Category Archives: Rehab Centers

Tug-of-War Over Ailing American Knees: What the Medical Tourism Industry Should Know

Total knee replacements in the US is growing, according to an article today in Kaiser Health News.

660,000 are performed each year, and will likely grow to two million annually by 2030, as reported by Christina Jewett. Knee surgeries are one of surgery’s biggest potential growth markets, and one that the medical tourism industry needs to be aware of.

Ms. Jewett described how an orthopedic surgeon from the Bronx, underwent his own knee surgery in a Seattle-area surgery center performed by a friend of his. The surgery began at 8 am, and by lunch, the doctor was resting in his friend’s home with no pain and a new knee.

Medicare is contemplating whether it will help pay for knee surgeries outside of hospitals, either in free-standing centers or outpatient facilities. Several billions of dollars are spent every year by Medicare for knee replacements, so what may be a bold experiment, may soon be more standard.

However, this issue is dividing the medical world, and the issue of money is just as important as the issue of medicine, according to Ms. Jewett.

Some physicians are concerned that moving surgeries out of hospitals will land vulnerable patients in the emergency room, but proponents say it will give patients more choice and better care. In addition, they contend that it will save Medicare hundreds of millions of dollars.

An “overwhelming majority” of commenters, Ms. Jewett states, said they want to allow the surgeries out of hospitals, as specified in recent rule-making documents.

Even if a policy change is made, according to the article, Medicare would still pay for patients to get traditional inpatient surgery. There would be a huge shift in money, the article reports, out of hospitals and into surgery centers.

Medicare could save hundreds of millions of dollars if it no longer paid for multiple-day stays in a hospital, and investors at outpatient centers could profit greatly, as well as some surgeons, especially those who have an ownership stake in the facility.

An open question remains as to whether this shift is beneficial for patients. Patients on Medicare tend to spend nearly three days in a hospital, and forty percent also spend time in a rehabilitation facility for further recovery.

Data from 2014 suggests that Medicare patients are taking advantage of the post-operation support at hospitals and aftercare centers. However, it is unclear what the percentage of eligible patients would choose outpatient care.

Of equal concern to patients are the financial consequences, and here is where the medical tourism needs to pay attention, because even though less care is given, outpatient procedures require higher out-of-pocket costs.

Medicare covers inpatient procedures 100%, with no co-payment, but outpatient procedures require a 20% co-payment, which could easily add up to thousands of dollars for knee surgeries.

One surgery center in California advertises a knee replacement surgery for $17,0300, and those who support the change in policy believe that a strict criteria should be used by doctors to choose which patients are good candidates for outpatient surgery.

All this began in 2012, Ms. Jewett states, when Medicare first considered removing the surgeries from its “inpatient only: list. At that time, many doctors and hospitals protested, calling the proposal “ludicrous” and “dangerous”, and Medicare abandoned the idea.

Another objection cited research that showed that patients who received such surgeries as outpatients were twice as likely to die, and that even one-day stays were twice as likely to need follow-up surgery.

A panel recommended that Medicare remove the procedure from the “inpatient only” list in August, but if they make a change, it will not go into effect for a year or so later.

It is quite obvious to this writer what you in the medical travel industry need to do, but then again, when did you ever listen to what I say?

Hey, Hey, Ho, Ho…HMO’s Have Got to Go: InHumana, cont’d.

Dear Readers: I beg your indulgence one more time, so that I can finish the narrative of my previous post, “InHumana”.

After spending untold hours yelling and screaming, complaining and pressuring the folks at InHumana, my mother was transferred to another facility late yesterday afternoon.

My day began by contacting InHumana’s Customer Service department, and after speaking to one woman, I asked her to transfer me to a supervisor. I told both the CSR and her supervisor that the facility my mother was in was a dump and a roach motel.

I criticized the company for limiting the choices of facilities in my county, and as I said in my previous post, that was like wanting to buy a car, and your auto insurance company limits your choices to x number of dealers, and an even smaller number of models to choose from, which corresponds to number of “InHumana beds” available in each contracted facility.

While the supervisor escalated the issue to the Access to Care team, I contacted InHumana’s CEO and President, Bruce D. Broussard’s assistant. She transferred me to their Expedited Resolution team, and spoke to two women.

I had previously sent my article, “InHumana” to Mr. Broussard on Sunday evening after I wrote it, and informed all four women I spoke to. I also tweeted Mr. Broussard throughout the day.

I gave InHumana an alternate choice, and was informed some time later that they did not have any “InHumana beds” available at that facility. I told the women that I did not care if they were contracted or not contracted with a better facility, I wanted my mother taken out of there by end of business day.

I told them that as a $41 billion dollar company, that is about to be sold to Aetna, they can afford to spend a little more to put my mother in a better facility. They informed me that because she was in their Medicaid HMO, she was limited to certain facilities.

In the meantime, I called that dump, and spoke to the Case Manager there and informed her that I was upset with the quality of the facility, and that I wanted to have my mother removed from there. She also said I was limited because of her insurance, and said the same thing to her that I said to InHumana.

I threatened to call our attorney if InHumana or the roach motel did not get her out of there, and spoke to his assistant, who had returned my previous call from the previous Friday.

Later in the afternoon, I received a phone call from a woman from InHumana who said she was the representative for this area of Florida. She was contacted to assist, and was having my mother’s case reviewed by their medical director.

After doing some more yelling and screaming at the Expedited Resolution team member to get my mother out of that roach motel, I received a call from the Admissions person at the first facility we contacted on Sunday. She told me that they had a patient go home and that there was a bed available, and that they were going to make arrangements to have my mother transferred.

So it wasn’t due to InHumana’s efforts that my mother got out of that roach motel, but rather serendipity that a patient went home, thus opening up a bed.

But it did not have to be that way. This could have ended early on in the process if InHumana was more interested in the medical care of the patient, instead of protecting their bottom-line, and their shareholder’s value, not to mention the compensation Mr. Broussard must be getting, which would probably cover my mother’s stay in this new facility for quite a long time.

Today I informed by the Admissions office that InHumana only pays for TWENTY DAYS of rehab, and since she spent one day in that roach motel, we already used one day, so we have nineteen more days for them to pay.

After that, it becomes our responsibility, at $150 a day. I don’t know how long she is going to be there, but we don’t have that kind of money, so I will contact our lawyer for his advice,

This is why, along with the aggravation they put me through yesterday, I called this article, “Hey, Hey, Ho, Ho…HMO’s Have Got to Go”.

THEY ARE CHEAP BASTARDS.