Category Archives: Hip replacement

An Old Story Resurfaces

My loyal readers may recall that in two separate occasions, I discussed a company in North Carolina called HSM that chose to send its employees to India and Costa Rica for medical care under their self-insured health care plan.

The two previous articles, US Companies Look to ‘Medical Tourism’ To Cut Costs and Self-Insured Employers and Medical Travel: One Company’s Experience came out of an interview in Business Insurance.com that was conducted by the author and the Director of Benefits for HSM, Tim Isenhower.

This morning, my good friend Laura Carabello of US Domestic Medical Travel.com published another interview with Tim, adding two more locations to their medical travel portfolio, Cancun and the Cayman Islands.

The interview is reproduced verbatim below, and pay attention to one point Tim makes about his company’s workers’ comp costs, a point I mentioned previously and cite as a basis for considering implementing medical travel into workers’ comp.

Here is the interview:

SPOTLIGHT: Tim Isenhower, Director of Benefits, HSM
Spotlight U.S. Domestic by Editor – March 20, 2018

About Tim Isenhower

Tim Isenhower, Director of Benefits – has worked with HSM and their self-insured health insurance for the past 25 years. Managing a self-insured health plan through the 90’s to today has provided him the opportunity to think out of the box for reduced healthcare cost programs including direct contracting, on site clinics, chronic disease management, and medical tourism. With IndUShealth, Tim and HSM were pioneers in self-insured companies offering medical tourism, as was presented on ABC News and Nightline.

About HSM

HSM is a privately-owned holding company based in Hickory, North Carolina, that specializes through its subsidiaries, in the manufacture of components for the furniture, bedding, transportation, packaging and healthcare industries, and the design and construction of automated production machinery for the bedding, apparel, aerospace and other industries.

Medical Travel Today (MTT): As a pioneer in the medical travel phenomenon, your story and your company’s role is so intriguing.

Tim Isenhower (TI): We are a manufacturing company and have had facilities coast to coast, as well as technologies in small towns and big cities. We were negotiating discount rates with hospitals across the country, where prices varied based on location.

I went to a human resource seminar in Raleigh in 2007 and Rajesh Rao’s company, Indus Health, was presenting medical travel to India as an option for employers. I went to India with Raj and his team, and got a physical exam which took less than six hours. In the U.S., this type of physical would have taken a month, from schedule to results.

So, we began offering medical travel to India for our employees during our annual enrollment process. We told them that if they chose to have a medical procedure done in India we would pay 100 percent, including travel with a companion.

We got no takers in the beginning. But at one of our final meetings, a fork lift driver from one our plants volunteered to have a knee replacement done in India – he simply couldn’t afford to have it done in the U.S.

He had never even been inside an airport, so I went with him and his travel companion. I was a little nervous because he had no experience traveling. But we got to India, and he actually did very well. He was impressed by the level of treatment he received.

When he returned home, he wrote a testimonial for our company newsletter. After that, more of our employees started traveling to India.

Soon word-of-mouth inspired more of them to get their surgeries in India because they saw what a positive experience it was.

MTT: So why did you shift your destination away from India?

TI: The cultural differences and distance resulted in many of our employees becoming homesick.

So, we started looking closer to home for medical care options. We have a large Hispanic population and Costa Rica had a history of high quality healthcare. We chose that area as the new medical travel destination.

Mostly, we send people for gastric procedures, joint replacements, back surgeries, hernia surgeries – a wide gamut of procedures.

Positive word-of-mouth has kept up the level of interest, and we also visit every location each year to promote the medical travel offering so more employees can understand its benefits.

MTT: And now you have expanded to Cancun. Do you find that there are other opportunities?

TI: We have. We had a patient go to Cancun just a couple of months ago. She did very well and that was a little different concept because it was an American doctor who flew down to Cancun to do her hip replacement. She was very happy with the services, pricing and results. We also send people to the Cayman Islands for various surgeries.

MTT: What has this experience meant to you, as an employer, beyond the cost savings?

TI: It’s really benefitted employee morale, to have a chance to travel to a place like Costa Rica, Cancun or the Cayman Islands. They come back and tell everyone about what a positive experience it was.

We’ve also been able to use our medical travel option as a recruitment tool.

What’s more, we saw our worker’s comp costs decline. [Emphasis mine]

I get thank-you notes from our medical travelers all the time, and we publicize these positive experiences within the company.

There’s no charge to the employee, and we give them a bonus when they return of 20 percent of what they saved the company.

MTT: Wow! That’s very generous.

TI: Up to $10,000. We are just trying to be a good employer, and this is just one way of doing that.

MTT: Do you know how many of your employees travel for surgery every year?

TI: I have lost count. We have roughly 2,500 employees now, and we’ve probably sent about 500 of them during the period of time that we have been doing this.

MTT: Did you ever have any unexpected outcomes?

TI: We’ve had people who had issues with back surgery, and they weren’t allowed to come home until the issue was resolved. But it was resolved.

They got better, came home and are doing very well.

That doesn’t always happen in a U.S. hospital. Here if a patient has issues down the road, they are on their own.

MTT: No legal issues?

TI: Fortunately, no. And the program is growing.

We’ve had everybody from executives to line workers utilize the program. Not everyone qualifies. A few have been eliminated because they have comorbidities that makes traveling for surgery unsafe, so these few were turned away.

MTT: And if you had to improve the program in any way, what would you suggest?

TI: I don’t know how I’d improve it.

Everybody that comes back is ecstatic about the program. The folks at Indus Health make it work. I know other administrators who couldn’t make it work. But Indus Health’s nurse case managers and screening process make it a no-brainer.

Rajesh Rao: We work very hard to make sure our patients are happy with our services. We don’t promise what we can’t deliver.

We work hard with our destinations to make sure we can provide assistance and high quality outcomes because that is what sells the program.

Jim Polsfut: I would like to add that it is a pleasure to work with Indus Health for all the reasons that Tim mentions. Their expertise and thoroughness have worked out very well with us.
We focus on three main objectives.

First, the quality outcomes.

Second, the satisfaction that we get from helping patients save money. In the U.S., it is so expensive to receive medical care even when you have a health plan. In that regard, the patient benefits in a significant way.

Finally, the cost benefit to the employer. For self-insured employers, this is important because of the hyperinflation of medical costs in the U.S. It’s difficult for employers to avoid the impact of healthcare expenses.

All of these factors motivate us, and give us a lot of satisfaction to provide a quality medical travel option.

Here is the link to the original: http://medicaltraveltoday.com/spotlight-tim-isenhower-director-of-benefits-hsm/

Advertisements

Ashley Furniture and Medical Travel, part 2

As promised last month, here is the Spotlight article from Medical Travel Today.com about Ashley Furniture’s foray into Medical Travel for their employees.

In case you missed it, here is the link to part 1 of the article.

Models, Models, Have We Got Models!

FierceHealthcare.com 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.

 

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.