Category Archives: Integration

Integral Healthcare

Doubling down on contentious issues is not just confined to the realm of politics.

An article in Monday’s Journal of the American Medical Association (JAMA) states that single payer for the United States is politically infeasible, and concludes that to achieve universal coverage without single payer, enforcing the individual mandates and assessing real penalties for not purchasing insurance is the best option.

To bolster their argument, the authors, Regina E. Herzlinger, Barak D. Richman and Richard J. Boxer, point to three countries that have a private-sector insurance system. These countries are Switzerland, Singapore, and Germany.

After exploring two other options, creating risk pools for enrollees with preexisting conditions, and pooling costly patients into Medicare, the authors contend that the individual mandate, which the Supreme Court characterized as an annual tax, would be assessed against individuals who did not purchase health insurance within that calendar year.

The authors believe that while it is vilified by some, it is attractive for the following reasons: it is easy to implement, is effective in pooling risk, and reflects the values of individual responsibility (more on values later).

But the authors are mistaken. Many Americans will balk at paying for health insurance, with or without penalties, for individualistic, libertarian reasons. Also, those individuals who are unemployed and who have not filed tax returns for several years, at least under the ACA as it is now enacted, will not be able to get even a subsidy to pay for it. (my own situation that I contacted my Congressman about twice)

Per the authors, Swiss citizens must purchase health insurance, if they do not, the government does it for them. And the insurers can implement debt enforcement proceedings against anyone failing to pay for insurance, collect a penalty and any back premiums.

Singapore has compulsory contributions from employers on behalf of their employees to create medical savings accounts, and it is up to the employee to maintain these accounts for expenses such as health and disability insurance premiums, hospitalization, surgery, rehabilitation, end-of-life care, and outpatient services. Failure to do so are subject to garnished wages and other legal actions. The unemployed, or poor are eligible for subsidies.

Lastly, German insurance is funded by compulsory contributions to private insurers levied as 7.3% of income. Those who are unemployed have theirs taken out of their benefits plus means-based sliding-scale subsidies, and uninsured, self-employed individuals who try to purchase insurance are faced with payment of back premiums for the uninsured period.

Some of the methods described above have been suggested here in the US, or are part of the ACA already, but is not sufficiently strong enough for the authors, or maybe part of the “repeal and replace” packages now stalled in Congress. Therefore, the authors have decided to double down on the one part that the GOP wants to eliminate and that many Americans find onerous, paying a penalty for not having insurance.

But is this really the right way to go, as I mentioned in yesterday’s post, “Damned If You Do, Damned If You Don’t.”

To answer that question, I would like to introduce you to Spiral Dynamics and the next generation economic system, MEMEnomics.

Spiral Dynamics is a biopsychosocial theory of human development based on the research of the late psychologist, Clare W. Graves. Graves was a contemporary of Abraham Maslow, whose “hierarchy of needs” was the first psychology model of a hierarchical nature of human development.

Graves’ framework, called the “Levels of Human Existence”, relates to Maslow’s needs, but Graves realized that Maslow’s model did not adequately express the dynamics of human nature, the process of emerging systems, or the open-endedness of the psychological development of a mature human being.

“Briefly, what I am proposing is that the psychology of the mature human being is an unfolding, emergent, oscillating spiraling process marked by progressive subordination of older, lower-order systems to newer, higher-order systems as an individual’s existential problems change. Each successive stage, wave, or level of existence is a state through which people pass on their way to other states of being. When the human is centralized in one state of existence, he or she has a psychology, which is particular to that stage. His or her feelings, motivations, ethics and values, biochemistry, degree of neurological activation, learning system, believe systems, conception of mental health, ideas as to what mental health is and how it should be treated, conception of and preference for management, education, economics, and political theory and practice are all appropriate to that state.”

Graves proposed that all the forces shaping the marketplace, whether individuals, groups, or cultures, should be looked at from a more integral view that includes the biologic, psychologic, and sociologic aspects, and to examine them in an ever-evolving dynamic culture. He placed these dimensions into eight known hierarchical levels of existence called value systems.

Graves’ ideas would have remained confined to the academic world if it was not for his colleagues, Don Beck and Christopher Cowan, who patented Graves’ work into what they called Spiral Dynamics, taking the name from Graves’ explanation of human psychology. They even wrote a book by that title, which should be read first to gain full understanding of the theory.

When they began their work, they translated Graves’ levels (he used pairs of letters starting from “A” to “H” and from “N” to “U” to represent the life conditions and ways in which humans solved their existential problems) to colors (Beige, Purple, Red, Blue, Orange, Green, Yellow, and Turquoise). This was a way to better memorize the vMEMEs, borrowing the term, meme, from Richard Dawkins, or value systems.

The following table shows the vMEMEs and the percentages found in the population, plus the percentage of power they have in human society. It is important to note that the American population can be found in the last three levels. It is the Blue/Orange vMEMEs that control much of the political, social, and economic agenda of the US, and explains why Green’s values have had a hard time getting accepted, which is why the US is unable to make the leap to the next tier.

sd-population

Colors of thinking.png

Dawkins described memes as “a unit of cultural information that is capable of self-replication and uses the human mind as a host.” For Beck and Cowan, vMEMEs, or value-systems memes begin to shape how individuals, organizations, and cultures think. Along the way, Beck partnered with philosopher Ken Wilber, whose Integral approach was adapted to Spiral Dynamics into Spiral Dynamics Integral.

The following chart illustrates the AQAL model of Spiral Dynamics Integral.

sdi-aqal-1024x690

There are two alternating types; individualistic and expressive, and group-oriented and sacrificial. Both types alternate, and with the passage of time, existential problems arise within each value system that can no longer be solved at the current level. The pressure and energy created by the value system’s inability to solve its problems leads to the emergence of the next level, spiraling upwards and alternating between the types.

So, for example, Capitalism is an individualistic vMEME system, whereas Socialism is a collective vMEME system.

Which brings us to discussing MEMEnomics. MEMEnomics is a composite of the words “meme” as we have been discussing, and economics. The book titled MEMEnomics, by Said W. Dawlabani, is sub-titled, “The Next-Generation Economic System.”

I have read it once, and in the process of re-reading it for better understanding, and explains clearly through Spiral Dynamics why the financial difficulties of the last decade occurred, and guides us to a better, integrated, and holistic future. Dawlabani says that the difficulties the US is facing today (published in 2013) are a result of the evolution from one system to another.

But most importantly, Dawlabani examines the history of the American economy from colonial times to the present day through a memenomic framework, that corresponds to the levels of human existence found in Graves’ work.

These two charts illustrate MEMEnomics and Spiral Dynamics better.

memenomics

memenomicsspiralchart-e1388953833163

Already, there are changes occurring in the economy that signal that there is an evolution. The emergence of the sharing economy found in companies like Uber and Lyft, and Airbnb, are just some of the examples of this emergence. The green economy, as in environmentally friendly, is an example of the healthy side of the Green vMEME, and even exhibits some aspects of Yellow Sustainability.

So where does health care fit in all this?

Health care as it is provided for in the US, is mostly through employers, government programs aimed at specific demographic groups such as the poor, elderly, and children, and through private insurance sold by insurance companies.

The reason for the passage of the ACA was to eliminate some of the disadvantages in employer and private health insurance plans, and to ensure coverage for all by making people purchase coverage. But that has angered many, and is the main reason for the repeal and replace rhetoric in Washington.

The authors of the JAMA article, like many before them, are doubling down on a method of providing coverage that is trapped within the Orange vMEME system. Yet, as Spiral Dynamics and MEMEnomics has shown, there must be an evolution in the way we think about many aspects of human life, health care and its provision included.

We must build the health care system of the future now, not the health care system of the past. Spiral Dynamics and MEMEnomics points us to a future where all aspects of human civilization is integrated and holistic, and health care is a part of that integration.

Any doubling down on the value systems of the past as human development spirals upward is unhealthy and must be avoided. If we continue to require the purchase of a commodity such as health insurance (Orange vMEME – value system) when human development has transcended and included Orange and moved on past Green into Yellow or Turquoise, it would be like Americans living today living like their ancestors did back in Roman times.

I don’t think that is possible, nor is it desirable. And neither is the solution the authors have recommended. We must integrate all our current health care systems into one integrated system, including Workers’ Comp, not because it will save money (which it will), but because human development is headed in that direction.

Not to do so is harmful to the spiral and to human development.

A Little Disruption is a Good Thing

Staying on the topic of single payer, this time discussing its impact on workers’ comp, David De Paolo wrote an article today that describes Colorado’s Amendment 69 as a disruption of the status quo, and he points out that the tech industry has disrupted business models and industries for several decades and that the work comp industry needs to be disrupted as well.

He goes on to say that ColoradoCare (Amendment 69) is a debate and idea that is long overdue. The arguments against the idea, De Paolo writes, of a single payer system strikes him as simply entrenched interests seeking to protect their turf and business models.

Earlier this week, Workers’ Comp Insider published an article, “It’s A Colorado Rocky Mountain Low” that opposed the approval by Colorado voters this November of the amendment, using the reasons David cites in his piece, and some of the usual misleading distortions that only confuse voters on substantive issues such as this.

Readers will recall my previous two posts, the first, “Colorado Gets Real on Workers’ Comp and Health Care” which introduced the Amendment and the push to bring the two silos of workers’ comp and health care together, and the second, “Colorado “Single Payer” in Health Care Industry’s Sights” which described the health care industry’s attempts to derail the amendment’s approval.

The issue of combining the two silos was brought up by yours truly in an earlier post, “Betting the Farm“, and as I wrote then, not an original idea of mine. Yet, by reading David’s post, and the one by LynchRyan, you get the feeling that the only reason not to combined the two is greed and protection of vested interests.

Yet, in the business world, mergers happen all the time. And while it is true that some are not approved by the Justice Department or other government agencies, most mergers do take place.

The argument about issues like return to work being the purview of insurance companies under work comp is specious at best, because if we consider two patients, both of whom injure the same body part and require the same surgery to repair that injury, one must be put in a return to work program because he is covered for his injury under work comp; the other does not because his injury is not work-related, but did cause him to miss time from work. Does that make sense? Doesn’t the second patient also need to get back to work?

It is not logical to divide injured individuals by who picks up the check. It is more logical to treat all injuries the same, and to treat all medical issues the same, no matter if they are work-related or not. Getting cancer from occupational exposure to carcinogenic chemicals is no different than getting cancer from smoking, or being genetically predisposed as in breast cancer, or other types of cancer. They both are going to be seen by an oncologist, maybe even the same one if they live in the same area.

So keeping workers’ comp and health care separate and unequal, like education and social accommodations once did to African-Americans, is not only stupid, it is wrong. ColoradoCare is one way this can be accomplished, and as David points out, “Nobody really knows how all of this will play out.”

Maybe it is time we find out.


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.

The Technological Revolution and Health Care: On the Same Track?

Yesterday, I ran across an interview on Truthout.com by Mark Karlin. Mr. Karlin was interviewing the two authors of a new book, People Get Ready, by Robert W. Mc Chesney and John Nichols.

Mr. Karlin’s first question, answered by Mr. Mc Chesney, intrigued me and got me thinking of what is happening in workers’ comp, as well as what is happening in health care.

As I mentioned briefly in my last post, automation and artificial intelligence will have a significant impact on the future of workers’ comp, and this is emphasized in Mc Chesney and Nichols’ book. There have been other books and articles recently on the subject, so this is nothing new.

But what got me thinking is that Mr. Karlin addressed the main question the book raises — namely that the conventional wisdom has always been that the more advanced technology becomes, the more beneficial it will be for humans.

Mr. Mc Chesney responded that convention wisdom said that new technologies will disrupt and eliminate many jobs and industries, and that they would be replaced by newer industries and better jobs.

Mc Chesney also said that they argue the idea that technology will create a new job to replace an old one is no longer operative; nor that the new job will be better than the old one.

According to Mr. Mc Chesney:

Capitalism is in a period of prolonged and arguably indefinite stagnation. There is immense unemployment and underemployment of workers, which we document in the book, taken from entirely uncontroversial data sources. There is downward pressure on wages and working conditions, which results is growing and grotesque inequality. Workers have less security and are far more precarious today than they were a generation ago; for workers under the age of 30, it is a nightmare compared to what I experienced in the 1970s.”

Likewise, Mr. Mc Chesney, continued:

there is an immense amount of “unemployed” capital; i.e. wealthy individuals and US corporations are holding around $2 trillion in cash for which they cannot find attractive investments. There is simply insufficient consumer demand for firms to risk additional capital investment. The only place that demand can come from is by shifting money from the rich to the poor and/or by aggressively increasing government spending, and those options are politically off-limits, except to jack up military spending, which is already absurdly and obscenely high.

Contemporary capitalism is increasingly seeing profits generated, he adds, not by its fairy tales of entrepreneurs creating new jobs satisfying consumer needs, (remember Mitt Romney’s ‘job creator’ line of bs?) — but by monopolies, corruption and by privatizing public services.

Finally, Mr. Mc Chesney states that:

Capitalism as we know it is a very bad fit for the technological revolution we are beginning to experience. We desperately need a new economy, one that is not capitalistic — based on the mindless and endless pursuit of maximum profit — or one where capitalism has been radically reformed, more than ever before in its history. It is the central political challenge of our times.

They are not the only ones arguing for such reform or revolution, Senator Sanders notwithstanding. In previous posts, I have mentioned the biopsychosocial theory, Spiral Dynamics, and the book by Said W. Dawlabani, MEMEnomics The Next-Generation Economic System.

Other authors such as Richard Wolff, and Robert Reich have written books about this subject, and like Mc Chesney and Nichols have reached similar conclusions. Yet, Dawlabani, accessing the Spiral Dynamics model, goes much deeper into why we got here and what we need to do to get out of it.

Such a future version of capitalism has been called by many different names that I have come across in the past decade or so. Natural Capitalism, conscious capitalism, and so on, to name a few. But the main point is as Mc Chesney and Nichols points out in their book, the technological revolution, rather than liberating humans and making our lives better, as Mc Chesney says in the interview, may have the perverse effect of reinforcing its stagnating tendency.

An issue related to automation and artificial intelligence and its impact on the future of work, is if we are all replaced by machines and software, how will people be able to live? How will the goods and services produced by automation be sold, and to whom? Only those who are fortunate to have employment in jobs that machines cannot do? Or will we have to go back to a time when money was only the purview of those who had it?

The answer to these questions have also been raised by those in the tech world, and one suggestion they have come up with is a national basic income (NBI), and naturally has already been shot down as a bad idea by those on the Right. I guess they really want people to be poor.

But this idea should be kept on the back burner for now, as given the political climate in this country, that idea will be dead on arrival. Yet, while many have acknowledged what Mc Chesney, Nichols and others have said is happening, the other side — namely the current Speaker of the House and others in his party, have doubled down on their stubborn adherence to the rantings of a two-bit novelist, Ayn Rand and Ayn Randism.

Which brings me to the other point I wish to discuss, and that bears on what happens in the overall economy at large.

If automation and artificial intelligence will lead to elimination of many, if not all jobs, and if that will require a new economy as Mc Chesney and Nichols, and others have argued, what does that mean for the health care industry that seems to be going in the opposite direction?

Even before the enactment of the ACA, health care has become more centralized, bureaucratic, consolidated and more profit-driven than ever. The ACA in many ways has accelerated this process, and the direction it is headed is towards a more consumer-driven form of health care, and one where large hospital systems have integrated physicians and insurance services into their business plan.

The move among some physicians and physician practices towards concierge medicine, also is a sign that health care is moving towards a more capitalistic health care, in that it creates two classes — those who can afford concierge medicine, and those who cannot.

The transition to a new economy will not happen overnight, and may not happen for some time, especially if the forces aligned against it remain strongly opposed to reform. But if the health care system collapses, as I mentioned previously in articles last week, then along with the stagnation of capitalism generally, there will be an opportunity to move in that direction in health care as well.

Calling for ‘Medicare for All’ now with firm opposition to anything that spends government money or has a social benefit other than producing profit for a few, is only a waste of time and a con job.

There are only two ways an economic system and its attendant political system changes; by revolution or evolution. One is violent and bloody, the other happens because the old is replaced by the new so seamlessly that no one gets too emotional when it happens. An election does not do that, especially when the opposition is headed toward fascism.

That issue is for another time and place, and the rest of Mc Chesney and Nichols’ book discusses the current presidential campaign. I wanted to discuss the dichotomy between where capitalism is headed and where health care is headed, and at some point, health care will have to fall in line with the new capitalism.


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.

Colorado Gets Real on Workers’ Comp and Health Care

A shout out today to David DePaolo of Workers’ Comp Central for publishing an article today about a subject I discussed about a year ago, the combining of the silos of workers’ comp and general health care.

Voters in Colorado, the first state to legalize pot (talk about a real ‘Rocky Mountain High’) will decide in November on a ballot initiative that would create ColoradoCare,  a state-run program that will would pay for medical treatment provided to all residents of the state, including those who are hurt on the job.

According to the initiative, “ColoradoCare shall assume responsibility for payment of all reasonable and necessary medical expenses incurred by workers who suffer injuries or illnesses arising out of and in the course of their employment after the date ColoradoCare assumes responsibility for health care payments,”

The law, David writes, will levy (must be Jewish?)  a 3.33% payroll tax on workers and a 6.67% payroll tax on employers, as well as a 10% health care premium tax on non-payroll income to raise $25 billion to pay for medical care.

A 21-person board of trustees would be created to oversee the program. And, employers would still have to carry workers’ comp insurance to cover indemnity benefits (lost wages).

This would be something left up to legislators to figure out, says DePaolo, because the law is only intended to consolidate health care and eliminate the myriad of silos that create delay, confusion and ultimately heath care consumer angst.

It is David’s opinion that the measure will pass, but that is up to the voters of Colorado to decide (are you listening, Maria?).

So what this will mean is this: should the measure pass in November, it is possible that injuries sustained on the job that requires surgery could be achieved through medical travel, since what is possible now under health care would also be possible in workers’ comp (see my post, “Medical Tourism and Workers’ Comp: What’s Good for the Goose is Good for the Gander“).

When it passes, the following warning should be issued to all potheads in Colorado:

Before going abroad for surgery under the provisions of ColoradoCare, should they allow you to do so, please leave all of your “medicine”, in whatever form you take it in, and the paraphernalia that goes with it home, or else you will end up like Billy Hayes in a Turkishmaninacanstan prison.

But the hospitals in Turkishmaninacanstan are much better, and that is one reason why you are going there in the first place. For world-class health care at a lower cost.

Borderless Healthcare: A Model for the Future of Medical Care in Workers’ Comp

By now, many of you, my faithful, and not so faithful readers (and critics) have been aware of my strong interest and passion about implementing medical tourism into workers’ comp.

The critics have not silenced me, they have only made me more determined than ever to get the word out…MEDICAL CARE UNDER WORKERS’ COMP IN THE US WILL HAVE TO GLOBALIZE, OR ELSE IT WILL FAIL TO PROVIDE ADEQUATE CARE AT LOWER COST AND AT EQUAL OR BETTER QUALITY THAN WHAT IS RECEIVED CURRENTLY.

I capitalized the above because in the three plus years I have been writing this blog, it takes a bit of shouting to get heard in this world.

To make the point I just shouted, I participated yesterday in a webinar on Bloomberg BNA.com produced by Manatt, Phelps & Phillips, LLP/Manatt Jones Global Solutions.

For all of you political junkies out there, Charles Manatt was the Chairman of the Democratic Party from 1981 to 1985, in the first term of that has-been Hollywood actor the GOP shoved down our throats.

The webinar, “Healthcare without Borders: The Opportunities and Challenges of Medical Tourism”, was an almost ninety minute, four-part presentation given by two Managing Directors, a Partner, and a Medical Director of a Mexican hospital system.

The presenters were Jon Glaudemans, Managing Director of Manatt Health Solutions, Andrew Rudman, Managing Director of Manatt Jones Global Solutions, Linda Tiano, Partner with Manatt, Phelps & Phillips, LLP, and Dr. Alfonso Vargas Rodriguez, Medical Director of Hospitales H+.

While the focus of the middle of the presentation dealt with conducting medical tourism in Mexico, the information presented by Mr. Glaudermans was concerned about the trends in healthcare that are pointing to greater demand for medical tourism, and are elaborated in the following graphic:

Megatrends

Source:  2016+Medical+Tourism+Deck.pdf Manatt, Phelps & Phillips, LLP

Here are the key points from Mr. Glaudemans’ presentation slides:

  • Consumers pay more and make more care decision, using social
    media/apps to acquire price/network data.
  • Providers take risk for population/patient/product outcomes, requiring new care models and contracts
  • Care monitoring and delivery move out of traditional settings, shifting the locus of/focus on patient loyalty
  • Providers and payers consolidate to manage costs and enhance power, fighting for CM (care management) space
  • States become more active regulators and purchasers, creating marketplace mosaics and more “experiments”
  • Data on health status and effectiveness become widely available, changing practice and payment patterns
  • Bigger datasets yield insights, informing personalized care and challenging price-setting and patient privacy
  • Employers’ role continues to erode, while exchange plans sharpen focus on multi-year patient loyalty
  • Digital natives’ and baby boomers’ interests coalesce, forcing focus on new ‘late-life/end-of-life’ care models
  • Visibility into global pricing and care models improves, requiring providers to justify value and pricing
  • Social determinants accepted as major cost driver, leading to increased focus on service integration

Naturally, many of these megatrends will not pertain to workers’ comp, but given the fact that comp sometimes follows the lead of healthcare, it is not out of the realm of possibility that some of these trends will be felt in medical care for workers’ comp.

Andrew Rudman’s presentation focused on what medical tourism is, and why Mexico is an ideal medical tourism destination for Americans. The main thrust of his presentation is the proximity to the US, the flight times between major American cities and those Mexican medical tourism destinations he focused on in the discussion.

Mr. Rudman also provided a cost comparison chart between US and Mexican costs of certain medical procedures, which is shown below.

Cost comparison 2012

Source:  2016+Medical+Tourism+Deck.pdf Manatt, Phelps & Phillips, LLP/PROMEXICO

Dr. Rodriquez discussed how Mexican doctors become certified in their sub-specialties and how they get re-certified once they are certified by their respective boards. In addition, he showed slides about the various hospitals in the Hospitales H+ system, and for our purposes here, outlined the price differential for certain orthopedic surgeries at the various hospitals in their system versus that of the US.

Ortho surgery prices

Source:  2016+Medical+Tourism+Deck.pdf Manatt, Phelps & Phillips, LLP/Hospitales H+

Lastly, Linda Tiano covered the legal issues of medical tourism, and those of you who have been reading this blog for three years, know that my original paper covered some of these issues, and I raised them in my presentation in Reynosa, Mexico in November 2014.

Here are the key points Linda made regarding medical tourism benefits.

Medical Tourism Benefits

Source:  2016+Medical+Tourism+Deck.pdf Manatt, Phelps & Phillips, LLP

3rd Party Facilitator

Source:  2016+Medical+Tourism+Deck.pdf Manatt, Phelps & Phillips, LLP

Liability issues

Source:  2016+Medical+Tourism+Deck.pdf Manatt, Phelps & Phillips, LLP

HIPAA

Source:  2016+Medical+Tourism+Deck.pdf Manatt, Phelps & Phillips, LLP

State Regs

Source:  2016+Medical+Tourism+Deck.pdf Manatt, Phelps & Phillips, LLP

At the end, I asked the question, “do you see the possibility of implementing medical tourism into workers’ comp, and what are the legal issues with that?” Ms. Tiano mentioned the state-specific laws regarding workers’ comp, and said that the workers’ comp industry is way behind health care, to which I heartily agreed.

So you can see from this brief, but thorough review of the presentation, that medical tourism is a serious research area for many interested parties. Yet, you guys in work comp refuse to see, hear or speak about the truth of what is happening around you. So here is another picture for you.

hear-no-evil-see-no-evil-speak-no-evil

This is the workers’ comp industry on the subject of global health care and medical tourism…three deaf, dumb and blind monkeys clinging to the same old statutes, laws and regulations that haven’t changed since the days of Taft and Wilson.

So when are you going to catch up to the rest of the world, and to the globalization of health care? In the 23rd century? When are you going to admit to yourselves that automation, new technology, the Internet of Things, telemedicine, etc., are going to make you guys OBSOLETE… to borrow a term from “The Twilight Zone”.

I have a vision for the future of medical care in workers’ comp. What you have is the same old, same old, and expecting different results. That’s not only crazy, that is doing a disservice to the people workers’ comp is supposed to be for, the claimant.

But suit yourselves…the dinosaurs are waiting to greet you.

 

 

 

SPOTLIGHT Interview – October 31, 2013

This is the original interview published on October 31, 2013 by Medical Travel Today.com.

Medical Travel Today (MTT): Tell us your position in the medical tourism industry, as well as your thoughts on integrating medical tourism into workers’ compensation cases in the U.S.

Richard Krasner (RK): Currently, I am a blogger, blogging about the implementation of medical tourism into workers’ compensation.

I first began looking into integrating medical tourism into workers’ compensation when I needed a topic for a paper in my Health Law class as part of my M.H.A. degree program in March of 2011. A lawyer who was working for a medical tourism facilitator company at that time, and who had written an article in a law journal about medical tourism, gave me the idea after my first topic did not pan out. She thought that the legal barriers to implementing international medical providers into workers’ compensation through medical provider networks was a good idea, and since I had a small interest in the subject of medical tourism, I submitted that as my topic to the instructor.

He gave me his approval and, as I started to do my research, I found many articles on medical tourism and nothing on medical tourism and workers’ compensation, so I knew my task was a difficult one. But as the point of the paper was to write about a legal issue and persuade people one way or the other, I felt that I could mention the lack of literature on the subject and perhaps open up dialogue in that area. I then found a roundtable discussion from the January/February 2008 issue of the journal Telemedicine and e-health.

In the discussion, I found something that I had been looking for, but had not expected in a medical journal: a validation from four of the participants for my idea to implement medical tourism into workers’ compensation. I made their discussion the centerpiece of my paper, and thus my argument in favor of implementation. They said essentially that they thought that medical tourism could work for non-emergent, i.e., non-emergencies or long-range issues, such as knee or hip replacement, chronic back injury and repetitive action injuries, and that it would not be a leading offering. That is when the light bulb went on, and I realized that it could be accomplished as an option for the injured worker to consider.

Initially, my research consisted of finding articles that discussed medical tourism in destinations, such as India, Singapore and Thailand, and my thought then was that it might be a stretch to send injured workers that far away, but that maybe it could be done. Later on, as I got more involved in medical tourism through my attendance at the 5th World Medical Tourism and Global Healthcare Congress in October 2012, and through conversations online with another lawyer, I realized that the best chance for this to happen was in Latin America and the Caribbean, and that given the rise of the Latino population in the U.S., sending patients home to their home countries for treatment would present no language or cultural barriers, and would allow friends and family in those countries to visit them during recovery, which will improve their self-esteem and improve their recovery time.

I have since come to believe that all injured workers could be offered this as an option, not just those of Latin or Caribbean origin.

MTT: How will the integration benefit individuals, health insurance companies, and the entire medical community, both domestically and internationally?

RK: I believe first and foremost that medical tourism will have its most important benefit on the individual because of some of the things I mentioned above, namely little or no cultural or language barriers to overcome between Spanish or English in most cases, or between Portuguese or other languages in the region. Also, as I said, their friends and families back home can visit, which would make their recovery more relaxing, more pleasant and would show them that the patient is not sitting at home just collecting a check. It would also give the patient greater self-esteem and speed recovery. Finally, by being treated in the better hospitals in the home country, a patient’s friends and family will see that their loved one is being cared for by the best doctors and at the best facility in their country.

I think the benefit for the health insurance company or, in this case, the workers’ compensation carrier would be that they will not have to pay for expensive procedures, such as hip or knee repair/replacement, shoulder surgery, spinal fusion surgery or carpal tunnel surgery. This is despite the fact that many states have fee schedules for workers’ compensation, which tells providers how much to charge the carrier for each procedure, and which may be less than the normal fees charged. Nonetheless, as the recent New York Times article indicates, the U.S. has the highest cost for healthcare, and it is not slowing down, nor has the average medical cost for lost-time workers’ compensation claims, as I have written about in my white paper and my blog.

I think for the entire medical community domestically and internationally, it will have several benefits, the first of which will be the realization that healthcare is globalizing and that it is no longer possible to consider that quality medical care is available only in the developed world. Second, it will lead to the development of international accreditation standards, quality standards and other standards that up to now have hampered medical tourism’s expansion and growth.

These standards will take time to be adopted and will be expensive to implement for the medical tourism facilities involved, as it has already been for the implementation of other standards and forms of accreditation, such as from the Joint Commission International.

Thirdly, it will have the benefit of bringing American patients to medical providers in other countries, those who otherwise would never be seen by foreign doctors except for those who have gone to foreign-born doctors practicing here in the U.S., whether in private practice or in a hospital setting. Fourth, and this is more of an issue with workers’ compensation cases, doctors abroad will be able to get broad experience treating work-related injuries that they have never seen, thus adding to their medical experience, and providing their fellow citizens with that experience should they ever require it.

Medical tourism will open up global healthcare to all inhabitants of this planet, not just those looking for cosmetic surgery, or procedures that are too expensive or unavailable in their home countries. It will certainly open it up to those who otherwise could not afford to travel out of their country for treatment.

MTT: What would you say are the steps necessary to take in order for medical tourism to be integrated into workers’ compensation effectively?

RK: First, there has to be a removal of all or many of the legal barriers that I mentioned in my white paper, as well as many others that I could not or did not mention. Also, there has to be some understanding on how the legal issues surrounding medical tourism can be solved such as malpractice, legal liability, privacy issues, medical records transfers, etc.

There are financial steps that need to be addressed, such as which currency the payments will be made in, any incentives to injured workers, referring physicians, treating physicians, destination hospitals, as well as travel insurance coverage for things not covered under workers’ compensation. And lastly there has to be a willingness on the part of employers and insurance companies, third party administrators, and lawyers to accept medical tourism as part of workers’ compensation. I have discussed this with several people recently through emails, and in the past six months since beginning my blog, and have written about this as well.

As the Chinese say, a journey of a thousand miles begins with the first step. An industry like the workers’ compensation industry in the U.S., which is concerned with issues, such as pain medication abuse, physician dispensing of drugs and dealing with cost-curbing strategies that have failed, must come to the realization that the journey for them must begin now — before costs skyrocket any further.

MTT: What can you see being potential deterrents in integrating medical travel benefits into workers compensation?

RK: First of all, let me say that I don’t have all the answers, and I cannot foresee all contingencies and problems associated with traveling abroad for care. But I do want to make this clear so that your readers will not think that I don’t know what I am talking about, or that they will think that integrating medical tourism into workers’ compensation will be easy and not fraught with difficulties and complications.

It will not be easy, there are and will be complications from flying after undergoing surgery abroad, just as there are if the patient was treated at the local hospital. I am not a medical person, so my knowledge of how patients will tolerate air travel after surgery or what complications will arise is beyond my experience. But I can say this: I don’t see a difference between a patient who traveled abroad for medical care as a private patient for cosmetic, body improvement or other forms of surgery usually associated with medical tourism and a patient who is traveling abroad for surgery as a result of an on-the-job injury. Yes, there are differences in the process of treatment and aftercare and recovery, but if the private patient can develop complications, so too can the workers’ compensation patient.

To answer the question then, I think deterrents include a lack of will, fear of lawsuits in countries with laws that do not favor the insurance company or the employer, malpractice insurance and legal liability that does not meet American standards, employee choice to stay at home, and pressure from special interest groups like doctors, hospitals, pain clinics, rehab facilities, trial lawyers, etc.

MTT: During a time of rapid healthcare reform, why do you think medical tourism hasn’t been connected to workers compensation already?

RK: Because there is so much uncertainty over the impact the Affordable Care Act will have, not only on healthcare, but also on workers’ compensation. In my research on that subject, I found that there will be little immediate impact, but down the line there will be, especially as more people get health insurance, and also because of the doctor and nurse shortage, which will affect both healthcare and workers’ compensation.

There are critics of the law who say it will raise costs, and then there are those who say it will lower costs, as some have already pointed out recently. But only time will tell who is right and who is wrong. Finally, I don’t think many in the workers’ compensation industry have ever considered looking abroad, except to plan their next vacation.

MTT: Is there anything else you would like to add at this point that you think is significant in terms of medical tourism, workers’ compensations and/or the integration of the two?

RK: Yes, as I said in my blog post, The Faith of My Conviction, what is needed is the will to do it, the courage to make it happen, the hard work to get it there, and the determination to bring the two industries together. I have had experts tell me that it won’t happen, but I pointed out right away in my post the discussion I found between the four medical professionals, and I believe that as medical professionals they have a better understanding of the issues involved than I do as a layman. I trust their judgment of the issue and defer to them for my belief that it can be done.

So who is right and who is wrong? I don’t know the answer to that, but I do know this: for 20 years, the average medical cost for lost-time claims has gone from around $8,100 to almost $30,000 with no decrease in cost, but with a slowdown in the rate of increase. Is that progress? Is that a sign that all other avenues tried have not succeeded? Perhaps it will take higher costs to wake people up to the reality that medical care, like all other goods and services, always goes to those places where the goods or services can be produced at cheaper cost with better quality.

Complications Insurance for Medical Tourism: Coverage for Implementing Medical Tourism into Workers’ Comp

Once again, I am turning to the medical tourism facilitator, Trip4Care for a brilliant blog piece on medical travel that should be of keen interest to those in the workers’ comp world who pooh-pooh my idea for medical travel and workers’ comp. You can connect with Trip4Care by email.

There are many companies that provide medical travel insurance, and by bundling it together with monoline work comp coverage, an employer can reap savings on expensive surgeries abroad, and provide their employees with the best care possible, at the lowest cost, and can get them back to work faster by having them recover in pleasant surroundings, instead of at home on a couch in front of the TV.

Here is the article:

http://trip4care.com/understanding-the-importance-of-complications-insurance-in-medical-tourism/

To deny this option to injured workers, while group health and private pay patients can go abroad, smacks of discrimination, class bias, racism, short-sightedness, and ignorance about the quality of medical care in other nations that is rapidly changing and catching up to that in the US and the rest of the Western world.

Imagine what this would do for peaceful understanding and cooperation, if the most common of us could see how the other half lives. I am not advocating going to war-torn countries, but to those that cater to medical travel patients, and that are relatively free of strife. This will help cement peace and respect for all nations.

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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.

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. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.