Category Archives: Surgical Procedure Volumes

New Hospital Rating System: A Step in the Right Direction?

Introduction

I received an invitation to connect on LinkedIn last Friday from Tucson Dunn, the CEO of Hanovera Healthcare International. After viewing his LinkedIn profile, I accepted his invitation. Prior to becomig CEO of Hanovera, Mr. Dunn was also the Chairman and CEO of the International Healthcare Commission (IHC) from June 2008 to June 2013.

Monday morning, I received an email from Mr. Dunn, introducing me to the International Healthcare Commission, and announcing that next month, the IHC will launch their “International Hospital Ratings” to identify hospitals that treat high numbers of foreign patients. Mr. Dunn also stated that this Award Mark will serve to attract more foreign patients to come to the top rated hospitals and cities.

According to Mr. Dunn, the Rating Criteria is simple and based on the annual volume of foreign patients treated (outpatient or inpatient) at the hospital. The ratings are listed below:

Over 1000 ― International Hospital rating
Over 5000 ― Distinguished International Hospital rating
Over 10,000 ― Outstanding International Hospital rating
Over 15,000 ― Premier International Hospital rating
Over 20,000 ― World Leading International Hospital rating

When I responded to his email, I asked him if this rating reflected actual medical tourists, i.e., those traveling from their home countries to a medical tourism destination, or does it include ex-pats living in those countries and getting medical care at those hospitals? I told him that many people engaged in the medical tourism industry have told me that most numbers are inflated with regard to actual medical tourists abroad.

In his follow up to my query, he said that was a very good question, and that it was the main topic of debate within the IHC for the past year. The final ruling, he said, leaned towards the Service Delivery itself. He also explained that if a hospital is treating vast numbers of international patients, then they know how to treat international patients, regardless of point of origin.

To summarize, he said, the award is not an indicator of inbound medical tourism, but rather a statement of capability based on performance. Same is true for Surgery Volume: If the hospital does 1000 CABGs in one year, then they probably know how to do CABGs. The Cardiac Surgery Award reflects the volume of Cardiac Surgery performed.

I responded that that will at least let those who are involved with inbound medical tourism, meaning both facilitators and patients, know which hospitals are the better ones in medical tourism destinations, based solely on the number of procedures performed at those hospitals. From those ratings, interested parties can probe deeper to find out just how good they are at performing those procedures, their success rates, outcomes, etc.

Mr. Dunn agreed, and then asked me to consider how many foreign patients come to the US for treatment per year. His reply stated that cost of those foreign patients was nearly US$5 billion worth. But as for which hospitals treat foreign patients, which hospitals have systems in place for large volumes, Mr. Dunn said, the IHC can help address those questions.

As an example, Mr. Dunn mentioned that the Medicover Hospital of Poland received a rating as a Distinguished International Hospital, based on the fact that they treated 8,614 foreign patients over the past twelve months. He went on to explain that if you were traveling as a tourist in Poland and needed a hospital, this award would be meaningful to you as a potential patient, since it would indicate that they have experience dealing with foreign patients, and that you would know that the staff could speak English.

About the International Healthcare Commission

The International Healthcare Commission is an independent healthcare ratings organization founded in 2009 in Atlanta, Georgia, and rates healthcare provider performance throughout the world. According to their website, the IHC is the Gold Standard for the international healthcare ratings industry. Likewise, they are the oldest, independent international healthcare performance ratings company. The IHC provides patients, referring physicians and payers with vital information they need when choosing an international healthcare provider.

The IHC supports hospitals, clinics and healthcare systems to achieve peak performance in international patient care. They help healthcare providers attract patient referrals. The IHC Rating Awards are recognized as Gold Seals of Approval, and they provide clear marks of distinction for performance, and they are evidence-based. The rating and award systems cover the following:

Foreign Patient Volumes
Surgical Procedure Volumes
Maternity Care

Their Mission

The International Healthcare Commission (IHC) works to guide patients and referring physicians to better healthcare providers. The IHC has been conducting healthcare market research in over 100 countries since 2009. IHC partners with hospitals, clinics, health systems and insurance companies to promote best-practice healthcare.

Their Ratings

International Hospital Ratings

There are five levels of International Hospital Ratings, and they identify hospitals that have dedicated systems, staff and resources for the care and treatment of foreign patients, as well as local patient communities.

International Hospital Rating

The IHC’s International Hospital Rating is the first rating level indicating that the hospital has achieved significant experience in the care and treatment of international patients. Hospitals achieving this level are rated and recognized as “International Hospitals” The criteria that determines this level is any hospital that treats over 1,000 foreign patients per year.

Distinguished International Hospital Rating

The IHC’s Distinguished International Hospital Rating is the second rating level indicating that the hospital has achieved substantial experience in the care and treatment of international patients. Hospitals achieving this level will be recognized and considered as “Distinguished International Hospitals”. The criteria that determines this level is any hospital that treats over 5,000 foreign patients per year.

Outstanding International Hospital Rating

The IHC’s Outstanding International Hospital Rating is the third rating level indicating that the hospital has achieved outstanding experience in the care and treatment of international patients. Hospitals achieving this level will be recognized and considered as “Outstanding International Hospitals”. The criteria that determines this level is any hospital that treats over 10,000 foreign patients per year.

Premier International Hospital Rating

The IHC’s second highest level of recognition is the Premier International Hospital Rating. This rating indicates that the hospital has achieved premier experience in the care and treatment of international patients. Hospitals achieving this level will be recognized and considered as “Premier International Hospitals”. The criteria that determines this level is any hospital that treats over 15,000 foreign patients per year.

World Leading International Hospital Rating

This is IHC’s highest rating for care and treatment of international patients. Only a few hospitals in the world ever achieve this level of experience and expertise. These elite hospitals are truly specialized in providing international care. Hospitals achieving this level are recognized and considered as “World Leading International Hospitals”. The criteria that determines this level is any hospital that treats over 20,000 foreign patients per year.

Surgery Excellence Ratings

IHC’s Surgery Excellence Ratings help patients, physicians and insurance companies identify surgical expertise and experience. Surgery Excellence Rating levels are based on annual number of surgical procedures within a surgical specialty area. These are the surgical specialty areas:

Cardiac Surgery Eye Surgery
General Surgery Gynecological Surgery
Neurosurgery Oral and Maxillofacial Surgery
Orthopedic Surgery Otolaryngology
Pediatric Surgery Plastic Surgery
Surgical Oncology Thoracic Surgery
Trauma Surgery Urology
Vascular Surgery

There are three levels of Surgery Excellence Ratings:

International Surgical Excellence Rating

The IHC’s Surgery Excellence Rating indicates that the provider has achieved significant experience in the selected specialty surgical area. Organizations achieving this level are rated and recognized as “Excellent” in the surgical specialty. The criteria that determines this level are 300 to 499 surgeries in the specialty per year.

International Five-Star Surgery Rating

The IHC’s Five-Star Surgery Rating indicates that the provider has achieved outstanding experience in the selected specialty surgical area. Organizations achieving this level are rated and recognized as achieving “Five-Star” performance in the surgical specialty. The criteria that determines this level are 500 to 999 surgeries in the specialty per year.

International Center of Excellence Rating

The International Center of Excellence for Surgery Rating is the highest international rating available. This elite rating indicates the organization performed over 1,000 surgeries in the specialty area within one year.

International Clinic Ratings

Like the International Hospital Ratings, there are five International Clinic Ratings. IHC’s International Clinic Ratings identify stand-alone outpatient centers that have dedicated systems, staff and resources for care and treatment of foreign patients, as well as local patient communities. And like the International Hospital Ratings, foreign patients have unique language, customs and cultural needs that must be considered when providing care and treatment. The international patients want to know that their provider can accommodate these unique needs. One of the best indicators of this capability is experience in treating significant volume of foreign patients each year. This volume indicator serves as the basis of IHC’s International Clinic Rating.

International Clinic Rating

The IHC’s International Clinic Rating is the first rating level indicating that the ambulatory care center has achieved significant experience in the care and treatment of international outpatient patients. Clinics achieving this level are rated and recognized as “International Clinics”. The criteria that determines this level is any clinic that treats over 1,000 foreign patients per year.

Distinguished International Clinic Rating

The IHC’s Distinguished International Clinic Rating is the second rating level indicating that the clinic has achieved substantial experience in the care and treatment of international patients. Clinics achieving this level will be recognized and considered as “Distinguished International Clinics”. The criteria that determines this level is any clinic that treats over 5,000 foreign patients per year.

Outstanding International Clinic Rating

The IHC’s Outstanding International Clinic Rating is the third rating level indicating that the clinic has achieved outstanding experience in the care and treatment of international patients. Clinics achieving this level will be recognized and considered as “Outstanding International Clinics”. The criteria that determines this level is any clinic that treats over 10,000 foreign patients per year.

Premier International Clinic Rating

The IHC’s second highest level of recognition is Premier International Clinic Rating. This rating indicates that the ambulatory care center has achieved premier experience in the care and treatment of international patients. Stand-alone clinics achieving this level will be recognized and considered as “Premier International Clinics”. The criteria that determines this level is any clinic that treats over 15,000 foreign patients per year.

World Leading International Clinic Rating

This is IHC’s highest rating for care and treatment of international patients. Only a few ambulatory care centers in the world ever achieve this level of experience and expertise. These elite clinics are truly specialized in providing international care. Clinics achieving this level are recognized and considered as “World Leading International Clinics”. The criteria that determines this level is any clinic that treats over 20,000 foreign patients per year.

What this means

Naturally, judging any enterprise by the volume of work performed does not necessarily tell us a lot about how well they perform that work. And knowing how many foreign patients a hospital treats per year does not tell us if these patients are real medical tourists, i.e., traveling from their home country to a medical tourism destination hospital, or are ex-patriots living in that particular country and getting medical care in a foreign hospital. This was the question I posed to Mr. Dunn earlier this week.

If that was the case, McDonalds would be a great company that serves the best hamburgers in the world, based solely on the billions of hamburgers sold, and on how many restaurants they have around the world.

What is missing from these ratings is quality of care, outcome measures, success rates of surgeries, and a host of other vital data which can tell a patient, their referring physician, their employer or their employer’s insurance company, that the foreign hospital and foreign physicians are just as good as or better than what is available locally.

Also missing from these ratings are the level of expertise of the physicians and nurses, and the professionalism and attention to detail that determines patient care. And finally, knowing whether or not the hospital or clinic has the latest technology and proficiency to use that technology is crucial to ascertain the true level of excellence of any hospital or clinic.

In many of my previous posts, the issue of transparency has come up, and generally I have written that the medical tourism industry needs to become more transparent on issues of price and quality, because that is the main selling point the industry makes to its customers and potential customers. Whether such transparency comes from the industry itself, or from outside, independent organizations like the International Healthcare Commission.

Like any other product or service, health care has its many rankings and ratings, but taken together, ratings from the IHC, JCI, NCQA, ISQua and other accreditation organizations, may be able to tell individuals, employers, and carriers that these facilities have obtained a baseline of care and expertise. More data is needed before medical tourism can be taken seriously as an alternative to high price and substandard medical care, but until that happens, this organization may be a step in the right direction.