Category Archives: Workers’ Compensation

The Further Adventures of Ashley Furniture in Medical Travel

Readers of this blog will remember two previous articles I linked to back in October 2017 and November 2017 about the Ashley Furniture Company’s foray into Medical Travel.

Now comes a new article, courtesy of Kaiser Health News, that shows just how American patients are saving money by having surgery in Cancun, Mexico for procedures such as knee surgery (are you listening, Workers’ Compsters?)

Not only are the patients traveling to Cancun, but so are the physicians from the US.  As pictured below, Donna Ferguson, the wife of one of Ashley’s employees, is shown in the hospital in Cancun, along with her doctors, one of whom will be performing knee replacement surgery. As stated in the article, all she had to do was walk out of her hotel, and into the Galenia Hospital through a short hallway.

Donna Ferguson, center, of Ecru, Miss., had no contact with Milwaukee surgeon Dr. Thomas Parisi, left, before meeting him in Cancun the day before he performed her knee replacement surgery. (Rocco Saint-Mleux for KHN)

Donna’s surgeon, Dr. Thomas Parisi, from Milwaukee, had flown to Cancun the day before. To get this surgery, which she was getting for free, she would also receive a check when she got home. (I’ve said this before, but you never listened)

According to the article, the employees of Ashley receive a $5,000 payment from the company, and all their travel costs are covered. They use this option because they have no out-of-pocket copayments or deductibles, so it made financial sense for both a highly trained orthopedist and a patient from Mississippi to leave the US and meet at an upscale Mexican hospital. (Let’s see Trump try to built a wall to stop that!)

Dr. Parisi spent less than 24 hours in Cancun, so no one could accuse him of slacking off to play golf, and was paid $2,700, which as the article stated, was three times what he would have gotten from Medicare. The cost of the surgery for Ashley was less than half of what it would have been in the US.

To understand better, just why Ashley is doing this for their employees and their families, let’s look at what the average knee replacement would cost in the US: about $30,000 — sometimes double or triple that; whereas in Mexico, at Galenia, it was only $12,000. according to Dr. Gabriela Flores Teón, the hospital’s medical director.

The standard charge for the night at Galenia is $300, compared to an average of $2,000 at US hospitals, said Dr. Flores.

But besides the big savings on the surgery, there was also savings on the cost of the medical device, made by a subsidiary of the Band-Aid people, J&J, in New Jersey. The implant cost $3,500 in Mexico, but nearly $8,000 in the US, Flores continued.

In case you WC hotshots were wondering, Galenia Hospital is not some fleabag hospital on the cheap. It is accredited by the international affiliation of the Joint Commission (JCI). They set the standards for hospitals in the US.

However, so that doctors and patients could feel comfortable with surgery, NASH (North American Speciality Hospital) based in Denver, and who has organized treatment for dozens of American patients at Galenia since 2017, along with Galenia, worked to go beyond those standards.

In the two SPOTLIGHT articles referenced above, the manager of global benefits and health at Ashley, Marcus Gagnon said, “We’ve had an overwhelming positive reaction from employees who have gone,”

The company has also sent about 140 employees or dependents for treatments at a hospital in Costa Rica, and together, the foreign medical facilities have saved Ashley $3.2 million in health care costs, said Gagnon. (Wake up, you WC guys! Why are you being so stubborn?)

Gagnon continued, “Even after the incentive payments and travel expenses, we still save about half the cost of paying for care in the United States,” “It’s been a nice option — not a magic bullet — but a nice option.”

So, if Ashley can do it, and if HSM could do it too, the so could you. Not all the hospitals outside of the US are fleabags. Galenia in Cancun is one example. Bumrungrad in Thailand is another, and there are plenty more around the world that cater to medical travel.

The whole point of my advocacy for medical travel and workers’ comp was so that American workers and their dependents like Donna could travel abroad and see what the world is really like, so that political, hate-filled rallies and incidents we are seeing everyday since the election of a white supremacist to the presidency, would not take place.

How else will the American worker learn about the real world beyond his borders if not this way? Certainly not from Fox News.

“Travel is fatal to prejudice, bigotry, and narrow-mindedness, and many of our people need it sorely on these accounts. Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one’s lifetime.”

― Mark Twain, The Innocents Abroad / Roughing It

 

Cross-Border Health Care – Insurance Industry Finally Takes Notice

Readers of this blog have no doubt read my first post on cross-border health care, Cross-Border Health Care a Reality in California, among others. Many of them dealt with getting medical care under workers’ compensation, and the others were confined to the health care space.

Thanks to fellow blogger, Joe Paduda, who sent me a copy of the following Quick Take from the GB Journal, a publication of Gallagher Bassett, the issue of cross-border health care, especially in workers’ comp (my idea originally) is finally getting traction in the industry.

Not that I am blowing my horn, mind you, but it would have been nice to get some recognition a few years back when I started writing.

Well, anyway, here is the item from GB Journal:

Quick Take 2:
Cross Border Health Care

Employers in Arizona and California’s huge agriculture business figured this out a long time ago. For many employees who are either Mexican nationals or who have extensive family connections in northern Mexico, getting needed medical treatment in Mexico can be both more convenient and much more cost effective than treatment north of the border. Your humble correspondent set up group health PPO networks in Mexicali and Tijuana for seasonal farm workers back in the 80s. They worked remarkably well and provided this generally underserved group with excellent care at affordable rates. A recent article in Risk & Insurance’s online service describes how the same concept is now being used for treatment under workers’ compensation. 

Yes, this is legal under California law. (The R&I article does not mention Arizona comp law.) The author makes specific reference to the Mexican HMO Sistemas Medicos Nacionales, S.A. de C.V. (SIMNSA), which is – an important point – licensed by the State of California. In addition to lower costs and convenience, treating in Mexico can have additional advantages for injured workers who are not fluent in English and who feel more comfortable in a familiar cultural setting. Getting medical treatment in Mexico is not suitable for all claims or all employees, obviously, but if you have a significant comp exposure close to our southern border, you might want to check this out with your comp carrier or TPA, if you have not already.

If you want any additional information, or would like to explore this option for your workers’ comp needs, contact me and I will work with you to put together a plan for you.

Medical Travel/Health Care Thought Leader Seeks Opportunities

 

Medical Travel/HealthCare Thought Leader and Blogger, seeks opportunities to speak, write, and collaborate on projects to bring about greater participation of patients to global medical travel facilities.

NOTE: DUE TO SEVERE FINANCIAL AND PERSONAL DISTRESS, I AM SEEKING IMMEDIATE OPPORTUNITIES IN MEDICAL TRAVEL. PLEASE RESPOND IF YOU CAN OFFER ASSISTANCE, AS THIS IS A MATTER OF LIFE AND DEATH.

BE ADVISED : I am not a physician, nor do I have patients or clients to refer to you. I am seeking persons already engaged in medical travel who want to expand into a new market. I offer my services in an administrative or managerial capacity.

Experience:

Over six years experience creating, maintaining, and analyzing current issues in Medical Travel, Health Care, and other topics.

Over six years research into the Medical Travel industry.

Promoted the implementation of medical travel into Workers’ Compensation insurance industry.

Analyzed the cost of healthcare and the options of alternative treatments abroad.

Presented White Paper to Medical Travel conference in Mexico in Nov. 2014.

Extensive experience in Insurance and Claims Management, especially in medical-related claims (Workers’ Compensation).

Strong administrative and financial skills.

Education:

Master’s in Health Administration, 2011

Interested in working remotely, willing to travel, willing to write and speak at conferences, has valid US passport.

Resume can be found here.

Blog: richardkrasner.wordpress.com

Phone number: +1 561-603-1685 (mobile)

 

Opt-Out: The Final Word?

For the first post of the new year, I want to return to a well-worn subject, thanks to Joe Paduda, who published his predictions for workers’ comp last week: Opt-Out in workers’ comp.

In part 2 of Joe’s predictions, he predicted that Opt-Out will not gain any traction, and that Opt-Out is a solution in search of a problem. By that, Joe means that workers’ comp is working well overall, and that costs are under control, employers don’t see it as an issue, and there is no political constituency that wants to make it happen.

Joe rightly points out that the problems facing work comp are tiny compared to other issues state legislatures are dealing with — such as taxes, school funding, gerrymandering, Medicaid expansion, rural hospital funding, industrial and economic development, natural disaster preparation and recovery.

However, Joe’s friend, Jennifer Wolf Horesjh, Executive Director of the IAIABC (International Association of Industrial Accident Boards and Commissions) believes that advocates are working diligently to promote Opt-Out/Non-subscription.

In my comment to Joe, I said the following: “The Koch Brothers and the companies behind ARAWC are free-market, libertarians who don’t want government social insurance programs like work comp. You are probably correct that it won’t happen, but that won’t stop them from trying.”

Whether Joe is right or wrong in his prediction, will have to wait until the end of this year. But since it is only a prediction, time will tell if Opt-Out moves forward. Thus the title of this piece has a question mark, because we don’t know what the final word is on the subject.

The Road to Recovery: Post-Acute Care in Workers Compensation

The following is directed towards all those engaged in medical travel and have been following my blog for some time. Sorry I haven’t been writing in a while. I either did not see anything to write about, or just wasn’t in the mood.

But the article below should be of extreme interest to all of you who deal with post-acute care and after care, even though you are not involved as of yet in workers’ comp.

As the original focus of the blog was transforming workers’ comp, this should be read by those of you who have followed my ideas on the subject. Let me know what you think.

NCCI, for those of you not familiar with them, is the organization responsible for collecting and distributing data about the American workers’ comp industry, what is driving the costs of comp, and of claims, and other financial data relevant to the industry’s function.

Here is the link to their article:

Source: The Road to Recovery: Post-Acute Care in Workers Compensation

Gauze: A Film by Suzanne Garber

Nearly a year ago, while channel surfing, I came across a short film being shown on my local South Florida Public Broadcasting System (PBS) station.

As I missed most of it, I was able to learn the name of the filmmaker from the credits, and saw that she had interviewed some of the leading names in the medical travel space.

One individual I saw listed in the credits was Keith Pollard, with whom I was connected with on LinkedIn, and had communicated over the years since I began blogging about medical travel. I reached out to Keith to ask him to put me in touch with the filmmaker, Suzanne Garber.

I later learned from Keith that before she gave Keith her permission to forward her email address to me, she wanted to know if I was legitimate. Keith vouched for me without hesitation, and I reached out to Suzanne.

Unfortunately, due to ownership of the rights to the film by PBS, it has taken nearly a year for me to get to see it. What follows is my review of her film, “Gauze Unraveling Global Healthcare”.

The film is a personal account of Suzanne’s exploration into the difference between US healthcare, with its bureaucracy and lack of transparency regarding cost to patients; plus its affordability, accessibility, and quality — the three characteristics of healthcare, according to Suzanne.

Suzanne had gone through some personal medical issues, and the film begins with her discussing statements she received that were very expensive. At one point, she describes how she was forced to sign a form at a hospital in order to get service that said she was responsible for the full amount if her insurance company refused to pay.

She asked the woman at the desk who gave her the form if she knew what it would cost her, and the woman replied that she did not know, so Suzanne said that she was signing away her right to know how much it could cost her.

Then Suzanne asked some of her friends the following question: where is the best healthcare?

Having been an executive credentialing hospitals for a company she was working for, Suzanne had vast experience visiting hospitals, and had personal experience of being admitted to a hospital in Spain as a child. She decided to go and visit some of the hospitals that cater to medical travel patients.

From 2014- 2015, she visited 24 countries, 174 hospitals, and interviewed over five dozen international healthcare experts. She wanted to know the answer to the following questions: Where to go, and where not to go?

But it was when she had a medical diagnosis of cancer that she traveled thousands of miles, flying from Philadelphia to Chicago, to Tokyo, and then to Bangkok, where she went to Bumrungrad Hospital. By that time, her position had been eliminated, she was unemployed and uninsured, so she took the chance and went.

She traveled to Singapore to get a second opinion with an orthopedist. A doctor there wanted to perform a bone density scan, and even though she brought along all of her MRIs, CAT scans, etc., the doctor had her go downstairs, wait forty-five minutes, and then go back upstairs to see the doctor after the results were entered into the computer.

In all, it cost Suzanne $29 dollars, not the amount she was quoted back in the US. And all this took one day.

As part of her journey, she visited the UK, India, and visited several hospitals in France. And what she found was that there is no one way to improve our healthcare, but it is possible. We need to ask questions, we need to contact our elected representatives, and we need to take responsibility for our healthcare.

A personal note: This film when shown on PBS last year, had a long list of names Suzanne interviewed. In addition to Keith Pollard, one other person, Rajesh Rao of IndUSHealth, was someone I met in 2014 at the ProMed conference in Miami Beach. Some other names in that list were familiar to me, but as of this screening, does not appear. One more comment, I was able to view the film online, but am not able to provide readers with a copy of it in this post.

This is a very important and timely film that should be viewed by both the health care industry and those in the workers’ compensation industry who have panned the idea of medical travel. The mere fact that Suzanne paid only $29 for a bone density scan, when she was told it would be $7,300 in the US, is not only criminal, it is insane to keep insisting that medical travel for workers’ comp is a stupid and ridiculous idea, and a non-starter, as one so-called expert has written.

When are you people in work comp going to wake up? You and your insurance carriers are being ripped off by an expensive medical-industrial complex. But you just go on doing the same things over and over again, and expect different results, or you boast that frequency is going down, yet medical costs are still too high. The choice is yours, but don’t keep making the same mistake.

I want to thank Suzanne for her patience in bearing with my periodic emails regarding my viewing the film, and for being courageous enough to put her personal struggles with health and health care front and center, and comparing it to our so-called health care system. I hope that Gauze Unraveling Global Healthcare will be seen by all those interested in better health care for all Americans, workers or not.

 

Injured Worker Arrested When Employer Could Not Cut WC Benefits

The Charlotte Observer today reported on the case of an injured worker who suffered a brain injury after a fall in 2003 at his employer’s workplace. And because they could not cut off his benefits, they had him arrested.

In case you find this incredible, here is the link to the article:

https://www.charlotteobserver.com/news/local/article217808590.html

Is this what it has come to today in Workers’ Comp? That insurance companies refuse to continue lifelong payments to injured workers because they believe he is faking his injuries, so they and his employer have him arrested?

This is more than harsh; this is despicable.