An article from a recent connection of mine.
The Medical Travel collaboration agreement puts AMCHAMDR membership available to connect service opportunities and solutions to medical travelers.
An article from a recent connection of mine.
The Medical Travel collaboration agreement puts AMCHAMDR membership available to connect service opportunities and solutions to medical travelers.
This morning’s post by fellow blogger, Joe Paduda, contained a small paragraph that linked to an article in the Harvard Business Review (HBR) about a hospital in the Cayman Islands that is delivering excellent care at a fraction of the cost.
Joe’s blog generally focuses on health care and workers’ comp issues, and has never crossed over into my territory. Not that I mind that.
In fact, this post is a shoutout to Joe for understanding what many in health care and workers’ comp have failed to realize — the US health care system, which includes workers’ comp medical care, has failed and failed miserably to keep costs down and to provide excellent care at lower cost.
That the medical-industrial complex and their political lackeys refuse to see this is a crime against the rights of Americans to get the best care possible at the lowest cost.
As I have pointed out in previous posts, the average medical cost for lost-time claims in workers’ comp has been rising for more than twenty years, even if from year to year there has been a modest decrease, the trend line has always been on the upward slope, as seen in this chart from this year’s NCCI State of the Line Report.
The authors of the HBR article asked this question: What if you could provide excellent care at ultra-low prices at a location close to the US?
Narayana Health (NH) did exactly that in 2014 when they opened a hospital in the Cayman Islands — Health City Cayman Islands (HCCI). It was close to the US, but outside its regulatory ambit.
The founder of Narayana Health, Dr. Devi Shetty, wanted to disrupt the US health care system with this venture, and established a partnership with the largest American not-for-profit hospital network, Ascension.
According to Dr. Shetty, “For the world to change, American has to change…So it is important that American policy makers and American think-tanks can look at a model that costs a fraction of what they pay and see that it has similarly good outcomes.”
Narayana Health imported innovative practices they honed in India to offer first-rate care for 25-40% of US prices. Prices in India, the authors state, were 2-5% of US prices, but are still 60-75% cheaper than US prices, and at those prices can be extremely profitable as patient volume picked up.
In 2017, HCCI had seen about 30,000 outpatients and over 3,500 inpatients. They performed almost 2,000 procedures, including 759 cath-lab procedures.
HCCI’s outcomes were excellent with a mortality rate of zero — true value-based care. [Emphasis mine]
HCCI is accredited by the JCI, Joint Commission International.
Patient testimonials were glowing, especially from a vascular surgeon from Massachusetts vacationing in the Caymans who underwent open-heart surgery at HCCI following a heart attack. “I see plenty of patients post cardiac surgery. My care and recovery (at HCCI) is as good or better than what I have seen. The model here is what the US health-care system is striving to get to.”
A ringing endorsement from a practicing US physician about a medical travel facility and the level of care they provide.
HCCI achieved these ultra-low prices by adopting many of the frugal practices from India:
And here is the key takeaway:
The HCCI model is potentially very disruptive to US health care. Even with zero copays and deductibles and free travel for the patient and a chaperone for 1-2 weeks, insurers would save a lot of money. [Emphasis mine]
US insurers have watched HCCI with interest, but so far has not offered it as an option to their patients. A team of US doctors came away with this warning: “The Cayman Health City might be one of the disruptors that finally pushes the overly expensive US system to innovate.”
The authors conclude by stating that US health care providers can afford to ignore experiments like HCCI at their own peril.
The attitude towards medical travel among Americans can be summed up by the following from Robert Pearl, CEO of Permanante Medical Group and a clinical professor of surgery at Stanford: “Ask most Americans about obtaining their health care outside the United States, and they respond with disdain and negativity. In their mind, the quality and medical expertise available elsewhere is second-rate, Of course, that’s exactly what Yellow Cab thought about Uber. Kodak thought about digital photography, General Motors thought about Toyota, and Borders thought about Amazon.”
Until this attitude changes, and Americans drop their jingoistic American Exceptionalism, they will continue to pay higher costs for less excellent care in US hospitals. More facilities like HCCI in places like Mexico, Costa Rica, the Caymans, and elsewhere in the region need to step up like HCCI and Narayana Health have. Then the medical-industrial complex will have to change.
My loyal readers may recall that in two separate occasions, I discussed a company in North Carolina called HSM that chose to send its employees to India and Costa Rica for medical care under their self-insured health care plan.
The two previous articles, US Companies Look to ‘Medical Tourism’ To Cut Costs and Self-Insured Employers and Medical Travel: One Company’s Experience came out of an interview in Business Insurance.com that was conducted by the author and the Director of Benefits for HSM, Tim Isenhower.
This morning, my good friend Laura Carabello of US Domestic Medical Travel.com published another interview with Tim, adding two more locations to their medical travel portfolio, Cancun and the Cayman Islands.
The interview is reproduced verbatim below, and pay attention to one point Tim makes about his company’s workers’ comp costs, a point I mentioned previously and cite as a basis for considering implementing medical travel into workers’ comp.
Here is the interview:
SPOTLIGHT: Tim Isenhower, Director of Benefits, HSM
Spotlight U.S. Domestic by Editor – March 20, 2018
About Tim Isenhower
Tim Isenhower, Director of Benefits – has worked with HSM and their self-insured health insurance for the past 25 years. Managing a self-insured health plan through the 90’s to today has provided him the opportunity to think out of the box for reduced healthcare cost programs including direct contracting, on site clinics, chronic disease management, and medical tourism. With IndUShealth, Tim and HSM were pioneers in self-insured companies offering medical tourism, as was presented on ABC News and Nightline.
HSM is a privately-owned holding company based in Hickory, North Carolina, that specializes through its subsidiaries, in the manufacture of components for the furniture, bedding, transportation, packaging and healthcare industries, and the design and construction of automated production machinery for the bedding, apparel, aerospace and other industries.
Medical Travel Today (MTT): As a pioneer in the medical travel phenomenon, your story and your company’s role is so intriguing.
Tim Isenhower (TI): We are a manufacturing company and have had facilities coast to coast, as well as technologies in small towns and big cities. We were negotiating discount rates with hospitals across the country, where prices varied based on location.
I went to a human resource seminar in Raleigh in 2007 and Rajesh Rao’s company, Indus Health, was presenting medical travel to India as an option for employers. I went to India with Raj and his team, and got a physical exam which took less than six hours. In the U.S., this type of physical would have taken a month, from schedule to results.
So, we began offering medical travel to India for our employees during our annual enrollment process. We told them that if they chose to have a medical procedure done in India we would pay 100 percent, including travel with a companion.
We got no takers in the beginning. But at one of our final meetings, a fork lift driver from one our plants volunteered to have a knee replacement done in India – he simply couldn’t afford to have it done in the U.S.
He had never even been inside an airport, so I went with him and his travel companion. I was a little nervous because he had no experience traveling. But we got to India, and he actually did very well. He was impressed by the level of treatment he received.
When he returned home, he wrote a testimonial for our company newsletter. After that, more of our employees started traveling to India.
Soon word-of-mouth inspired more of them to get their surgeries in India because they saw what a positive experience it was.
MTT: So why did you shift your destination away from India?
TI: The cultural differences and distance resulted in many of our employees becoming homesick.
So, we started looking closer to home for medical care options. We have a large Hispanic population and Costa Rica had a history of high quality healthcare. We chose that area as the new medical travel destination.
Mostly, we send people for gastric procedures, joint replacements, back surgeries, hernia surgeries – a wide gamut of procedures.
Positive word-of-mouth has kept up the level of interest, and we also visit every location each year to promote the medical travel offering so more employees can understand its benefits.
MTT: And now you have expanded to Cancun. Do you find that there are other opportunities?
TI: We have. We had a patient go to Cancun just a couple of months ago. She did very well and that was a little different concept because it was an American doctor who flew down to Cancun to do her hip replacement. She was very happy with the services, pricing and results. We also send people to the Cayman Islands for various surgeries.
MTT: What has this experience meant to you, as an employer, beyond the cost savings?
TI: It’s really benefitted employee morale, to have a chance to travel to a place like Costa Rica, Cancun or the Cayman Islands. They come back and tell everyone about what a positive experience it was.
We’ve also been able to use our medical travel option as a recruitment tool.
What’s more, we saw our worker’s comp costs decline. [Emphasis mine]
I get thank-you notes from our medical travelers all the time, and we publicize these positive experiences within the company.
There’s no charge to the employee, and we give them a bonus when they return of 20 percent of what they saved the company.
MTT: Wow! That’s very generous.
TI: Up to $10,000. We are just trying to be a good employer, and this is just one way of doing that.
MTT: Do you know how many of your employees travel for surgery every year?
TI: I have lost count. We have roughly 2,500 employees now, and we’ve probably sent about 500 of them during the period of time that we have been doing this.
MTT: Did you ever have any unexpected outcomes?
TI: We’ve had people who had issues with back surgery, and they weren’t allowed to come home until the issue was resolved. But it was resolved.
They got better, came home and are doing very well.
That doesn’t always happen in a U.S. hospital. Here if a patient has issues down the road, they are on their own.
MTT: No legal issues?
TI: Fortunately, no. And the program is growing.
We’ve had everybody from executives to line workers utilize the program. Not everyone qualifies. A few have been eliminated because they have comorbidities that makes traveling for surgery unsafe, so these few were turned away.
MTT: And if you had to improve the program in any way, what would you suggest?
TI: I don’t know how I’d improve it.
Everybody that comes back is ecstatic about the program. The folks at Indus Health make it work. I know other administrators who couldn’t make it work. But Indus Health’s nurse case managers and screening process make it a no-brainer.
Rajesh Rao: We work very hard to make sure our patients are happy with our services. We don’t promise what we can’t deliver.
We work hard with our destinations to make sure we can provide assistance and high quality outcomes because that is what sells the program.
Jim Polsfut: I would like to add that it is a pleasure to work with Indus Health for all the reasons that Tim mentions. Their expertise and thoroughness have worked out very well with us.
We focus on three main objectives.
First, the quality outcomes.
Second, the satisfaction that we get from helping patients save money. In the U.S., it is so expensive to receive medical care even when you have a health plan. In that regard, the patient benefits in a significant way.
Finally, the cost benefit to the employer. For self-insured employers, this is important because of the hyperinflation of medical costs in the U.S. It’s difficult for employers to avoid the impact of healthcare expenses.
All of these factors motivate us, and give us a lot of satisfaction to provide a quality medical travel option.
Here is the link to the original: http://medicaltraveltoday.com/spotlight-tim-isenhower-director-of-benefits-hsm/
The comment yesterday that the current occupant of 1600 Pennsylvania Avenue said, is not only revolting, disgusting, sick and racist. It is also a threat to the national security of the United States, and to the economic health of the nation, and of the medical travel industry.
A host on the Fox News network defended what was said Thursday by saying that this is how forgotten men and women talk. If by “forgotten men and women” he means the men and women who lost their jobs because their wealthy bosses sent their jobs overseas or they were lost due to automation, then they only have to blame themselves for voting against their economic interests, and not the immigrants they blame for losing their jobs.
As to what this means for medical travel, think carefully about who travels from the US to other countries like India, Thailand, Singapore, Costa Rica, Mexico, and others, and not to mention those countries he did mention as “s**tholes”, especially in Africa, the Caribbean, and the Middle East (a region he did not mention yesterday, but has singled out for a Muslim ban).
And consider also what this means for inbound medical travel from those continents and countries that American hospitals might want to attract. Would you, as a citizen of those countries, travel to the US if that was what the leader of the US thought about you and your country? I don’t think so.
The notion that we should take in people from Norway (not that there is anything wrong with Norwegians, in fact, I am watching a series on early Norwegian history, Vikings on the cable channel History) is proof that he is a racist and a white supremacist.
Comments on social media have even gone so far as to indicate that Norwegians would never consider moving to the US because they have a better standard of living and have free education, health care, and rank higher on all social metrics.
So, those of you in the medical travel industry should be aware that some of the resistance to medical travel from America, and from the very people who would benefit greatly from it, are the forgotten men and women the Fox host mentioned. If so, it will be a tough sell to get them over there.
From the One Hand Washes the Other department comes the following Spotlight article from Medical Travel Today.com.
Ashley Furniture, based in Wisconsin, is one of the largest manufacturers of home furnishings in the world.
I met Rajesh Rao in 2014 when I attended the Costa Rican Medical Travel Summit in Miami Beach. Rajesh’s company was also instrumental in convincing another furniture manufacturer, HSM in North Carolina, to first send patients to India, then to Costa Rica for medical care. I have written about this in previous posts.
This article is part one, and part two will run next month.
Note: Here is Laura’s second article on repeal of the ACA and its’ impact on medical travel. She breaks the article down by areas of the healthcare industry that will be affected by repeal and that might benefit from medical travel.
Repeal of Affordable Care Act Impacts International Medical Travel
by Laura Carabello
wphealthcarenews.com- The repeal of the Affordable Care Act (ACA) has been met with considerable market uncertainty. As the transition gets underway, many Americans will be scrambling to access affordable, quality care.
Fortunately, the international medical travel industry -“Travel for Treatment” – may finally gain the attention it deserves from the American public and U.S. employers. Experts predict that the number of Americans traveling abroad for medical care or episodes of treatment is expected to increase 25 percent annually over the next decade.
Medical travelers are likely to come from every market sector: the growing ranks of uninsured individuals, self-insured employers facing higher healthcare expenditures, disenfranchised Medicaid beneficiaries, as well as Medicare enrollees with high out-of-pocket expenditures and the loss of coverage for preventive care.
Once “minimum essential healthcare coverage” is no longer mandated, the burden of payment will transfer onto healthcare providers and systems that will be forced to continue cost shifting onto the backs of paying customers.
Fewer insurance companies will be willing to underwrite coverage in the exchanges. In fact, many will leave the individual marketplaces altogether because of the potential loss of federal subsidies for both beneficiaries and insurance companies themselves.
Burdened by hefty cost-shifting, more Americans will be forced to pay out of their own pockets for surgeries or treatments in the U.S. Those who can afford a plane ticket will find it increasingly attractive to travel outside the country for quality, affordable options, such as joint replacement, cardio-thoracic surgery, oncology, bariatrics, and a host of other medical procedures, including treatment for Hepatitis C.
Low-Income (Medicaid) and Seniors (Medicare)
For Medicaid beneficiaries who remained optimistic that their home state would offer expanded coverage, their prospects look dim. The unraveling of the ACA will leave millions of the poorest and sickest Americans without insurance. Many states may either abandon Medicaid expansion or be forced to significantly redesign their programs to ensure that individuals below 400 percent of the federal poverty level can receive affordable healthcare coverage and services.
While these low-income families may not have cash reserves to fund expensive care in the U.S., they might be able to gather the resources to access needed surgeries overseas – and pay less than half of the US rates. Those who have emigrated from Latin American countries, in particular, will take advantage of opportunities to travel to their homelands to gain access to care that is substantially less expensive, and in a familiar setting.
The 57 million senior citizens and disabled Americans enrolled in Medicare could also benefit from accessing international medical travel. Under a full repeal of the ACA, seniors face higher deductibles and co-payments for their Part A, which covers hospital stays, and higher premiums and deductibles for Part B, which pays for doctor visits and other services. Medicare enrollees may also lose some of their free preventative benefits, such as screenings for breast and colorectal cancer, heart disease and diabetes. The opportunity to access quality care at lower costs – plus prescription drugs that are sold at far lower price points outside the US – present attractive options.
Healthcare will continue to be driven through employers, and cost pressures will push high-deductible plans, risk-based contracting and consumerism. In the United States today, even a negotiated, discounted rate for a total knee replacement at a local hospital may well exceed $45,000, $60,000, or more. The bottom line for self-insured employers – the coverage model that now dominates the marketplace: even after factoring in the cost of travel and accommodations for the patient and the companion, as well as waiving deductibles and co-pays as incentives to program adoption, the savings on surgical procedures such as joint replacement are significant.
Employers will also be more likely to send workers to emerging COEs outside the country in light of the many partnerships that are underway between US providers and foreign hospitals. These collaborative programs are bringing American ingenuity, sophisticated technology and advanced levels of care to institutions throughout the world.
Quality and safety standards at many institutions are now equal to or exceed US benchmarks. Many foreign hospitals are accredited by Joint Commission International, an extension of the US-based Joint Commission. Select hospitals outside the country adhere to US clinical protocols.
In fact, one organization that serves self-insured employers – North American Specialty Hospital in Cancun – even offers U.S. surgeons with US malpractice insurance who perform pre- and post-operative care in the US and then travel to Cancun for surgery. This ensures continuous engagement and continuity of care.
The ACA has contributed to hospitals experiencing higher volumes of insured patients, but those volumes would drop with the law’s repeal. It could also cause fewer people to keep prescription coverage, which would be modestly negative for the pharmaceutical industry.
Experts believe the majority of primary care physicians are open to changes in the law but overwhelmingly oppose full repeal, according to a survey published in The New England Journal of Medicine.
Insurance coverage for the 20 million people who obtained insurance from the exchanges sparked growth in patient numbers for hospitals, which offset lower payments. Without this, hospitals can expect deepening economic problems. This could lead to higher prices, and greater impetus among individuals to seek medical care outside of the U.S.
Key Destinations for International Medical Travel
With the growing ranks of uninsured, medical travel options are likely to emerge as a critical solution to healthcare cost woes. Hospitals and providers in nearby locations such as Latin America – known as the LAC Region – are likely to become destinations of choice: less expensive travel expenses, reduced language barriers, and cultural familiarity. Individuals and employers will require guidance in terms of choosing the right providers and determining costs to overcome the challenges that lie ahead.
To view the original article, click here.
Note: Laura Carabello’s Medical Travel Today has been the best partner a writer such as myself could have in getting my idea for medical travel out to the world, and it is only fitting that I return the favor. Here is an article written by Laura on a subject I have covered many times before.
Without the Affordable Care Act Will Medical Tourism Increase?
by Laura Carabello
mdmag.com- The impending repeal of the Affordable Care Act (ACA) has created uncertainty in the US healthcare marketplace. As the existing system is dismantled, and programs shut down or replaced, many Americans will be scrambling to access truly affordable, quality care.
This phenomenon has many implications for US physicians as people in every market sector begins to explore their options – from uninsured individuals to Medicare and Medicaid beneficiaries, as well as employees covered by self-funded companies.
If the ranks of the uninsured grow as a result of the demise of the ACA, medical travel options could represent an ideal solution. According to the research published in the Annals of Internal Medicine in January 24, 2017, even after implementation of the ACA, 15% of people with chronic diseases still lacked health insurance coverage and more than a quarter of them didn’t get a checkup in 2014. About 23% of people with chronic disease went without care because they found that costs were still too high.
This signals a potential boon for the international medical travel industry, further propelling the steady growth it has experienced in recent years. Medical travel was valued at $439 billion, and is projected to grow 25% a year over the next decade. In 2016, an estimated 1.4 million Americans traveled abroad for a medical procedure.
US physicians may also find that even Medicaid beneficiaries and Medicare enrollees will be lured to hospitals and providers outside the US.
For Medicaid patients who remained optimistic that their home state would offer expanded coverage, their hopes are fading. Repeal of the ACA will leave millions of the poorest and sickest Americans without insurance. Many states may either abandon Medicaid expansion or be forced to significantly redesign their programs to ensure that individuals below 400% of the federal poverty level can receive affordable healthcare coverage and services.
While these low-income families may not have cash reserves to fund expensive care in the US, they might have the resources – or may be able to gather support from family and friends – to access affordable surgeries overseas.
As for Medicare enrollees, including 57 million senior citizens and disabled Americans, higher premiums, deductibles and cost-sharing could spark a shift toward medical travel, especially given the country’s aging population and the likelihood that many seniors will require surgery.
Seniors could face higher deductibles and co-payments for their Part A, which covers hospital stays, and higher premiums and deductibles for Part B, which pays for doctor visits and other services. Under a full repeal, Medicare enrollees may also lose some of their free preventative benefits, such as screenings for breast and colorectal cancer, heart disease and diabetes.
Self-insured employers are actively seeking to lower health-care costs and increase their financial margins, and they may opt to steer workers to more cost-effective Centers of Excellence outside their home state or region. As a result, and despite long-term relationships with their hometown physicians, patients will be incentivized to leave the country and access care at foreign hospitals that demonstrate quality care at lower cost. By waiving deductibles or copays – and even paying cash rewards for choosing the medical travel option – employers will prompt patients to make the decision to travel.
Further raising patients’ comfort levels regarding medical travel is the increased quality of care now offered at international hospitals. This improvement is due to the success of knowledge transfer programs and training offered by US institutions and providers to hospitals worldwide. These collaborative efforts are bringing American ingenuity, sophisticated technology, administrative simplification and advanced techniques to hospitals in Mexico and throughout the Caribbean, as well as to locations as far away as Malta and the United Arab Emirates.
If the ACA is fully repealed, distinct changes in medical travel patterns are expected.
While Americans traditionally traveled out of the country to access elective procedures — dental care, esthetic surgeries or wellness care not typically included in their health benefits packages – they are now more likely to seek reliable medical treatment for complex conditions in destinations that are cross-border but only requiring three to four hours of travel time.
Hospitals and providers in the Latin America-Caribbean Region are likely to become destinations of choice for employers, as well as individuals. The lure of less expensive and shorter travel, reduced language barriers, and more cultural familiarity are appealing to all. The challenge will be to access benchmarks for selecting providers, ascertaining costs, determining legal recourse regarding less-than-optimal outcomes and other issues. Without the guidance of a health plan or administrator, this process may be challenging to many.
With the steady rise of medical travel, a growing number of US physicians will encounter patients seeking consultation prior to getting treatment abroad. This means providing medical records or consulting directly with the international team.
Physicians will also encounter more patients who require follow-up care after undergoing a procedure in another country. In this case, it will be important to access treatment information and discharge papers from the overseas hospital, as well as records for blood work, X-rays or other screenings for use as a roadmap for the patient’s post-care. Physicians may also be reticent to perform additional services that may be required following care performed outside the US and not in their control.
Beyond the medical details, physicians need to understand every aspect of medical travel to deal with the increased competition and cost pressures. They may want to look into making improvements and upgrading services to justify the expense of treatments here in the United States. The strongest transformation will occur in what is today the most lucrative part of the industry: high-cost surgeries and procedures. Keep in mind that US treatment costs often justify travel elsewhere, despite additional travel and accommodation costs.
Going forward, physicians can play a role in guiding patients to seek the best possible care – wherever it is available — while helping them understand the benefits and potential risks of medical travel.
To view the original article, click here.