Category Archives: Transparency

Fam Tours for Self-Insured Employers

The subject of medical travel for self-insured employers is one that this blog has rarely discussed from the point of view of the medical travel facility.

Previous posts here have discussed a possible scenario for medical travel by self-insured employers under workers’ comp, the experience of one company that did so for its employees under their group health plan, and why self-insured employers are failing to adopt medical travel, as well as other posts that briefly mentioned self-insured employers.

Yet, at no time has this reviewer, in the position of content writer, ever discussed how the medical travel facilities can market their services to potential self-insured customers.

A new book by Maria Todd, her sixteenth in fact, does exactly that. Organizing Medical Tourism Site Inspections for Self-Insured Employers is a well-written manual for medical travel facilities seeking to highlight the services they offer by hosting site inspections, or more colloquially known as “fam tours,” or familiarizing tours.

Note: This writer had participated in only one fam tour to medical facilities when I spoke at a medical tourism conference in Mexico in 2014.

Knowing the Customer

Dr. Todd’s book focuses on the ways medical travel facilities can know their customers by knowing which self-insured employers are more likely to develop a medical travel program for their plan beneficiaries, and the criteria the Plan Administrators will look for to engage their services and the conditions under which such travel is possible.

One example given is if flying time to a medical tourism destination is less than three hours by plane. For American workers, who have US passports, longer distances would eliminate travel to parts of Asia, the Middle East, parts of South America, and Russia. Such locations would be possible if the employees were working there or nearby, and they were the closest facilities available.

She also discusses what will attract multinational employers who have workers around the world to select facilities that can handle industrial accidents, as well as general health and rehabilitative services. Some employers may be self-insured for their domestic employees, but purchase an insurance cover called an International Private Medical Insurance, or “IPMI.”

Selling Solutions

To educate hospital executives and managers on how to sell solutions to Plan Administrators, Dr. Todd includes a chapter on a topic she says executives and managers often do not consider important.

The chapter focuses on what not to say or do when conducting a site inspection. You, as the seller might consider certain areas of your facility important to highlight, or is one that you take pride in, but may not be something your guests are particularly interested in.

One such area is Accreditation. Not knowing abbreviations for accrediting organizations such as the Joint Commission International (JCI), or what the big deal is about accreditation, is something the executives and managers need to be aware of beforehand and to be prepared to explain why it is important.

Proper accreditation will go a long way to ease their minds over deciding to use that facility, and being presented with an unfamiliar or disreputable accreditor, or one whose certificates are not worth the paper they are printed on, is something to be aware of also.

Another area of concern when hosting a site inspection is scientific presentations. It is quite possible that some of your guests may be physicians and nurses who will benefit from seeing such presentations, but for those Plan Administrators who are not medical personnel, such tours maybe considerably boring, if not completely too technical for them to comprehend.

Technology Tours

A similar mistake made is taking business-focused guests to see the technology the facility has installed and uses. Dr. Todd recommends they create a spreadsheet of the expensive equipment they have and write a short blurb about each.

Her main point is this: Plan Administrators are seeking three things: transparency, good value, and superb, culturally-sensitive customer service.

Other areas to avoid on Fam tours

The Emergency Department, laboratory, radiology and imaging department, cardiac catheterization lab, and the PET/CT, and PACU’s are a waste of time, per Dr. Todd, and may even disturb the patient’s privacy and recovery.

Final five chapters

The final five chapters deal with developing relationships, the contracting and provider network criteria (where to get preliminary data, contract terms and payment agreements, and avoiding payment hassles with the right language), the basics of ERISA (ERISA fiduciary responsibilities, self-insurance plan sponsorship not limited to the US, and government employers pay for healthcare services outside of their countries), how to prepare for site inspections, and lastly, rate proposals.

Closing

Dr. Todd’s book is a must for any self-insured employer considering a medical travel program for their beneficiaries. For those employers who self-insure for general health care, this book provides them with the knowledge they need to have to explore doing so. For those self-insured employers who self-insure for workers’ comp, this too is an important book.

The likelihood that the Affordable Care Act will be repealed or replaced, with something worse, or with nothing at all, grows stronger every day now. Once that happens, premiums will rise, and alternatives such as medical travel will seem much more plausible and cost-effective.

While this book was written from the perspective of the seller of healthcare services, purchasers of such services, either domestically or internationally, can benefit from reading it. Not knowing what to look for will only cost you time and money and be harmful to the health of your plan and your employees. I highly recommend this book to you.

Ten Facts About Medical Travel

Maria Maldonado has put together a list of ten facts about medical travel that people in the workers’ comp world should know about.

While it is true that there have been serious medical issues abroad, the same medical errors can and do occur right here at home. One particular one that stuck in my mind some years ago was a patient at a hospital in Tampa who had the wrong body part removed.

Also, there may be some who question whether the JCI’s accreditation is sufficient enough to justify patients going abroad, but absent any other reputable institutions, the JCI will have to suffice as a starting point or floor to which any such future institutions will have to better.

Here is the link to Maria’s post:

https://www.linkedin.com/pulse/10-things-you-should-know-medical-tourism-maria-maldonado?trk=hb_ntf_MEGAPHONE_ARTICLE_POST

Challenges Facing Work Comp

In three weeks, members of the medical tourism industry will gather in Puerto Vallarta, Mexico to attend the 6th Mexico Medical Tourism Congress.

You may recall that I was invited and attended the Congress last year, and was invited again this year. However, due to personal and financial reasons, I am not attending this year.

I am however, posting my PowerPoint presentation below for your viewing, with narration by yours truly. I hope you find it interesting and informative.

Challenges Facing Workers’ Comp (PowerPoint)

Challenges Facing Workers’ Comp (video)

 

Don’t Drink the Kool-Aid Just Yet

While the Tennessee Legislature has put the issue of opt-out on hold for this year, the South Carolina Legislation is moving ahead with opt-out, according to James Moore’s blog piece today.

David De Paolo and I have both come close to drinking the Kool-Aid on opt-out expansion, but until there is transparency and real data that opt-out offers employers and employees better medical care, opt-out is just another right-wing, anti-worker, pro-business scheme that will take this country back, quoting Grover Norquist, back to the 19th century, when workers had no rights when they got hurt, and had to sue for benefits, if they were lucky to get to court.

It figures that the state that seceded from the Union first, would jump on the opt-out bandwagon.

As I said last week, it’s a double edged sword; only one edge is up against the throat of the American worker.

For opt-out to be truly worthwhile, it has to prove it is better than what we have now, with all that we know about the high cost and abusive practices of certain bad actors, but it also has to provide the injured worker with the opportunity to get medical care where the cost is lower, the quality is better, and is offered as an option.

Given that opt-out’s biggest proponents are funding the organization called ARAWC (A-Rock), there will be many who will oppose or question the push towards opt-out expansion nationwide.

There has to be a better way to lower the cost of medical care in workers’ comp than doing it on the backs of injured workers. In other words, don’t drink the Kool-Aid just yet.

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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.

The Stench of Fraud, Continued

In The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System, I briefly mentioned the plight of one individual, who I called “Ms. X”.

I called her that because her case is still winding through the medico-legal system in her state, and I do not want to prejudice her case, or add to her woes by embarrassing her, even though she herself is bringing light to her situation by using all resources available to her,

But I felt that once I mentioned her in my previous post, it was alright to expound on the subject of fraud, and discuss her case without identifying her personally.

According to her own words to me [bracketed below] and in her correspondence to others, this is how her nightmare began:

I am an injured worker who was maimed by the medical providers in the insurance carrier’s network of medical providers. Mine is a long story that began December 12, 2011 when I was hurt at work.

[A herniated lumbar disk from working in a sitting position in excess of 65 hours one week and during that week, picking up boxes of banking and files from time to time. I began to feel discomfort in my lower back, went home, took it easy over the weekend, went back to work on Monday, worked for approx. an hour or hour and a half, got up, went to the copy machine, made my copies, bent over to pick them up and then that is when the disk herniated.]

On the day that I was hurt at work, the human resources manager told me that she was going to call the insurance carrier to find out what to do or where to send me. When she returned, she wanted me to sign a “release letter”. I had just gotten that job on November 16, 2011. I got the message that someone there didn’t want me to file a WC claim by virtue of the effort to induce me to sign a release letter. I needed that job and hoped that my back would feel better. I didn’t sign a release letter but I did write a letter indicating that I was hurt at the copier but that I didn’t want to go to their Doctors. I asked if I could go home. At some point, the HR manager gave me a couple of Advil and water for the pain. I had gone home from there – Monday, 12/12/2011. By Thursday, 12/15/2011, my back did not improve, so I placed a call into the HR Mgr. and said that I need to see their Doctors… the HR Mgr. responded by saying something to the effect “Why, you don’t have any money to go to your own Doctor?” (Not verbatim). I was taken aback by this. She knew I was hurt at work. She continued by saying, “We have a release letter signed by you!”. I responded by saying something to the effect that I never signed a release letter. We argued… and so on.

She goes on to say in her correspondence that:

…former employer who fired me less than 3 months after I filed a WC injury. On the very day that I filed a WC claim, my employer placed an ad on Craigslist to replace me. I didn’t learn until sometime in May 2012 that my former employer lied to the insurance carrier about the circumstances of my injury and what I had said. For the record, I was hurt at work and due to the working conditions and surroundings, including my desk and number of hours that I had to work, 65-66 hours the previous week. Our office had very little storage, therefore, myself and the other Escrow Officer, had to pack up boxes of files for closings and banking. We lifted these boxes weekly and sometimes daily due to the lack of space.

Because of what has happened to me, I have been upfront with Doctors outside of the workers comp system. At one of the Doctors, a pain management Doctor that I went to see in early 2014 – March or so, one of the female investigators that I had seen near my apartment on prior occasions (or was her twin) showed up and was placed inside a room before I was, I arrived first, was placed inside the room next to her. During that visit to the Doctor after being placed in the room next to the investigator, the receptionist from the front desk asked me several times if I did recreational drugs and had I ever done recreational drugs. Clearly, a continued effort to create a negative review of me and/or my history. Another Doctor who I visited to get a referral to an orthopedic Doctor insisted that what I describe does not happen. She said that there are no instances in the US of a person being forced under anesthesia. Further, she said that I was delusional and that I should see a psychiatrist, and that the pain that I have is psychologically driven and not real pain.

She was given three epidurals, and this is what happened to her after the first epidural, which went without incident:

I was forced under anesthesia for simple lumbar epidurals. At the 2nd epidural procedure, after objecting to anesthesia, I was told I had no choice, that it was the policy of the surgery center (_____ ___ Outpatient Surgery Center) that all patients must undergo anesthesia. I awakened from that with severe neck pain and slight left arm pain. My Doctor had injected my neck, left side of my spine, left leg with some sort of chemical that tingled and popped like Alka Seltzer. In fact, the tingling went from my lower left lumbar down my left leg all the way up my back and felt like a popping sensation in my head. I was there to receive a lumbar steroid epidural injection and “trigger point shots” in the left side lumbar area.

The next epidural procedure, I made it clear I that I did not want to be placed under anesthesia not only on the phone (a day prior to the procedure) but also before the procedure in pre-op and I re-stated the same in the operating room for everyone to hear. I restated that I was to get a local pain blocker (just as I had during the first lumbar epidural). Instead, my Doctor abruptly shoved the needle into my back without any pain blocker whatsoever. I could feel the needle going through the textures of my back (not precisely or with care into the spinal area where the disk is). My head flew up as I screamed “Wait!” or “Stop!”. He would not relent! As my head hit the operating room table (where a towel and prop to lay my head was), he moved the needle inside me to the nerve in my back next to my spine and held it against the nerve! The pain was so excruciating that I bit into the towel that was for my head to rest on and screamed with the towel in my mouth. Pure agony! He would not stop! I had no choice once again but to give into anesthesia. When I awakened, I thought to myself, Oh my God, they didn’t! I had injuries now throughout my back, neck, shoulders and arm. I could feel the nerves firing all over my back and next to both sides of my spine from the injections of some sort of chemical (the Alka Seltzer feeling again) that over the coming months, burned and corroded the ligaments in my spine, tendons and muscles in my back. It felt as though I was being burned from the inside out. PAIN from burning, PAIN from damage and maiming! I can now and then could feel that some of the tissue/muscles were pushed away from my spine creating the feeling of divots or holes on both sides of my spine. I could feel what seemed to be a muscle pushed away and hanging down on to the right mid side of my person. The ligaments that are in my neck and run up into my skull feel damaged, sore. My spine felt “chiseled” in specific areas most prominently in the top of my back and neck and the bottom near the lumbar sacrum area. I now have instability in my spinal column. I can feel the vertebrae in my spinal column moving not in sync with the other vertebrae…

There is a lot more detail to her case that is beyond the scope of this blog to address, but I am sure my readers have gotten a clear idea of what she has gone through. As a former Claims Examiner and Claims Administrator for a wrap-up insurance program, I have never seen, nor heard of such abuse inflicted upon an injured worker.

This poor woman, who was just doing her job, was taken advantage of by a broken, corrupt and dysfunctional workers’ compensation system that makes the injured worker seem like the guilty party, when it is the providers and legal system who are guilty of injuring and maiming the worker.

To illustrate just how they are characterizing this woman, here is another part of her correspondence regarding an attempt to make her out to have a psychological problem:

The insurance carrier and/or it’s attorneys are working hard to impair my credibility. Several attempts to have me include a psych claim ,since I finally realized that I was being maimed, have been made. Even the AME has placed a notation in his last report that is false – saying that I have ongoing psychological “???”. For the record, I haven’t any history of psych issues. This is a lie that is meant to bode well in favor of the defense. I have never before had a psychological condition. I did mark on a form that I was depressed but that was due to the pain! Not anything else.

In my insurance career, I came across another poor soul who suffered from depression due to the pain he suffered as a result of his injury. At the time, I was the No-Fault Claims Supervisor of the NY office of an automobile insurance company that insured Black Car limousines (Owner and Owner and Another). A Coptic Christian gentleman from Egypt cried in my office before he was seen by our medical consultant. Recognizing that my job was to limit the amount of money we paid to this individual, I did speak to our consultant just prior to the examination. It was the least I could do for this person. So reading what Ms. X has written does not surprize me in the least.

A letter Ms. X forwarded to me from a defense attorney even stated that her epidurals were harming her and not helping. This letter was part of a plan to get her to settle for a few thousand dollars. The lawyer’s text is as follows:

Additionally, the applicant appears to not be benefitting from the treatment, in fact, the treatment by both the employer’s physician and your physician [addressing claimant’s former attorney] appears to be harming rather than helping the applicant.

She also stated in her correspondence that she discovered that:

…some of my medical forms, surgery reports, paperwork had been falsified, changed over and above my signature and due to the anesthesia form (copy handed to me) was marked differently than the first page that I signed and more.

Finally, to make matters worse, she received a letter from a law firm representing her workers’ comp primary physician, demanding her to cease and desist from making false and libelous statements on the internet about their client. From what I understand, this is the physician who the defense attorney said above was harming her. It is no wonder that by mistreating Ms. X this workers’ comp doctor prompted her to take the actions she did to warn people about his conduct.

As I mentioned in the last post on this subject, Ms, X would have been homeless if it was not for her sister. She was subsequently fired from her job as a Manager of her department by her employer after filing the workers’ comp claim.

The events and actions discussed by Ms. X and disclosed here by me, further elaborates just how much the stench of fraud and abuse in the system has become unbearable. These words that I have quoted are but a small part of the whole story Ms. X has told people about, but it is clear that there is something rotten in the state of CA, if not in the state of Denmark, paraphrasing Shakespeare. And we all know that when something is rotten, the stench is overpowering.

Yet, the medico-legal system is arrayed against Ms. X, and the end result, I am afraid will be that she loses, and her work comp settlement will be liened against by the primary physician’s attorney, or the case will be decided in the insurer/employer’s favor, and Ms. X will be unable to go back to work, and will be forever marked as someone who brings attention to herself and not in a positive light. And furthermore, she may be marked as having a psychological issue, when in reality, she is only trying to get the proper treatment for her herniated disk. This psychological defense strategy smacks of something the Soviets used to do to political dissidents.

One gets the feeling that even though the Soviet Union is no more, we are more like the Soviet Union and other authoritarian states, in that the individual is powerless against the power and prestige of physicians, hospitals, lawyers, the courts, and other medical providers, and the system itself.

If ever there was a more clearer case of why we need to transform workers’ comp from the broken, corrupt and dysfunctional system I have been describing these past two years, this case is it.

How different Ms. X’s life would have been if she had gone to an honest and reputable treating physician, received the proper medical treatment, and if necessary, gotten back surgery to repair her herniated disk, even if she received the surgery from her employer or insurance carrier in another country, as a medical tourism option.

And how different her life would be if she did not have to be threatened with a lawsuit from a shyster law firm that is representing a shyster physician, as well as being misrepresented by bad attorneys, so that I had to ask someone I knew if he could help her. There is a saying, “a fish rots from the head down”, and in this case, the stench of the fish called ‘Workers’ Comp fraud’ is taking down the entire system.

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.

What A Long Strange Year It’s Been – My Year as a Medical Tourism Blogger

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Introduction

Today marks one year that I began my blog on medical tourism and its implementation into workers’ compensation.  From the beginning, I did not have any idea if my blog would be successful, or if it would be a complete failure. One year in, with over 8,000 views, and less than 100 followers, the jury is still out, so it remains to be seen where the blog goes in the next year.

Yet, just this month, on October 7th, I had 233 views (highest ever) and 205 visitors. But one thing is certain; I have had a very interesting time writing it, and have made some wonderful connections both in the medical tourism industry and out of the industry, from all over the world. But I have also had some rather disappointing experiences as well. This post then is a look back and maybe a look forward to another year of blogging, hopefully more rewarding, both career-wise and financially than this year coming to a close has been.

Why I started the Blog

I started the blog for three reasons: One, I had just attended the MTA Congress in Hollywood, Florida three days earlier, after they had published my White Paper on their website. The White Paper was too long for their online magazine, so they asked me if I would not mind it if they published as a White Paper. When I said yes, they eventually invited me to come to the Congress free of charge, for which I was very grateful, since I was unable to spend that much money to participate. After the Congress was over, I had learned from a few industry sources and two legal experts, that the MTA copyrighted my paper without my written permission, so I had one of the lawyers find me a template so that we could use to send them a letter asking them to either remove the copyright, and remove the Editor-In-Chief’s name from it, or remove it altogether and let me know in writing. They did remove the paper, but I had to find out for myself when I went to their website.

The second reason I started the blog was because of my MHA degree (Masters in Health Administration) which I received a year earlier, and for which I wrote the term paper that was the basis of the much longer White Paper. My Health Law class required a paper on a legal topic in Health Care, and since I had neither a legal background, nor a health care background, I went out to social media to find a topic. The first topic suggested to me did not yield much information and was not a good research subject, so again I went out to social media, and a lawyer in CA gave me the idea to write about the legal barriers to implementing international medical tourism into workers’ compensation. She helped with getting legal cases and some of the editing of the original paper, as well as some of the work expanding it into the larger White Paper. I was unsuccessful in getting any legal journals to publish it, so that is when I turned to the MTA.

The third and most important reason why I began my blog was to explore new avenues of employment in either medical tourism or in workers’ comp, or even health care. I did this because I felt my workers’ compensation and insurance experience, which consists of work in Auto No-Fault, Risk Management and Insurance Data Processing with regard to claims, brokerage and statistical reporting of workers’ compensation claims and policy data, would be valuable to organizations in those industries. Unfortunately, due to the economic downturn and jobless recovery, many companies have curtailed their hiring, and many are just filling jobs that require a finite set of skills and background that I do not possess. I have made connections both before my degree and after with executives in many companies, and in many parts of the US, but have gotten little or no response to my inquiries.

My career has been somewhat broad and varied, depending on the nature of jobs available at the time, but they have given me an insight into the world of insurance in general, and the world of workers’ compensation in particular, so after attending the Congress, and meeting different people from other countries, and hearing one company’s experience as a self-insured employer utilizing medical tourism for their employees on their health care plan, I thought that it might be possible to do the same for those employers who are self-insured for workers’ compensation, as well as those who purchase workers’ compensation insurance in the insurance market.

A Brief Review of Past Posts

My first post, on October 29, 2012 was a recap of what I learned at the Congress and what I thought about medical tourism as a viable alternative to high cost medical care in the US. The post, entitled, What I Learned at the 5th World Medical Tourism & Global Healthcare Congress, and Why It Matters to the Workers’ Compensation Industry, also discusses the three cases I cited in my paper which involved some form of medical tourism; either domestic medical tourism, or cross-border medical tourism,( i.e., Mexico), from CA and FL.

The third post I wrote was a shortened version of my White Paper, called Medical Tourism and Workers’ Compensation: What are the barriers? Here, I attempted to get the workers’ comp industry interested in the idea by giving them the highlights of my original paper. Almost immediately after I began blogging, my posts were picked up by other blogs and newsletters in the health care and medical tourism industries, and I am thankful for their faith in me as a blogger that they continue to do so.

As a further inducement to get some interest in the idea of implementing medical tourism into workers’ comp, I created a fictional case study about a self-insured employer who is self-insured for both health care and workers’ comp, but whose Risk Manager was unaware of how much money he could save if he followed what the Employee Benefits Manager was doing on the health care side with medical tourism. In the case study, A ‘Case Study’ in Implementing Medical Tourism into Workers’ Compensation, three workers sustained injuries while working at a job site and needed surgery that would have cost the company thousands of dollars. The Risk Manager told the Employee Benefits Manager about this, and learned that the company was sending its workers to countries in Central America for less expensive health care with better quality outcomes, and the Benefits Manager suggested he do the same with the injured workers.

The one topic that I have written the most about in the past year was about the impact of immigration reform on workers’ compensation, and subsequently, on medical tourism. The following posts were written because I came to believe that Latin America and the Caribbean was the most logical region of the world to pursue medical tourism, since it is so much closer to the mainland US and the workforce here is increasingly Latino and Caribbean.  These are the four posts:

The Stars Aligned: Mexico as a medical tourism destination for Mexican-born, US workers under Workers’ Compensation, Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation, Immigration and Workers’ Compensation: Round Two, Testimonial on Medical Tourism in Mexico.

The last post was supposed to be followed by even more testimonials, and may still be, but it will have to wait until after this one is posted. Finally, I decided that I should acquaint the workers’ comp industry with some of the medical tourism facilities that had booths at the MTA Congress, so I wrote the following post from literature I gathered during the last two days when the Exhibition Hall was open. No Back Alleys Here: Medical Tourism Hospitals, Clinics and Networks in Latin America and the Caribbean, simply listed the hospitals and clinics by country and listed the hospital’s websites, where available. It would be up to the reader, I felt to check them out.

What I have learned About Medical Tourism – The Good, the Bad, and the Ugly

My experience writing the blog has educated me about the medical tourism industry, even though I do not actually work in it at present. Perhaps being an outside observer gives me an honest and forthright perspective that many inside the industry don’t have, but in my email conversations with some of them, they are already aware of the nature of the beast, as it were, so here are my thoughts about the industry —the Good, the Bad, and the Ugly (with apologies to Sergio Leone, but not to “Mr. Talks-to -empty-chairs”).

The Good

In the past year, I have met some very nice and dedicated people who want to provide patients with quality health care, at affordable prices, plus a little extra on the side. Whether it was at the MTA Congress last October where I met people from Mexico, Guatemala (Belgian, actually), Australia, Singapore, China, Canada, Finland and the US, or online through my blog or my LinkedIn profile, I know that the medical tourism industry has very good promoters and patient advocates.

Many of the online connections I have made are in India, which is the primary destination for medical tourism. But there have been other connections made all across the globe from Europe, the Middle East, East Asia, Africa, and some from Latin America and the Caribbean. This proves to me that medical tourism is a growing and dynamic industry that will continue to grow, provided that it attracts the same kind of people I have connected with over the past year. Yet, as we shall see below, there is a grey cloud and a dark cloud over the industry, which threatens its long-term sustainability and growth…the bad and the ugly sides of medical tourism.

The Bad

Any industry and any business in that industry must be able to not only justify its existence, but to prove its value and worth to the customer, and medical tourism is no exception. So, it has been disheartening to me that I have been unable to get exact cost figures for certain surgeries that are common to workers’ compensation from some medical tourism facilities in Latin America and the Caribbean, as I described in my post, If You Have to Ask…Fuggedaboutit!.

In that post, I said that transparency on costs was vital if the medical tourism industry wanted to pursue business in the American workers’ compensation industry, because employers, insurance companies, and third party administrators will want to know up front if this is really a less expensive alternative to high-cost surgery in the US. I even cited surgical costs from some countries in the region, and some costs from Asian countries that I originally cited in my White Paper. These last figures, I have been told by some people are not accurate and therefore, are only a guesstimate of the actual costs.

In addition, I have been told that figures on the number of Americans going abroad for care are inflated, often because they count expatriates who are living and working in those countries as patients, besides those who actually did travel abroad for treatment, so again here is another area where transparency is needed.

Finally, as I point out in my post, Ensuring Patient Safety: Making Sure Medical Tourism Puts Its Money Where Its Mouth Is, patient safety and quality are also important areas where transparency must be observed if the medical tourism industry is to be more than just a rich man’s game. You have to prove to all stakeholders in the care and treatment of patients, and even the patients themselves, that you have equal or better quality outcomes than what is available in the US, and that patient safety, like costs and numbers of treated patients, are presented upfront and clearly to all interested parties. Failing to do so will only drag down the growth of medical tourism, and may even give it a black eye from which it may never recover.

The Ugly

As in any endeavor, individuals are bound to find detractors who critique and even attack you for your beliefs and for your efforts. I am no exception to that, and have received my share of critiques and attacks during the past year. I answered these critics in the following two posts, The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible and is not a Pipe Dream, and Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation.

I am not going to rehash this issue here again, but only bring it up as one part of what I see as the ugly side of medical tourism. There is too much personal animosity among certain individuals and organizations, especially in an industry that is still in its infancy. And while I have accepted an apology from one of my critics, there are still some ugly and vile behaviors that have been perpetrated against well-meaning and decent people who just want to grow this industry from the bottom up, instead of from the top down. There is no reason why people have to be nasty to each other, there is enough business on this planet of seven billion to go around.

Any organization that purports to represent the interests of an industry at large, and whose executives claim to be reputable spokespersons for that industry, must not engage in childish and unprofessional behavior that casts doubt on the individuals involved, the organization they belong to and the industry as a whole.

Holding fancy conferences around the world and charging big numbers only to see a handful of attendees actually paying and the rest being invited or begged to attend, does not suggest a healthy and vibrant industry, nor does it show that the leading organization promoting that industry is a trustworthy and honest one.

What I have not gotten from both industries

Medical Tourism industry

Perhaps it is because many in the industry have a background in general health care, or perhaps it is because they have experience in the travel, wellness and resort industries, that many of the people who have connected with me are not familiar or aware of what potential the US workers’ compensation market can be. I have received many offers of partnerships with these individuals, but I have to point out to them that I am not a doctor, I am not a medical tourism facilitator, nor do I have any other business that would partner with them in such an endeavor, and therefore, cannot refer patients to them.

Naturally, I thank them for considering me, but given that many of them are in Asia, and I am focusing on Latin America and the Caribbean, there is no reason for me to explore it. I would, however, like to hear from some organization or company doing business in that region who is seriously considering entering a new market such as workers’ compensation, given the increase in the Hispanic and Caribbean workforce in the US. That region has many “rising stars” in the medical tourism world, and can be very lucrative if the right people recognize its potential.

In addition, the newsletters and blogs that have re-posted my posts have for the most part, not generated much feedback or comments, and I wonder if anyone besides the publishers and their staffs are reading them. My own blog publishing site, WordPress.com, has garnered me nearly 10,000 views since I began blogging, but again, the response has been rather weak.

Workers’ Compensation industry

As I stated above, the most important reason why I began the blog was to simply find a job in the workers’ compensation industry after spending two years in school getting my MHA degree and looking for work after the recession and jobless recovery following the events of 9/11, the housing bubble that burst in 2007, and the financial collapse of 2008. The problem that I and many others are facing is that the industry is shrinking and companies are being bought by either their competitors, or by private equity firms, such as what just was announced recently when a company called Apax Partners bought One Call Care Management (OCCM), a workers’ compensation services company in a multi-billion dollar deal.

In May, I had lunch with one of OCCM’s Regional Sales Directors who shares my idea about medical tourism and workers’ compensation, and who thought we might be able to put something together that would address his clients’ concerns about the high cost of surgery. His company provides transportation, translation, home care equipment and medical devices to the work comp industry, and even has an in-house travel agency, which would make them the ideal medical tourism facilitator for workers’ compensation patients.

After several phone calls that ended without any further action on our parts, I decided to contact the top management of his company, even sending my White Paper and resume to the Chairman of the company and the President and CEO. That was back in September, and one month later, I have not heard from either of them.

I learned recently that because of this deal, it is unlikely that the President of the company will do anything with my idea. That seems to be the case with many other companies, and why I have gotten no traction with my idea from anyone else in the workers’ comp industry. When I post my blog posts on social media, it is like they are falling on deaf ears, or in this case, blind eyes. They seem to more concerned with being bought up, dealing with the opioid issue, or the physician dispensing issue (which is related to the opioid issue), or they just don’t see this as a viable alternative because they are too conservative and too cautious, and too willing to do the same things over and over again and expect different results. That, as I said before in a more recent post, is The Definition of Crazy.

Predictions

Making predictions nowadays is a little like knowing what Ted Cruz is going to do next for an encore; they’re unpredictable and designed to make the person doing so look good, so to spare you and me from any embarrassment, let me just add that health care is changing, and the direction that it takes will depend a lot on what has already happened, and what is currently happening, especially in light of the problems with the ACA rollout earlier this month.

But my recent post, Ten Years On: One Person’s View of Where the Medical Tourism Industry will be a decade from now, spells out some of the things that may influence the direction medical tourism takes in the future. Hospital costs, outpatient costs, consolidation of hospitals, cost to employees, immigration reform and technology will all play a role in determining the direction medical tourism takes in the next ten years and beyond.

Conclusion

As I begin a new year of blogging, I am grateful for the opportunity to provide my readers with new knowledge and insights to different topics, ideas and issues that affect not only workers’ compensation, but all of health care, medical tourism included. I hope that my writing has made many of you stop and think and look at things in a different light. I also hope that you have been entertained by my writing, as far as a serious subject can be entertaining when it pertains to human life.

But most important, I hope that this next year will provide with me everything I had hoped the last year would have; a new position, recognition of my idea as a viable alternative to high cost health care for workers’ compensation, and greater opportunities to personally interact and meet so many of the people engaged in the medical tourism industry around the world.

Here’s to a better blogging year!

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Thank you so much,

Richard