Rural Hospitals to Fail If Medicaid Expansion Ends

In April of 2015, I wrote the following post, Hospital Closures Due to Failure to Expand Medicaid.

This morning, Health Affairs posted a brief, Ending Medicaid Expansion Would Cause Rural Hospitals to Go Under.

As the current regime in Washington, and its allies in Congress slowly dismantle the ACA, rolling back Medicaid expansion will lead to rural hospitals closing, and rural patients being forced to travel long distances to get to a hospital, or to forgo medical at all.

What impact this will have on the entire health care sector is too early to tell, and what this may mean for workers’ comp, is also speculative, but it can’t be good if hospitals in the heartland go out of business.

Some way to make America great again. On the backs of, and on the health of, rural Americans who voted for this clown.

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Cross-Border Medical Travel in Tucson

Happy Holidays to all!

Hope you all had a good holiday.

Here is an article from Fierce Healthcare.com that describes what actions the city of Tucson, Arizona is taking to become a medical travel destination.

Readers of this blog will recall a few past posts that discussed cross-border medical travel, albeit due to an on-the-job injury. The article, NAFTA, Work Comp and Cross-Border Medical Care: A Legal View, discussed a Workers’ Comp claim in Arizona when a Mexican truck driver was thrown from his cab, received medical care first in Mexico, then in Arizona, as the state had changed their laws, and he was able to file a second claim.

A follow-up article, NAFTA, Work Comp and Cross-Border Medical Care: A Legal View: Update, reported the continued status of the driver’s claim.

Several other posts discussed cross-border medical travel into California, and into Mexico.

Here is the article in its entirety:

 

Tucson aims to become medical tourism mecca
by Ilene MacDonald | Apr 10, 2017 11:36pm
Tucson, Arizona, is on a mission to become a healthcare and wellness destination for international visitors, particularly Mexican families with enough disposable income to pay for medical care in the United States.

The Tucson Health Association—which includes Banner Health, the Carondelet Health Network, Northwest Medical Center and Tucson Medical Center—hopes to entice tourists to come to the city for elective, nonemergency services, such as total knee replacements, the Arizona Daily Star reports.

Although some Mexican insurers will pay for certain procedures in the U.S., Felipe Garcia, executive vice president of Visit Tucson, which is also a member of the association, expects most visitors will likely pay out-of-pocket for the procedures.

“If your patient needs a certain procedure we have in the U.S., we’ll take care of it in Tucson, do the surgery and then we’ll send the patient back to Mexico where the provider there can take the next step with recovery,” Garcia said.

Tucson hospitals are hoping their efforts will be as successful as Texas Medical Center in Houston, a group of nonprofit health providers that includes MD Anderson Cancer Center and the Texas Children’s Hospital. Those provider attract 15,000 medical tourists a year, according to the article.

Medical tourism has become a lucrative business, for both healthcare providers and the local community, as visitors usually have extended stays in hotels and leased apartments, according to the article. Josef Woodman, CEO of the North Carolina-based Patients Beyond Borders, told the publication that approximately 250,000 medical tourists come to the U.S. for treatment each year and spend as much as $40,000 per patient.

To attract Mexican patients, Visit Tucson intends to develop a website in Spanish and hire a concierge to help patients connect with medical care in Tucson and navigate the healthcare system. It plans to market heavily to those who live in the Northern Mexico area due to geographical proximity. Eventually the association plans to market medical services to Canadian citizens.

 

Here is the link: https://www.fiercehealthcare.com/healthcare/tucson-aims-to-become-medical-tourism-mecca-for-mexican-patients

Number 400

Richard’s Note: The following post was taken from an article posted by Michelle Chaffee a few days ago on LinkedIn. I am re-posting it here so that you can chew on it while you are having your holiday dinner. While you are eating and having a good time with family and friends, look around the table and imagine if one of them was in the same situation Michelle was in. How would you answer the question she poses? And think about this carefully, now that the GOP tax bill has passed and 13 million Americans will lose their healthcare, and millions of children will lose theirs. Then tell me that health care is an entitlement.

Is Healthcare a Right or an Entitlement?

Published on December 12, 2017

Michelle Chaffee

Some of you who have followed my posts over the past few years know that I am a cancer survivor. It’s been almost two years since I was very unexpectedly diagnosed with ovarian cancer. I have shared some of what it’s been like to suddenly find myself in the position of being a patient after spending a career caring for people who are sick, believing I wouldn’t find myself on the other side of this equation. I still struggle with the reality that I have had cancer and that I will have to monitor for it rearing it’s ugly head, for the rest of my life. What I haven’t shared is how the costs of healthcare contributed to my situation, delayed diagnosis and increased my chance for a recurrence. I am sharing it now because as I continue on this journey, I am starting to think the current system is discriminatory and I know it needs to change.

When I was diagnosed with ovarian cancer, I hadn’t been to my doctor for my yearly recommended examination for about 20 months. When I called to make my yearly appointment, I was told I had an outstanding bill I had been unaware of because I had moved and they didn’t have my new address. The bill was a result of “coinsurance” that was from a necessary and fairly routine procedure, still it was substantial enough that I had to set up payments over time because I couldn’t afford to pay it in full. I was told I could not see my doctor until there was a zero balance. I felt fine and had no concerns of any illness so I skipped my routine exam that year. Fast forward almost 2 years later when an unusually potent migraine resulted in a suggestion by my neurologist that I get my hormone levels checked. I contacted a new gynecology group because I couldn’t be seen by my regular ob/gyn because of the balance that still remained. On this routine exam, a very large mass was found on my ovary. So large that even though I was assured it was benign, it needed to be removed. During the surgery, the mass ruptured but the doctor told me not to worry because “It’s not cancer.” She told me the rupture was because it was so large that it made it difficult to remove. She called me about a week later to tell me it was in fact, cancer and the rupture, unfortunately complicated the staging and made recurrence more likely. The fact is, if I had gone to my regular appointment, it would have been discovered when it was much smaller and may not have ruptured. I am not blaming the doctor or the organization where I received care but, it wasn’t discovered because I owed the clinic money and they wouldn’t see me until the bill was paid. I don’t let myself think about that too much, but it’s the truth and it’s the way healthcare works in our current system.

The cost of just the surgery to remove the cancer was over $250,000. This included just one night in the hospital and no chemotherapy or radiation treatment. I had a good insurance plan but even with that, my responsibility was over $30,000. I can safely say most Americans would find it a challenge to add that expense to their yearly budget. The ongoing costs of testing for a possible recurrence are approximately $20,000 every year. That is on top of the nearly $10,000 I pay in premiums each year because I am self employed. I can’t afford this so I stretch out the time between scans and labs further than my doctor recommends.

In the back of my mind I know this could mean I don’t detect something as soon as I should again and that it can literally mean the difference between life or death.

I also know that if I owe a balance again at the hospital where I get my testing, they can refuse to treat me and I have been down that road before.

So as I write this, I find myself waiting again to find out if something discovered on a diagnostic test done almost 9 months after the doctor ordered it, is something that could take my life. Not only that, I brace myself for the cost of repeated imaging, biopsies and what may follow and I am angry, frustrated and of course, afraid. I know I am not alone and for many, it has been worse. I have worked in healthcare long enough to remember when people were denied insurance coverage because they had an illness like cancer or diabetes or a heart defect. I heard the desperation of new mothers who were grateful their precious newborn had received life saving heart surgery but had already reached their life time insurance maximum and had no idea how they would pay for the ongoing care their child needed to stay alive. The Affordable Care Act changed some of that, at least we aren’t denied coverage but it costs too much and patients can still be denied care if they owe a system money. So we constantly pray we don’t get sick again and try to find the right balance between what we can afford and what will keep us alive.

For those of you out there who say “Healthcare isn’t a right,” I tell you to save your breath unless you have faced a condition that could take your life or the life of someone you love.

To those of you who say patients should forego a smartphone or daily “fancy” coffee drink in order to pay for healthcare I say, what fantasy world do you live in where eliminating those things would make even a miniscule dent in the healthcare costs millions face?

You can also put aside the delusion that someone is sick because they did something wrong. I hate to break it to you but just because you exercise, eat healthy or have no family history of disease doesn’t mean you are magically immune to a life changing diagnosis. It can happen to anyone and I am walking proof of that reality. I ate right, exercised, never smoked, have no family history of cancer and like millions of others in this country I got sick anyway.
I find it especially ironic as I travel to other nations and collaborate with healthcare leaders to improve delivery of care to their citizens that I, a struggle to access the care I need in the United States of America. So I pose the following to ponder:

Should we get the same rights as prisoners?

Shouldn’t we at least get the same rights that criminals in this country get? The supreme court has held that those under government control must have “ Adequate food, clothing, shelter, and medical care as a component of the protections accorded by the Eighth Amendment and that “Deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain,’… proscribed by the Eighth amendment,” equating this pain with cruel and unusual punishment. Does “Cruel and unusual punishment” only apply to prisoners? It seems pretty cruel to make law abiding citizens suffer because they can’t afford medicine or treatment or to force them to choose between food or medical care.

Are we discriminated against if we are sick?

It used to be that healthcare provided through programs like Medicare, Medicaid and CHIP seemed sufficient to mitigate an accusation that there was discrimination based on a citizen’s ability to pay for adequate healthcare. Unfortunately, over time there has been an increasing group of Americans that don’t meet the criteria to receive these supplementary services but also can’t afford the cost of the healthcare available to them. I don’t consider myself poor but I can’t afford $30,000 a year or more for basic healthcare. Do I have the same rights to life and general welfare as anyone else? If treatment to save my life is available, should I be denied it because I don’t have the ability to pay? Did the founders of our country mean to make good health only available to the wealthy? It isn’t just what used to be considered the poor or elderly who can’t afford basic healthcare or medication anymore. Hard working people who have made contributions to their communities and are necessary to our countries security and growth can’t afford necessary care. This is a problem for all of us.

Where do we draw the line?

For those of you who continually argue that the government doesn’t pay for our car insurance or life insurance I will explain the difference. Driving a car isn’t necessary for survival, neither is providing an inheritance for your heirs. These things aren’t the same as access to professional healthcare services that prevent you from dying. Suggesting these things as examples of why healthcare isn’t a right, is a faulty argument and insulting to anyone who is sick. Our founding fathers and leaders were concerned for the health and welfare of our citizens. Franklin D. Roosevelt even tried to enact a “Second bill of rights” that included access to adequate medical care and the opportunity to enjoy good health. They couldn’t have imagined how costly healthcare would become as the model ushered in with the advent of health insurance, has progressed and costs have skyrocketed. I am not even insisting the government cover the cost. Even making it affordable, meaning something I can pay for that doesn’t consume my entire grocery budget for a year is a good place to start. At the very least, insuring people with truly life threatening disease have an opportunity to take advantage of the treatment we can provide seems reasonable to me and maybe it’s time to make it an undeniable right of every American.

“Extreme Makeover” Surgery Leads to Death

A story from the Australian network, ABC, tells of an Australian man who went to Malaysia for cosmetic surgery, and came back with holes in his body and died.

I am posting the link here:

http://www.abc.net.au/news/2017-12-18/medical-tourism-mother-warns-of-risk-coroner-delivers-findings/9260626

We all know there are risks to any surgery, but in the case of medical travel, one or two bad outcomes can be serious to not only the brand of the facilitator, but to the entire industry,.

Rather than conducting conferences around the world where you pat each other on the back, why don’t you call one big meeting to set out some global standards of treatment and declare that you will drive those causing harm, both facilitators and providers, out of the industry.

Stand up and make this industry safe. And stop patting each other on the back with useless certificates and awards that have no meaning to real people.

The Seven Dirty Words of Healthcare

A report on Friday, in the Washington Post, said that the current regime in Washington was forbidding the Centers for Disease Control and Prevention (CDC) from using seven words and phrases in official documents being prepared for their budget for next year.

When news of this development became public, no doubt images of the George Orwell novel, 1984 came to mind, with its doublespeak and newspeak concepts straight out of a dystopian future. The novel was published in 1948.

But it also brought to my mind, something many Americans of my generation and older remember from the world of comedy. The late comedian, George Carlin, had a routine about the seven words you could not say on television.

This being a family blog, I will not repeat them here, but I bet the folks at the CDC did when they learned about this attempt to stifle free speech.

The seven words that the Orangutan Regime is forbidding are as follows: “Diversity”, “Entitlement”, “Evidence-based”, “Fetus”, “Science-based”, “Transgender”, and “Vulnerable.”

According to the Post, policy analysts at the CDC in Atlanta were told of the list on Thursday at a meeting with senior officials who oversee the budget, an analyst at the meeting said.

The analyst, who spoke anonymously, said that the analysts were given alternative phrases such as “CDC bases its recommendations on science in consideration with community standards and wishes.” Talk about Doublespeak.

In other cases, the analyst said there were no replacement words. Since the Orangutan took office, questions as to how to address sexual identity, gender identity, and abortion rights has surfaced in federal agencies. Several departments have changed some federal policies and how they collect information on lesbian, gay, bisexual and transgender Americans, the article in the Washington Post reported.

For instance, in March, HHS dropped questions about sexual orientation and gender identity in two surveys of older Americans.

HHS also removed information about LGBT from their website, and the Administration for Children and Families achieved a page that outlined services available to LGBT persons.

The meeting on Thursday was led by Alison Kelly, a senior leader in the agency’s Office of Financial Services, the anonymous analyst said. It was pointed out that this person was not authorized to speak publicly. At the meeting, Kelly did not say why the words were being banned, and said she was merely relaying information.

The existence of this list of forbidden words was confirmed by other CDC officials, and it is likely that other parts of HHS are operating under the same guidelines, the analyst told the Post.

According to the analyst, the reaction of people at the meeting was “incredulous”, “Are you serious?”, and “Are you kidding?” There were probably some other choice words thrown in, such as the seven dirty ones I mentioned above from the world of comedy.

Alison Kelly told the analysts present at the meeting that “certain words” were being sent back for correction. Those words were “vulnerable”, “entitlement” and “diversity.”

In a related story from The Hill, HHS is pushing back on the report saying the agency was not allowing personnel at CDC to use words like “diversity”, “transgender” and “fetus” in official documents.

HHS spokesperson, Matt Lloyd told The Hill Saturday, “HHS will continue to use the best scientific evidence available to improve the health of all Americans. HHS strongly encourages the use of outcome and evidence data in program evaluations and budget decisions.”

What’s next? Big Brother is Watching You?

An Open Letter to the Medical Tourism Industry

Dear Medical Tourism Industry,

I am writing you all to address some issues I am having with the industry on the occasion of my having past my five year anniversary writing this blog, and nearing another milestone, that of publishing 400 articles. At present, I am at 396.

For the past few weeks, I have noticed on the social media site, LinkedIn that some of my connections in the industry have been attending conferences around the world, and more recently, I have replied that I wished I was there and posted a recent post with the message to advertise my willingness to collaborate, or attend such conferences.

With the exception of one person this evening, not one person has responded positively, nor in the past five years has anyone other than one person invited me to speak at a conference, and that was three years ago in Mexico. The other two conferences I attended were here in Florida; one in Miami Beach, the other in Hollywood, Florida. The first in 2014, the second in 2012, and was the reason why I started writing my blog three days after it ended.

My intention then, as now, was to transition into a new career path, so that I could be employed and enjoy the things other people enjoy, and see the world before I am unable to. But In the past five years, while I have connected with practically all the major players in the industry, defended the industry in numerous posts, and even been critical of the industry at times; no one, not here in the US, nor anyone in Latin America or the Caribbean has invited me to a conference or a fam tour, nor to any other part of the world that is not part of some current conflict.

Recently, an American filmmaker had the premier of her film on medical travel on American television, on what we call the “Public Broadcasting System”. or PBS. I missed most of it, but was able to see two names in the credits that I recognized. One person I met in Miami Beach in 2014,  the other I am connected with on LinkedIn, but have never met. I tried to contact the filmmaker, but when she did not respond, I contacted my connection, who told me she was leery about responding because I had had an association with an organization we all know, but do not like that purports to represent the industry. He had to tell her that I am legitimate.

Folks, after five years of writing, and six, almost seven, of researching the industry, and being viewed on every major continent, you would think that many of you would know that I am honest, sincere, and definitely a legitimate advocate for medical travel.

Last week, I discovered that there was a conference in Dusseldorf, Germany, and today, I learned that one of my other connections, who I did meet in Reynosa in 2014. was invited to a conference in China. What does it take to be taken seriously and given the respect and courtesy of being invited to attend these functions after all this time?

I began my work in 2011. This coming March will be seven years since I wrote my White Paper. The paper is on my blog. My articles, even those covering Workers’ Comp and Health Care have not generated many views on a daily basis, save for a few here and there. I admit, they all cannot be prize winners, but at least I am persistent. Yet, I am not making headway with the industry, nor am I getting any compensation for writing,

I don’t want to sound like I am complaining, but I feel that after all this time, it is wrong for me to be ignored. I have committed long hours of my time and my life to this industry, even as my health over the summer was an issue. I am not out of the woods yet, but I am doing ok, and with the proper treatment, and eventual surgery, I should be healthy in the future, and can travel until such time, as long as I have more than two weeks notice.

In the beginning of my blog writing, I added a section where I asked readers to tell me where they are from and who they were. No one responded, so I stopped the practice. I still would like to hear from you, but after reading this letter, I hope you will do more than just dropping me a note.

I am waiting to meet you and to participate in future conferences.

Sincerely,

Richard Krasner, MA, MHA

Map shows countries to date where my blog has been viewed.