Category Archives: Medical Travel

Major Surgery Wait Times for Workers’ Comp: Can Medical Travel Assist?

Last week, the Workers’ Compensation Research Institute (WCRI) released their FlashReport — Time from Injury to Medical Treatment: How States Compare, and I requested a copy.

While the report is rather lengthy, covering slightly more than fifty pages, I decided to focus on one aspect of the report that related to the length of time from injury to medical treatment with major surgery.

The report examined the time from injury to treatment in 18 states, and each of the services studied were ranked by median number of days from injury to medical service for each service. The report looked at claims from 2015/2016 with more than seven days lost time.

I wanted to make the medical travel industry aware that major surgery under workers’ compensation was not something that happened immediately after an on-the-job injury, and to alert the industry to figure out how they can improve the wait times for such surgeries.

Here is the summary of key findings from the report:

  • Considerable variation across states in the time from injury to first treatment for physical medicine and “specialty” services such as major radiology and pain management injections across injury types.
  • Patterns in time to first medical treatment were fairly consistent for some states; that is, some states tended to show shorter or longer time to first treatment across injuries and services.
  • Little variation in time to first medical treatment for “entry” services (such as emergency, office visits, and minor radiology) for most injury types.
  • Initial medical treatment was slightly faster for objective injuries (like fractures) than for subjective injuries (like sprains and strains).
  • Timing of medical services varies by type of injury, likely a reflection of different treatment patterns.

Based on the analytical approach WCRI used for other services, they identified Indiana, New Jersey, Pennsylvania, Virginia, and Wisconsin as having a shorter median number of days to the first major surgery.

California, Georgia, Iowa, North Carolina, and Texas had the longest median number of days to first major surgery and was based on the number of days average in rank order. Arkansas and Louisiana were excluded due to small cell size.

Major surgery was ranked third by type of non-entry service by maximum number of days from injury to first medical service: 118 days. Major surgery was ranked sixth by percentage of claims receiving medical services by maximum number of days at: 36.5%. Indiana had that distinction.

Major surgery was defined by WCRI as including invasive surgical procedures, as opposed to surgical treatments and pain management injections. The most frequent surgeries in this service group include, but are not limited to, arthroscopic surgeries of the shoulder or knee, laminectomies, laminotomies, discectomies, carpel tunnel surgeries, neuroplasty, and hernia repair.

Five types of injuries had the maximum medium number of days from injury to first major surgery: Neurologic spine pain, Inflammations, Upper extremity neurologic, Other sprains and strains, and Knee derangements.

The table below illustrates the maximum for each injury with the corresponding minimum, in order of maximum number of days.

Type of Injury

Maximum

Minimum

State

Neurologic spine pain

187

105

CA

Inflammations

173

96

CA

Upper extremity neurologic

169

85

CA

Other sprains and strains

140

69

CA

Knee derangements

133

52

CA

What does this mean?

This report is by no means conclusive as it relates to length of time for major surgery in the other states that were not analyzed. Yet, it is instructive to both the workers’ comp industry and the medical travel industry that given predicted shortages of both physicians and nurses, it would be prudent to explore other avenues so that the maximum wait times can be lowered, which would enable the injured employee to return to work faster.

Not doing so will be more expensive in the long run and will be detrimental to the well-being of the patient.

To purchase a copy of the report, click here.

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Ten Most Reported Worker’s Compensation Injuries – Machine Safety Blog

Back in March of 2015, I wrote about the top 10 causes of workplace injuries. I posited the idea that medical tourism (medical travel) could save employers money so that the workers’ comp industry would take medical travel seriously as an option for injured workers. The same holds true for the medical travel industry, as they seem to be AWOL when it comes to workers’ health.

Here is an updated report on the Machine Safety Blog from Rockford Systems, LLC:

Last year in America 2.9 million employees (U.S Bureau of Labor Statistics) suffered a workplace injury from which they never recover, at a cost to business of nearly $60 billion (Liberty Mutual Insurance). These statistics are staggering. To help gain a better perspective on the realities of workplace danger, we have compiled a list of […]

Source: Ten Most Reported Worker’s Compensation Injuries – Machine Safety Blog

Update to Cayman Islands Hospital Delivers Lower Cost Care

Last week, The Economist published a short article on how the medical travel industry  thrives.

I had intended to write about the article, but there was not much there to go on, except for the part that mentioned Health City Cayman Islands. (See post, Cayman Islands Hospital Delivers Lower Cost Care).

As reported in The Economist, when the work first began on the 2,000-bed hospital, the $2 billion project was expected to attract more than 17,000 foreign patients annually, mostly from the US.

However, when the first wing opened in 2014, fewer than 1,000 overseas patients arrived in its first year, according to the International Medical Travel Journal.

One reason give for this was that the backers of the project based their projections of customer numbers on a flawed study, according to an investigation by a government public-accounts committee.

Fewer Americans came, the article said, partly because health care insurance companies were not interested in sending people overseas.

This is not unexpected, even if the backers themselves expected more patients to come from the US. American exceptionalism and the belief that the American health care system is the best in the world, is one reason for the reluctance of US insurers to send patients out of the country.

The other reason is that doing so would not bring in more profit from the ever-growing health care systems that hospitals are building as they purchase more and more practices, and add on more services like insurance that used to be separate from the provider community.

Until health care providers travel overseas to treat patients, as The Economist reports, the lack of patients at Health City Cayman Islands and elsewhere will continue. During the Olympics a few years ago, Dubai Health City advertised regularly during commercial breaks, Perhaps that is what Health City Cayman Islands should do.

Medical Tourism Agencies and Facilitators: Legal Pitfalls and Risk Mitigation: A Case Study Analysis – SDCBA Calendar

This is an upcoming webinar led by the person who got me started in writing about medical travel, Kristen Montez, Esq. I think that anyone in this space should listen to what she and the other attorneys have to say on the matter.

I am paying her back for all her wonderful efforts on my behalf. Please pay me back by attending.

Thank you.

Your humble blogger.

List of upcoming SDCBA and legal community events including section, committee and division meetings, CLE and other events.

Source: Medical Tourism Agencies and Facilitators: Legal Pitfalls and Risk Mitigation: A Case Study Analysis – SDCBA Calendar

Cayman Islands Hospital Delivers Lower Cost Care

This morning’s post by fellow blogger, Joe Paduda, contained a small paragraph that linked to an article in the Harvard Business Review (HBR) about a hospital in the Cayman Islands that is delivering excellent care at a fraction of the cost.

Joe’s blog generally focuses on health care and workers’ comp issues, and has never crossed over into my territory. Not that I mind that.

In fact, this post is a shoutout to Joe for understanding what many in health care and workers’ comp have failed to realize — the US health care system, which includes workers’ comp medical care, has failed and failed miserably to keep costs down and to provide excellent care at lower cost.

That the medical-industrial complex and their political lackeys refuse to see this is a crime against the rights of Americans to get the best care possible at the lowest cost.

As I have pointed out in previous posts, the average medical cost for lost-time claims in workers’ comp has been rising for more than twenty years, even if from year to year there has been a modest decrease, the trend line has always been on the upward slope, as seen in this chart from this year’s NCCI State of the Line Report.

The authors of the HBR article asked this question: What if you could provide excellent care at ultra-low prices at a location close to the US?

Narayana Health (NH) did exactly that in 2014 when they opened a hospital in the Cayman Islands — Health City Cayman Islands (HCCI). It was close to the US, but outside its regulatory ambit.

The founder of Narayana Health, Dr. Devi Shetty, wanted to disrupt the US health care system with this venture, and established a partnership with the largest American not-for-profit hospital network, Ascension.

According to Dr. Shetty, “For the world to change, American has to change…So it is important that American policy makers and American think-tanks can look at a model that costs a fraction of what they pay and see that it has similarly good outcomes.”

Narayana Health imported innovative practices they honed in India to offer first-rate care for 25-40% of US prices. Prices in India, the authors state, were 2-5% of US prices, but are still 60-75% cheaper than US prices, and at those prices can be extremely profitable as patient volume picked up.

In 2017, HCCI had seen about 30,000 outpatients and over 3,500 inpatients. They performed almost 2,000 procedures, including 759 cath-lab procedures.

HCCI’s outcomes were excellent with a mortality rate of zero — true value-based care. [Emphasis mine]

HCCI is accredited by the JCI, Joint Commission International.

Patient testimonials were glowing, especially from a vascular surgeon from Massachusetts vacationing in the Caymans who underwent open-heart surgery at HCCI following a heart attack. “I see plenty of patients post cardiac surgery. My care and recovery (at HCCI) is as good or better than what I have seen. The model here is what the US health-care system is striving to get to.

A ringing endorsement from a practicing US physician about a medical travel facility and the level of care they provide.

HCCI achieved these ultra-low prices by adopting many of the frugal practices from India:

  • Hospital was built at a cost of $700,00 per bed, versus $2 million per bed in the US. Building has large windows to take advantage of natural light, cutting down on air-conditioning costs. Has open-bay intensive care unit to optimize physical space and required fewer nurses on duty.
  • NH leverage relations with its suppliers in India to get similar discounts at HCCI. All FDA approved medicines were purchased at one-tenth the cost for the same medicines in the US. They bought equipment for one-third or half as much it would cost in the US.
  • They outsourced back-office operations to low-cost but high skilled employees in India.
  • High-performing physicians were transferred from India to HCCI. They were full-time employees on fixed salary with no perverse incentives to perform unnecessary tests or procedures. Physicians at HCCI received about 70% of US salary levels.
  • HCCI saved on costs through intelligent make-versus-buy decisions. Ex., making their own medical oxygen rather than importing it from the US. HCCI saved 40% on energy by building its own 1.2 megawatt solar farm.

And here is the key takeaway:

The HCCI model is potentially very disruptive to US health care. Even with zero copays and deductibles and free travel for the patient and a chaperone for 1-2 weeks, insurers would save a lot of money. [Emphasis mine]

US insurers have watched HCCI with interest, but so far has not offered it as an option to their patients. A team of US doctors came away with this warning: “The Cayman Health City might be one of the disruptors that finally pushes the overly expensive US system to innovate.”

The authors conclude by stating that US health care providers can afford to ignore experiments like HCCI at their own peril.

The attitude towards medical travel among Americans can be summed up by the following from Robert Pearl, CEO of Permanante Medical Group and a clinical professor of surgery at Stanford: “Ask most Americans about obtaining their health care outside the United States, and they respond with disdain and negativity. In their mind, the quality and medical expertise available elsewhere is second-rate, Of course, that’s exactly what Yellow Cab thought about Uber. Kodak thought about digital photography, General Motors thought about Toyota, and Borders thought about Amazon.”

Until this attitude changes, and Americans drop their jingoistic American Exceptionalism, they will continue to pay higher costs for less excellent care in US hospitals. More facilities like HCCI in places like Mexico, Costa Rica, the Caymans, and elsewhere in the region need to step up like HCCI and Narayana Health have. Then the medical-industrial complex will have to change.

Health Care, Immigration, and the Supreme Court

This week America underwent a shock of such magnitude that many believe that this is the end of the experiment begun in 1776, and the United States lost its standing as the “Shining City on a Hill.”

We have witnessed the cruelty of the Trump regime towards innocent children snatched from the arms of their parents, simply because their parents want to escape the violence and oppression of the drug gangs rampant in their home countries.

These parents want not only to secure for their children a life free from being recruited into these gangs, they also want to provide their children with a better life.

And most of them did so according to US immigration law. They presented themselves at legitimate border crossings, and were summarily arrested, had their children separated from them, the children, some as young as a few months old, put in cages, or transferred across the country, and placed in facilities where no press or Congressional observers are allowed to see for themselves, except on special guided tours where they cannot speak to the children.
Recently, a judge in California ordered the regime to re-unite the children with their parents and effectively ended the zero-tolerance policy.

Tomorrow, at 11 am, I, and many others around the nation will take part in a march to protest this cruel and un-American action. The march I will be attending will be held in West Palm Beach and will cross the Intracoastal Waterway by way of a bridge connecting the mainland with Palm Beach island. The march will terminate at Mar-a-Lago, the former home of Marjorie Merriweather Post, heiress to the Post cereal fortune, and that is now owned by the Orangutan.

Why am I writing this, and what does it have to do with health care? And what does the Supreme Court have to do with these other issues?

That is what this post will attempt to address.

To begin with, the immigration issue will have a profound effect on the health care system, as the older Americans get, the more home health and nurses’ aides they are going to need.

Preventing these unfortunate men, women and children, fleeing violence and drug gangs, and civil war and corruption at home, will mean that in the future there will be fewer workers to take these and many other jobs in health care and other industries.

In addition, the so-called “travel ban”, is really a cynical attempt to impose a Muslim ban without calling it one. The Supreme Court weighed in on this move this week, ignoring the racist comments made by the Orangutan, and gave him wide latitude to ban anyone he does not like.

This will have the chilling effect of preventing both medical students and physicians from coming to the US, not only from the countries on the list, but all other Muslim nations. The medical travel industry, also may feel some effect, as providers and facilitators from Gulf states, and other nations in the region, may be prevented from attending conferences and speaking engagements, and Americans who go to the UAE may be given greater scrutiny upon return to the US.

As a grandson of immigrants, this un-constitutional, un-American, and inhumane action by this regime is very disturbing and sickened me when I heard the cries of those children. But, according to recent polling on the issue, 58% of Republicans approved of the separation of children from their parents, while 92% of Democrats disapproved. The CNN poll results are here:

On top of the immigration debacle, and the “travel ban”, there was a third and more devastating blow to American democracy and to the Republic this week. The retirement of Justice Anthony Kennedy, a swing vote on many issues brought before the Court, portends that the Court will be radically altered once a replacement is chosen and confirmed by the Senate.

But unlike the Merritt Garland nomination, Mitch McConnell is vowing to confirm whatever nominee the Orangutan appoints, and the regime promises to appoint a strict Conservative justice. Several commentators have indicated that abortion, LGBTQ rights, and maybe even health care, could be overturned if one more current justice, most probably Ruth Bader Ginsberg, retires or like Scalia, dies in the next two years. She is 85.

Overturning Roe v. Wade and making abortion illegal once again, will force women to seek back alley abortions, and will severely impact their health and lives. Also, it is possible that birth control and access to it, may be denied to women, and that will have serious impacts on health care in the future. Some believe that Roe is settled law, but don’t count on them being right. The Religious Right is waiting for the day that women are forced to carry to term pregnancies they don’t want, and then have any neo-natal or post-natal care taken away, so that they and their babies suffer needlessly.

A strict Conservative on the bench also threatens gay marriage and LGBTQ rights, as it was Justice Kennedy who broke with the Conservatives and said that gay people had a constitutional right to marry. It may mean that more cases like the recent Colorado case may be decided in the plaintiff’s favor, albeit without the bias the state Commission showed to religion.

Lastly, health care could face enormous challenges ahead if the makeup of the Court swings radically to the right. The current Court ruled that the ACA was Constitutional, but since the coup of 2016, the GOP has steadily destroyed the law and a radical Supreme Court just might put the last nail in the coffin and deny millions of Americans health care. There is also a health care bill in Congress that will remove many diseases and pre-existing conditions from coverage.

This is especially disturbing to yours truly, as I have one of those pre-existing conditions: ESRD. Right now, I have Medicare only, but who knows what a radical Court may do to that and the other health care programs such as Medicaid, CHIP, etc.

In college, I was taught that the Court generally swings from liberal to conservative, but in my lifetime, it has gone from liberal to conservative, to radically conservative, so that now we may be headed for a judicial, corporate dictatorship where the people have little or no rights, and Corporate and religious interests have all the rights.

The following quote sums up our predicament:

“When fascism comes to America it will be wrapped in the flag and carrying a cross.”
Sinclair Lewis

So, what do we do?

Well, the march tomorrow morning is a start. I have been critical of those groups opposed to this regime sitting on their kiesters and doing nothing except marching once a year in January for two straight years in the Women’s Marches. This crisis is bigger than just one demographic group. This fight is for the soul of the nation and for the Republic as a democratic republic. A journalist heard this morning on MSNBC said she went to Minnesota recently when the Orangutan was there, and she said that the cab driver told her that he is a Republican, is against the Orangutan, and cannot speak to friends about him because they believe him 100% and think he is a god.

Great! Now we have a Caucasian version of Kim Jong Un.

We have to work together, because in the words of Pastor Niemoeller:

First, they came for the Socialists, and I did not speak out—
Because I was not a Socialist.
Then they came for the Trade Unionists, and I did not speak out—
Because I was not a Trade Unionist.
Then they came for the Jews, and I did not speak out—
Because I was not a Jew.
Then they came for me—and there was no one left to speak for me.

The Founding Fathers knew something like this would happen, but never thought that the Electoral College, created to prevent this, would actually make it a reality. We are living in scary times.

Have a good weekend everyone, and if I don’t write before Wednesday, have a safe and happy Fourth…it may be our last.

Hospital Outpatient Payments Rising — Again

The Workers’ Compensation Research Institute (WCRI) released a study today that indicated that hospital outpatient payments were higher and growing faster in states with percent-of-charge-based fee regulations or no fee schedules.

This study is an annual study that compares hospital payments for a group of common outpatient surgeries in workers’ compensation across 35 states from 2005 to 2016.

According to WCRI’s executive vice president and counsel, Ramona Tanabe, “Rising hospital costs continue to be a focus for public policymakers and system stakeholders in many states.”

The study found that states with percent-of-charge-based fee regulations had substantially higher hospital outpatient payments per surgical episode than states with fixed-amount fee schedules.

Percent-of-charge-based states were 30 — 196% higher than median of the states with fixed-amount fee schedules in 2016.

States without fee schedules also had higher payments per episode; 38 — 143% higher than the median of fixed-amount states in 2016.

Lastly, WCRI found that hospital payments per episode in most states with percent-of charge-based fee regulations or no fee schedules, grew faster than states with fixed-amount fee schedules.

The study also compared payments for workers’ comp with Medicare rates for the most common group of surgical procedures across states. The following chart highlights the variation in the difference between average workers’ comp payments and Medicare rates. The variation was as low as 38%, or $2,012 below Medicare in Nevada, and as high as 502%, or $21,692 above Medicare in Alabama.

Source: WCRI

So, what does this mean?

It means that hospital outpatient payments for the most common group of surgical procedures in Workers’ Comp are not decreasing, and are likely adding to the slow, but steady rise in the overall total average medical cost for lost-time claims, a development I have followed for some time now with the release of NCCI’s State of the Line Reports.

This is not the first time I have discussed this topic, and probably won’t be the last, as I keep reminding you that surgical costs for most common workers’ comp surgeries are a fraction of the cost here in the US in countries that provide medical travel services.

If this study is right, wouldn’t you rather pay for a surgical procedure in Costa Rica, for example, that costs $12—$13,000, than paying $21,692 in Alabama? Eighteen out of thirty-five states listed on the above chart have higher payments than the median of 100. This represents 51.4% of all the states examined in the study. Just more than half.

And this idea of medical travel is stupid, ridiculous, and a non-starter? Ok, keep shelling out more money for hospital outpatient procedures. After all, it ain’t your money, is it?

To download this study, visit WCRI’s website at https://www.wcrinet.org/reports/hospital-outpatient-payment-index-interstate-variations-and-policy-analysis-7th-edition.