Category Archives: Unions

Satori Files For Bankruptcy: What that Means for Medical Travel

As reported last month by US Domestic Medical Travel.com, Satori World Medical, Inc., a company based in San Diego, filed for bankruptcy.

When news of this story broke, I inquired with my contact at US Domestic Medical Travel.com to learn what this meant for the patent Satori had taken out that had a chokehold on the growth and development of the medical travel sector, both domestic and international.

Her reply was that she was not sure, so I looked up what happens when a company goes bankrupt. Most of the information concerned companies who manufactured products and what happens to the patents to those products after a bankruptcy. The gist of what I found was that they transfer to the receivers/liquidators.

But since Satori’s patent is for an idea, and not a tangible asset like manufactured goods or inventory, I doubt the receivers/liquidators for this action would be willing to take this asset. What would they do with it?

So, instead of wondering, because that may be a fruitless exercise, let’s look at what the patent was all about, what it allowed and did not allow, and then you can decide how best to model your business plan going forward.

The Satori patent, trademarked as the “Health & Shared Wealth Program”, is actually two patents; the first, U.S. Patent 8160897, titled the “Satori Integrated Health & Financial Benefits System and Method” and U.S. Patent 8224668, a Continuation-in-Part to Patent No. 8162897.

They are part of a portfolio of other patents of intellectual property that regard the calculating and sharing of the dollar savings from a medical travel health benefit. The patents provided Satori with exclusive rights to the only permissible medical shared savings model in the medical travel industry.

I know what you all are thinking, how can anyone patent an idea such as this? Isn’t this restraint of trade, you may wonder?

Well, as I am not a patent attorney, nor an intellectual property expert either, I would think not, except that was the case before the bankruptcy.

As Satori’s own website states, the Health & Shared Wealth Program supports organizations by lowering their cost structure for health benefits by providing plan members with a highly-valued benefit option at no cost to the plan sponsor or members.

The parent patent, they continue, is a system and method that calculates the savings generated when a patient selects medical care outside the US.

It waves all co-pays, deductibles, and/or co-insurance, making the selection of outbound medical care a 100% medical benefit for the patient. In addition, it shares the savings between the patient and the insurer/employer.

I want to stop here in the explanation of the patent to tell you my idea, and why this patent seems to me to be a restraint of trade issue and a virtual monopoly.

My idea was to implement medical travel into workers’ compensation in the US, and along the way, after writing my paper on the subject, and this blog, I learned from other individuals that the best way to do so was to offer an financial incentive from the savings to the claimant/patient from either his employer or insurance carrier.

At the same time, I learned from one individual, that in order for this to be advantageous, the savings had to be greater than $5,000 for medical care received outside the US. So for example, if a knee surgery in the US cost $30,000, in order to convince an employer or insurance company of the efficacy of outbound medical travel, the cost of that knee surgery would have to be $25,000 or less.

How much the claimant/patient would receive and when and how they would receive it is a matter of discussion. It could be a percentage of the savings, a flat-rate of say, $2,000 or $2,500, or come from the overall settlement of the claim, but that could take years to realize.

Returning to the patent, the Health & Shared Wealth Program, Satori states, precludes certain entities such as medical travel/medical tourism facilitators (I bet you are hoping mad at this point; I sympathize), health plans, self-funded and fully insured employers, Taft-Hartley trusts (labor unions), unions, workers’ compensation carriers (this got me mad), municipalities, pension plans, etc., from offering any shared savings model similar to the one described above to their clients and/or plan members without written permission from Satori (now you must be steaming!!!!).

So, what does this mean? If Satori is out of business, we can all take a sigh of relief that now the wicked witch of the west (Satori) is dead. What comes next is up to you. Prior to the announcement, there were ways to get around the patent’s restriction. Now, that may not be necessary.

My suggestion is get yourselves some good IP attorneys to see if you are good to go, and if you are given the green light, adjust your business model and plan accordingly. You will only benefit from the fall of the house of Satori.

 

A History Lesson: What it Means for the Health Care and Workers’ Comp Industries

Allow me to take off my blogger’s cap, and put away my MHA degree, and write about something I do know a lot about, and that is American history. After all, the MA after my name means “Master of Arts”.

On September 6, 1901, President William McKinley, was shot by Leon Czolgosz, an anarchist, and died on September 14th. McKinley, who had been re-elected the previous November, was succeeded by his second Vice-President, Theodore Roosevelt.

When Roosevelt became the 26th President, the course of American history changed forever, or so it seemed, through most of the twentieth century. The fact that it did not completely change the course of history is the subject of this essay.

You are probably wondering what impact this all has on the American health care system, and workers’ compensation in particular.

The answer to that can be found in a statement made decades later by the anti-tax lobbyist and Bush 43 White House aide, Grover Norquist, who said, “his goal is to bring America back to what it was “up until Teddy Roosevelt, when the socialists took over…

It was Roosevelt who first proposed national health insurance that future presidents, both Republican (Nixon) and Democrats wanted to create. Roosevelt also passed the Pure Food and Drug Act of 1904, which created the FDA, and led to food and drug safety.

For several decades in the late 19th century, progressive reformers had unsuccessfully tried to change things, and not always peacefully, as the various riots and bombings and strikes can attest to.

But after Roosevelt, and after his defeat in the 1912 election, progressives moved closer to the Democratic Party, first under Woodrow Wilson, then twenty years later, under Teddy’s cousin, Franklin.

It was during Taft’s last years in office, and Wilson’s first years, when workers’ comp laws were enacted by states. And in the years to follow, such reforms as direct election of senators, the right to vote for women, end of child labor, the right of unions to strike and bargain collectively were won, and unemployment insurance, social security, welfare, and many other social programs were created.

But some thirty-five years ago, that began to change, when men like Norquist became President, Senators, and Congressmen, and a slow process of destroying the social safety net began.

We are seeing this in the resistance to, and threat of repeal of the ACA, the assault on statutory workers’ comp through the expansion of opt-out, and the corruption of the workers’ compensation system by carriers, employers, judges, lawyers, physicians, and service providers.

To illustrate this point, David De Paolo wrote today about responses to two previous posts he wrote, in which several respondents made threatening remarks towards persons’ unknown, who had heaped further injury on already injured workers.

While I do not advocate personal harm towards any one claims person (I was one myself a long time ago, and was threatened, or so I was told, but never by whom), I have expressed the opinion that those who inflict pain on those already in pain, are inviting trouble. But that is to be directed towards the system, not a person.

In response to an article by Jodi Mathy about the employee experience of claim management, I said that such action should be,

“Not against claims people, but against a system that causes pain to people who are already in pain. WC was supposed to ameliorate the harshness of the laissez-faire, industrial revolution, not redistribute wealth. If that was the case, claims awards would be in millions.”

To further drive home this point, I quoted the following:

Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

Karl Marx

Now before any of you see red stars, or hammers and sickles before your eyes, calm down. I only quoted him because what he said was true when he wrote it, and could be true again in the future, if we allow ourselves to be deluded by those like Norquist who want to go back and party like it’s 1899.

So if you are afraid of socialism, just remember these inconvenient truths, or facts. One, many of us alive today would never have gone to college without socialism. Two, our parents would not have gone to college either, especially those who fought in WWII, Korea, and other conflicts. Three, our parents would not have been able to retire to Florida, Arizona, or anywhere else without Social Security, and would not have gotten medical care after 65 without Medicare, and if they were poor, Medicaid.

Four, all of you no doubt has flown for both business or pleasure. Do you not like the idea that there is a federal agency, the FAA that regulates airlines, and oversees airports? What about interstate highways, railroads, cruise ships, etc.? All of that because of socialism, although a limited form of socialism.

Last week, the GOP elected a new speaker, Paul Ryan. A while back, it occurred to me that since Ryan was a devotee of Ayn Rand, and Rand Paul was running for president, that there was a curious connection between the three of them. If you take Ayn Rand, then Rand Paul, then Paul Ryan, put their names together, you get “AynRandPaulRyan”, and if you take Ryan’s name, drop the “R” and move the “y” after the “a”, you get back to where you started.

It doesn’t mean anything, but it is curious, given their libertarian values.

And getting back to where we started, i.e., in 1789, is no way to run a modern, post-industrial society, so yes, history does matter, and both health care and workers’ comp will be the worse off if we forget it, as per Santayana.

Workers’ Comp Plans Can Be Dumped in TX and OK

To follow up on previous posts about the opt-out option in workers’ comp, a shout-out goes to JJ Schmidt, Senior Vice President at WellComp for bringing the following NPR report to my attention.

Here is the link to the NPR report and audio:

http://www.npr.org/2015/10/14/448544926/texas-oklahoma-permit-companies-to-dump-worker-compensation-plans

I have already said that opt-out is not all that its proponents say it is, but as we get more into the motivation behind the expansion of the option through various state legislatures, where the actual legislation is being written by an organization called ARAWC (A-Rock), it is not hard to see that workers’ comp is under serious threat from the right-wing, anti-union, anti-worker, Corporatists who are funnelling huge sums of money into this expansion.

This is something that was not brought up in last night’s Democratic debate, but should be on the minds of all those who want to protect the rights of workers.

Paralysis by Analysis: Or the Only Thing We Have to Fear Is, Fear Itself

Having now written this blog for more than two and a half years, I find that when I discuss the issue of medical travel, either for workers’ comp or for general health care, that there are dozens of reasons (or maybe they are excuses) given by various individuals I have conversations with, as to why medical travel is not feasible or even profitable.

Being an intelligent, well-educated person, I know that this country has put men and women into orbit, landed on the Moon, and have sent unmanned space crafts to every single planet and planetoid in our system, as well as sent two probes out of the solar system and into deep space.

And yet, as complicated as these space missions were, no one ever said it was impossible, no one ever said it would never work, no one ever said it was not profitable, and no one ever said there was no incentive in it for this one or that one, etc., ad infinitum.

However, that is not the case with medical travel. There always seems to be some kind of reason, some kind of caveat, and some kind of negative excuse given against this idea. And mostly, it concerns what some lawyer would do to an employer, or other entity that puts the fear of a lawsuit or economic ruin if this were to be attempted.

But it is not just lawyers who are at fault here for the fear that I am sensing. Laws and regulations designed to deal with all aspects of the health care and benefits fields, not to mention the statutes and regs in workers’ comp, are to blame for what a career counselor I knew years ago here in Florida, used to tell unemployed people at the weekly workshop.

He was a retired engineer, and in his field, they talked a lot about “paralysis by analysis”, and how we stop doing things once we analyze it to death. This was true in the engineering field, and is true in doing a job search, and even implementing medical travel into either health care or work comp.

We are so used to being afraid of doing new things, we are so afraid of doing something different and out of the norm, that one has to wonder why any of us get out of bed in the morning, or leave the house for that matter, fearing that something terrible is going to happen.

As pertains to medical care, of course bad things can happen. They can happen in the hospital across town, or on the way to the hospital, but we don’t avoid it because of what might happen. The same is true for medical travel. The same complications and negative outcomes can occur here that they are afraid of might happen over there.

Then there is the legal liability excuse. Damn, if I had to worry about legal liability, I would not take my car out of the garage.

And here again, we come back to the issue of lawyers and lawsuits, etc. As many of you may know, my father died last September, and since then, and earlier that year, we had to deal with lawyers to handle family matters in the event one or both of my parents passed away.

The first lawyer we used is the best friend of my first cousin, and was the person who drew up several legal documents for my parents in the past. The second lawyer was referred to me by the first lawyer after my father died, and I was using him up until April, when my brother decided to go with someone who was referred to him by a fourth lawyer he sat next to on the plane to Miami when my brother came for a short visit.

I have known many lawyers in my life, as no doubt many of you have, and on the whole, they are not a bad lot. But some of them are just out for the money and to prevent progress on a whole range of fronts, including health care and workers’ comp.

I have worked for and under two lawyers in my career in claims. Both of them did not leave me with a good feeling for insurance lawyers, so when I hear that employers are afraid to consider medical travel to save money on expensive surgeries, or that some large organization in the labor world might sue an employer or a union, because benefits are negotiated in collective bargaining agreements, then it tells me that people are afraid that it might work.

Instead, the lawyers force employers and insurers to spend more money because it is in a contract, or they want to use American medical providers, etc.; when it has been clearly proven that ours is the most expensive health care system in the world.

FDR said in his first inaugural address that the only thing we have to fear is, fear itself. It would seem that in the case of medical travel, it is not fear itself we fear. We fear lawyers and lawsuits, we fear what others might say or do, we fear that employees will like to go abroad because the care is better, we fear that employers will save money which rightfully belongs to those who are profiting from the status quo, and most importantly, we fear that we aren’t the best in everything, except in self-delusion and in paralysis by analysis.

We can do better.

————————————————————————————————————————————

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.

Is Medical Tourism “Anti-Union”?

In a Wall Street Journal article this week, Dr. David J. Leffell, the former CEO of the Yale Medical Group and a professor at the Yale School of Medicine wrote an Opinion column entitiled, The Doctor’s Office As Union Shop, brillantly pointed out that one outcome of the enactment of the Affordable Care Act (ACA) next year will be the trend that physicians will become employees of large hospital groups, rather than self-employed professionals that has marked the practice of medicine in the US for many years. Leffell writes that this trend, which will directly affect the quality of patient care, and could affect its cost, has gone unnoticed and unreported.

This, Leffell says, is a radical transformation of health care, in that doctors who have traditionally practiced either alone or in small groups, will become union workers. In the past, physicians have been more difficult to regulate and monitor, unlike hospitals who operate under the rubric of large regulatory agencies. Leffell believes that:

For cost control to be effective, the professional autonomy and independent clinical judgment of the physician and other providers must in some measure be sacrificed to standardization.

Leffell also writes that by reducing the reimbursement for certain office-based specialists while enhancing related payments to hospitals, the Obama Administration had, by accident or intent, created this change in the status of physicians. He believes they are compelling more and more physicians to seek employment with health systems or large physician groups.

One other factor he cites for this move towards physician as worker, is a generational shift. Doctors who are in training now, Leffell writes, are willing to forsake income for a better quality of life, and are less interested in the entrepreneurial tasks required to run a practice. They want regular hours and do not want to be responsible for patients after hours. In 2012, Leffell states, approximately half of physicians were already employed by large health care entities, and that in the next few years, these systems will employ close to 80% of all doctors.

This shift, Leffell says, is important for many reasons.

The migration of physicians into large, regulated entities is essential if the practice of medicine is going to be transformed into the corporatist-government model that is the only way health-care costs can be controlled.

This new status will provide doctors with the right to collective bargaining, something that some Republican governors have tried to restrict in recent months, especially for public service workers. What they will do with doctors working in large hospital groups, private or public is unknown at this point.

All this has not been without notice by the leaders of organized labor, Leffell points out. They see service workers with nonexportable jobs as the last best hope for their unions, whose membership has been declining for years. Leffell quite clearly states, that physicians are becoming service workers; they are well-educated, expensive to train, their decisions have significance to the lives of others, but they provide a service that cannot be outsourced to India or China, according to Leffell.

This raises the question as to whether they have a right to strike, which is the key to collective bargaining.

As we already know, some expensive or unavailable procedures are already being “outsourced” to India, Thailand, Singapore, and other medical tourism destinations. My posts on Mexico and on hospitals and clinics in Latin America and the Caribbean make this very clear. What is different here is this, if doctors in one or more hospitals go on strike, and Americans cannot get even those procedures that are not very expensive or that are available here, will medical tourism be seen as “anti-union” as scab workers are seen by striking workers in other industries? And if the trend towards unionization of doctors goes the way the unionization of workers in industrial workplaces has done, will future rising costs of unionized healthcare providers mean that as an alternative, medical tourism will be anti-union?

We cannot know for certain, because the factors that determined past unionization movements and the associated costs of labor it has engendered, does not necessarily mean that it will follow the same path. And this does not mean to imply that implementing medical tourism, for health care generally, and for workers’ compensation specifically, as I have been writing about, is in itself anti-union. On the contrary, I support unions, but am only pointing out an issue that will need to be addressed by the health care industry, physicians, unions, lawyers and politicians in the years to come.