosting site inspections, or more colloquially known as “fam tours,” or familiarizing tours.

Note: This writer had participated in only one fam tour to medical facilities when I spoke at a medical tourism conference in Mexico in 2014.

Knowing the Customer

Dr. Todd’s book focuses on the ways medical travel facilities can know their customers by knowing which self-insured employers are more likely to develop a medical travel program for their plan beneficiaries, and the criteria the Plan Administrators will look for to engage their services and the conditions under which such travel is possible.

One example given is if flying time to a medical tourism destination is less than three hours by plane. For American workers, who have US passports, longer distances would eliminate travel to parts of Asia, the Middle East, parts of South America, and Russia. Such locations would be possible if the employees were working there or nearby, and they were the closest facilities available.

She also discusses what will attract multinational employers who have workers around the world to select facilities that can handle industrial accidents, as well as general health and rehabilitative services. Some employers may be self-insured for their domestic employees, but purchase an insurance cover called an International Private Medical Insurance, or “IPMI.”

Selling Solutions

To educate hospital executives and managers on how to sell solutions to Plan Administrators, Dr. Todd includes a chapter on a topic she says executives and managers often do not consider important.

The chapter focuses on what not to say or do when conducting a site inspection. You, as the seller might consider certain areas of your facility important to highlight, or is one that you take pride in, but may not be something your guests are particularly interested in.

One such area is Accreditation. Not knowing abbreviations for accrediting organizations such as the Joint Commission International (JCI), or what the big deal is about accreditation, is something the executives and managers need to be aware of beforehand and to be prepared to explain why it is important.

Proper accreditation will go a long way to ease their minds over deciding to use that facility, and being presented with an unfamiliar or disreputable accreditor, or one whose certificates are not worth the paper they are printed on, is something to be aware of also.

Another area of concern when hosting a site inspection is scientific presentations. It is quite possible that some of your guests may be physicians and nurses who will benefit from seeing such presentations, but for those Plan Administrators who are not medical personnel, such tours maybe considerably boring, if not completely too technical for them to comprehend.

Technology Tours

A similar mistake made is taking business-focused guests to see the technology the facility has installed and uses. Dr. Todd recommends they create a spreadsheet of the expensive equipment they have and write a short blurb about each.

Her main point is this: Plan Administrators are seeking three things: transparency, good value, and superb, culturally-sensitive customer service.

Other areas to avoid on Fam tours

The Emergency Department, laboratory, radiology and imaging department, cardiac catheterization lab, and the PET/CT, and PACU’s are a waste of time, per Dr. Todd, and may even disturb the patient’s privacy and recovery.

Final five chapters

The final five chapters deal with developing relationships, the contracting and provider network criteria (where to get preliminary data, contract terms and payment agreements, and avoiding payment hassles with the right language), the basics of ERISA (ERISA fiduciary responsibilities, self-insurance plan sponsorship not limited to the US, and government employers pay for healthcare services outside of their countries), how to prepare for site inspections, and lastly, rate proposals.

Closing

Dr. Todd’s book is a must for any self-insured employer considering a medical travel program for their beneficiaries. For those employers who self-insure for general health care, this book provides them with the knowledge they need to have to explore doing so. For those self-insured employers who self-insure for workers’ comp, this too is an important book.

The likelihood that the Affordable Care Act will be repealed or replaced, with something worse, or with nothing at all, grows stronger every day now. Once that happens, premiums will rise, and alternatives such as medical travel will seem much more plausible and cost-effective.

While this book was written from the perspective of the seller of healthcare services, purchasers of such services, either domestically or internationally, can benefit from reading it. Not knowing what to look for will only cost you time and money and be harmful to the health of your plan and your employees. I highly recommend this book to you.

Interesting Article on PPO’s

Forbes.com has published an extensive article claiming that PPO’s have perpetrated a great heist [author’s words] on the American middle class.

According to the article,  trillions has been redistributed from the American workforce to the healthcare industry, creating an economic depression for the middle class.

The article consists of an interview conducted by author Dave Chase and Mike Dendy, Vice Chairman and CEO of Advanced Medical Pricing Solutions, Inc., a healthcare cost management company.

Here is the link to the full article:

http://www.forbes.com/sites/davechase/2016/09/05/have-ppo-networks-perpetrated-the-greatest-heist-in-american-history/#25489cd66d00

Is it any wonder why work comp is also so screwed up? Too many cooks (or is that crooks?) taking their “cut” out of the middle class.

But we keep insisting that we have the best health care system in the world, that our workers get the best care when they are injured and don’t need to have any alternatives explored to improve the care and treatment they get, and that the free market is the best way to provide health care. It’s free alright. Free for the greedy to become more greedy. But not for you and me.

ERISA, Stop Loss and Unintended Consequences

“The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were.”

John F. Kennedy

“Some men see things as they are and say why. I dream things that never were and say why not.”

Robert F. Kennedy

“It is not because things are difficult that we do not dare, it is because we do not dare that things are difficult.”

Seneca

Those quotes were included at the top of my June 19, 2013 post, “Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation” where I defended myself against the charge that I was offering “simplistic solutions” to medical travel and workers’ comp. In that post, and in “The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible and is not a Pipe Dream” I acknowledge that is won’t be easy, but there are ways to do it.

In my last post, “Self-Insured Employers Fail To Adopt Medical Travel“, I discussed the reasons given by Irving Stackpole for why US employers have failed to adopt medical travel into their corporate health plans.

In conversations with a noted ERISA and medical travel expert, I have been making the case that laws and regulations such as ERISA, Stop Loss, and other “barriers” erected decades ago, in order to address specific problems such as tort claims, aggregate claim losses, etc., have the unintended consequence of holding back the globalization of health care, which includes workers’ comp.

I have addressed the legal barriers in comp in my White Paper, and found that there were outdated federal and state laws and regulations, intended to protect consumers, actually increase costs and reduce convenience, restrict public providers from outsourcing certain expensive medical procedures, and that federal laws inhibit collaboration, while state licensing laws prevent certain medical tasks being performed by providers in other countries.

Let me state here that I, in no way, am advocating the removal of these laws and regulations. My chief argument is this: our best minds have split atoms, launched satellites and men into space, discovered cures for diseases plaguing humans for centuries, but to send patients to other countries for medical care is impossible, and not worth pursuing, smacks of cowardice or fear that it actually might save money and provide better care. Do we not have the best minds to figure out how to deal with these “barriers”, or are we too fearful and litiginous a society that we have given up accepting new ideas?

Every industry is being affected by two powerful forces today: globalization and automation. With globalization, jobs, plants and other forms of capital are moving across borders. With automation, jobs that were once held by humans and considered very dangerous, are being done by robots, and soon other jobs will be done by artificial intelligence.

Neither force can be stopped, and how we address the consequences of these forces is what many minds are working on right now. But to say that one industry is going to draw a line in the sand and say, “NO” and stop globalization from happening is either insanity or a deliberate attempt to profit from the maintenance of the status quo that many along the supply chain of medical care services, both within the general health care space and workers’ comp have carved out for themselves.

When I was in college, I studied International Relations, and back then, globalization was a word very few outside of academia ever heard. There was an organization created in 1973 by David Rockefeller and Zbigniew Brzezinski called the Trilateral Commission. Its purpose was to foster better cooperation between the countries in North America, Western Europe and Japan (the Trilateral countries) and their multinational corporations. In the ensuing decades, the Commission expanded the membership to the rest of the world, and globalization became a household word.

Coincidence? I think not, since the heads of major US, Western European, and Japanese companies were members, and so were many politicians, including a former peanut farmer from Georgia and most of his top administration personnel. Other politicians after him also have been members, from both sides of the political spectrum.

Their chief goal is to allow capital, goods and jobs to cross national borders, or to eliminate them altogether, and I doubt they expected the health care industry to stand in their way. These are men who generally get what they want, and damn the consequences. We see this in the breakup of the European Union, which many of them advocated for years, just like they advocated for NAFTA, CAFTA, the TPP, and other trade deals, and don’t give a fig about the impact they have.

So, it is important to realize that the only real thing preventing medical travel is what unintended consequences have on the growth and development of the industry. This is where the industry needs to focus its attention, not on slick advertising, but on hard work and cooperation to overcome these “barriers”.


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’ 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.

Self-Insured Employers Fail To Adopt Medical Travel

When I began my writing, one of the ways I saw medical travel could be implemented into workers’ comp was through employers who self-insure.

There are not that many companies who do self-insure for several reasons, one of which is the administrative costs and extra hoops they would have to go through just to get approval from state regulators to be self-insured. This is something most small employers will not do. More on what I think about this later.

Today, Irving Stackpole, President of Stackpole & Associates (a LinkedIn connection of mine), wrote an article in the International Medical Tourism Journal (IMTJ) about why US employers have failed to adopt medical travel benefits.

For the sake of transparency and honesty, I have never met Irving, but have had discussions with him a few times on LinkedIn in some of the groups we have in common. I have met his co-host of his radio show, Elizabeth Ziemba, when we both attended the 5th Medical Tourism and Wellness Business Summit in Reynosa, Mexico in November 2014.

In his article, Irving mentions that while some small employers such as HSM (who I have written about in earlier posts), Hannaford Supermarkets, the Casino and Hotel of the Blue Lake Rancheria Tribe in Northern California, and IDMI Systems have added medical travel to their health plans, he does not know of any large employers who have.

When I attended the 5th World Medical Tourism & Global Healthcare Congress in 2012, large employers such as Disney Institute, American Express, and Google sent representatives to speak at the Congress. If they attended, then surely their companies must be involved in some degree with medical travel? What did they discuss? Certainly not the weather (Hurricane Sandy was right outside the hotel).

But I digress, yet again.

According to Irving, six percent of firms offering fully-insured plans reported that they intend to self-insure because of the ACA. So, he is correct in that not many companies are self-insured.

However, Irving also states that it is estimated that the average self-funded plan covers between 300-400 employees, and that 59% of them in the US self-fund as part of their health plan.

And he goes on to say that many small companies are looking to self-fund to reduce their share of the cost burden, but that because small employers are not able to assume the same risk levels, stop loss rates are rising. This pressure, he adds will serve as a limitation on the expansion of self-funded health insurance into the smaller market.

Irving concludes that there are four reason why large self-insured companies would add an additional medical travel benefit to their insurance plans:

  • Current implementation of the ACA has distracted or absorbed attention of insurance markets, including self-insured companies. Many companies are wrestling with far issues of how many employees will be included/excluded, potential penalties, and avoiding fines under the ACA;
  • Self-insured plans are exempt from many of the more costly and burdensome requirements of the ACA as long as they don’t make significant changes, therefore they are careful about keeping their plans unchanged;
  • Reinsurance, or stop loss coverage may be limited for plans offering a medical travel benefit, and;
  • There is no history of outcomes , evidence or actuarial models to support the case among employers for a disruptive change such as international medical travel. Reports suggesting cost savings and quality outcomes are not yet supported by evidence.

One other factor Irving suggests as to why many employers have avoided medical travel is because many find it necessary to contract with a third party administrator (TPA) to collect premiums, manage membership enrollment, claims adjudication and payment. These TPA’s are sometimes referred to as providing “Administrative Services Only” contracts or “ASO” contracts, where they provide typical third party administration services, but assume no risk for claims payment.

Because of these contracts, Irving says that while economic logic suggests that self-funded employers should be interested in high quality, lower cost destinations, it is necessary to convince both the benefits manager and the TPA/ASO  of the value of being a destination provider, and the low risk associated with accessing international medical travel.

Okay, now it’s my turn.

“Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.”

Muhammad Ali

While everything Irving wrote about appears to be factually true at the moment, and I cannot dispute what he says, the fact that employers have been unwilling to pursue medical travel is more complicated than the reasons he gives above.

True, the ACA has many things in it that may or may not seriously impact health care and the health insurance industry, but what he does not mention is that many of the things holding employers back pre-date the enactment of the ACA, and are more concerned with keeping health care the purview of those along the supply chain who profit the most from the system we have created, and not concerned with providing people either under health insurance or workers’ comp, with the best medical care possible, at the lowest cost, no matter where it comes from.

TPA’s and ASO’s and ERISA, and many other mechanisms such as stop loss insurance, and risk avoidance, etc., are mere barriers to the implementation of medical travel into both health care and workers’ comp.

Using my oft-time quoted analogy of going to the Moon, imagine if the baby steps we took to get there such as the Mercury, Gemini and early Apollo programs were not baby steps to the Moon, but actually barriers set up so that we are thwarted every step of the way to getting there or to go even further, such as landing humans on Mars. Don’t you think there would be people just like Irving who would say that it cannot happen?

That is why I quoted the late Muhammad Ali. For a poor black kid from Louisville, he sure had a better understanding of what can be than most folks who did not grow up like he did.

But this does not let the medical travel industry off the hook. I said so in my post, “Ensuring Patient Safety: Making Sure Medical Tourism Puts Its Money Where Its Mouth Is“.

But it is not just the industry itself that needs to come clean. Foreign governments and their travel ministries, the medical travel facilities, the providers, and the facilitators must present hard evidence that better quality and lower cost is possible, and so that when some of the dire predictions of the impact of the ACA are fully realized, or the US health care system collapses of its own weight (see my post, “Colorado “Single Payer” in Health Care Industry’s Sights“), medical travel as an alternative will become more acceptable to US employers, large and small, and not just for health care, but for workers’ comp as well.


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’ 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.

RESISTANCE IS FUTILE!: What is the reason behind Medical Tourism’s Rejection?

My friend, Maria Todd, PhD, noted International Expert on Healthcare & Health Tourism Business Strategies & Operations, Business Owner, Author, and Speaker, has written a very cogent and to the point article challenging American hospitals on why they eschew inbound medical tourism.

For the uninitiated, inbound medical tourism, or travel, refers to foreign patients traveling to the US or other countries for medical care from their home country.

A case in point was the late, and not lamented, Shah of Iran who was allowed to come to the US for treatment of his cancer, and which led to the taking hostage of our embassy staff, destroying what was left of one presidential administration, and secretly aiding another to win the election, and thus look good in the eyes of the American people, only some time later to that administration selling arms to Iran for other hostages, the cash then used to support the Contras in Nicaragua.

But I digress.

As the Shah had money, he was welcomed with open arms, but Maria wonders why other American hospitals, knowing that they will receive cash, still refuses to seek out inbound medical tourism as an alternative source of revenue.

According to Dr. Todd, “It is estimated that the USA is the 3rd most popular destination for inbound medical tourism from other countries, but the practice of traveling for health has been a “thing” in the USA for more than 100 years.

Corporations such as Pepsico, Lowe’s Home Improvement, Boeing, WalMart and many other corporations, she writes, with self-funded health plans under ERISA, have the freedom to contract with any hospital, anywhere in the world without going through a managed care network, but can’t because the hospitals with lots of value to offer simply don’t seem interested enough to talk to them.

She wants to know why not? In order for her to find the answer to that and other questions, she is asking her colleagues in healthcare business development and business administration who are executives at leading healthcare institutions and well-equipped ASCs across America: “Why do you eschew medical tourism business?

This question, and the others that she poses in her article, also relate to outbound medical tourism as well.

Why do employers, insurance companies, the domestic health care industry, which is beset by so many problems and potential shortages and inefficiencies, as well as the entire workers’ compensation industry eschew medical travel for non-work-related illnesses and diseases, and work-related injuries requiring surgery?

I’ve written about this many times before. I have cited American Exceptionalism, racism, xenophobia, greed, ignorance of the quality of medical care abroad, and many other factors, but as Maria points out for US hospitals turning down cash patients, employers and carriers can save money by looking outside our broken and dysfunctional medical care system under workers’ comp.

It’s high time the US joins the rest of the world, and allows our citizens the freedom to go wherever they want for medical care, no matter what the cause, or condition that prompts them to seek medical care that is high quality, and will save money for their employer, and provide them an opportunity to see the world that also belongs to them.

Not to do so is tantamount to enslavement to a corrupt and rigged system that benefits unscrupulous physicians, pharmacies, pain management centers, and other workers’ comp service providers, and harms injured workers.

Medical travel will happen. Resist at your peril.