Tag Archives: Caribbean

Don’t Shoot Me, I’m Only The Messenger

From the “I Think It’s Time for Another Rant” Department

In response to my last post, The Further Adventures of Ashley Furniture in Medical Travel, I received several comments about the facts presented in the article, which by the way was also published in The New York Times, A Mexican Hospital, an American Surgeon, and a $5,000 Check (Yes, a Check).

Now I don’t mind comments, I welcome them. But they should not be directed towards me personally, because I am not responsible for any misleading or inaccurate reporting by the author or authors of articles I write about.

Some of the comments should, rightly be directed to the individuals or organizations mentioned in the article, as they are the active participants in what the article was describing, namely the knee replacement surgery of the spouse of an employee of Ashley Furniture Company.

I would like to point out one fact I failed to mention. Ashley has sent about 150 employees or dependents to either Mexico or Costa Rica, and since 2016, they have saved $3.2 million in health care costs, according to Marcus Gagnon, the company’s manager of global benefits and health.

Mr. Gagnon, as a side note, was featured in two previous articles published by Medical Travel Today.Com back in October and November 2017. (See my posts: Ashley Furniture and Medical Travel, part 1 and Ashley Furniture and Medical Travel, part 2)

Points were raised as to why NASH is sending patients and exporting surgeons to other countries to perform cheaper surgery pricing? NASH stands for North American Specialty Hospital. To answer that question, go to the source, NASH.

Another point was raised about pricing, and it was mentioned that US facilities charge as low as $14,990 for a total knee replacement, implant included, as a transparent bundled case rate. Hotel room for that is $149 plus tax, no hospital overnight required. And that malpractice insurance has no additional cost, plus there is no need for expensive flights, passports, etc.

Good question, Then why does the medical travel industry exist at all in the US, if what was commented is true? The fact is, it isn’t. That’s why Ashley, and HSM, a furniture manufacturer in North Carolina has been doing this for some time, as I have previously reported, and because I met the patient advocate for one of HSM’s employees at the ProMed event in 2014.

The patient in the KHN article, Donna Ferguson, also works for a furniture manufacturer in her Mississippi home town, and I bet that her employer was sure glad it wasn’t his dime that paid for her surgery, but that her husband’s company did.

Another point was made about the “concerns about quality of care” and the way Mexico does not require continuing education credits, and other criticisms of the Mexican health care system. Yet, as the article stated, they went beyond the JCI standards, and even got an extra autoclave to sterilize instruments more quickly.

Also, a comment was made about where the surgeon was from. In this instance, he was a Mayo Clinic trained, orthopedic surgeon from Milwaukee, and he would not have done this if he felt it would ruin his standing in the profession. Oh, and maybe there have been other physicians who have traveled to meet patients elsewhere. So what. The article was talking about this one, not a whole list of them.

Yes, I have not visited Galenia or Bumrungrad, as many of you have. That has been the point of my writing a blog for nearly seven years. But I have only been to three events, and only one invited me to speak. What am I, chopped liver? I post my articles to my blog and LinkedIn so that folks can read them and invite me.

Of course, I’d like to take fam tours of facilities. Of course, I’d like to meet other people in the industry, but since October 2012 when I began, I have struggled financially, personally, and medically to just stay alive. A little concern and interest on your part would have been nice.

The other points raised in the comments about the $5000 dollars she received and fees and patents, waiving deductibles and copayments were more than likely handled by Ashley’s medical travel plan administrator, IndusHealth, who also happened to be the administrator for HSM, and whose president I also met at ProMed in 2014. Again, I am only a messenger.

Finally, a comment was made that my next to last paragraph was a stretch. Perhaps so, but in light of this past weekend’s protests in Portland between anti-fascists and fascists, and the shootings in Dayton and El Paso, not to mention, three that were foiled last week, and Trump’s Nuremburg-style rallies, I can be forgiven if I want to express an idea that could bring some people to understand what the rest of the world is like.

I am not interested in what other protests happen around the world. I am only concerned, as far as Americans and medical travel are concerned, with showing them that there are no “shithole” countries, and that there are good and bad everywhere. I believe a little on-the-ground education, especially among the working class, white or otherwise, will improve racial and ethnic relations. Call me an idealist, but that is all we have to go on if we are ever going to have peace in the world.

There was something mentioned in the article that is kind of puzzling. A medical travel expert was quoted as saying that “Building a familiar culture in a foreign destination may be appealing to some American consumers, but I do not see it as a sustainable business.” If that is so, then why is he in the business in the first place, and why is he partnered with someone else on a podcast on that very subject, and who are both known in the medical travel world?

That’s the end of my rant. I invite anyone who wants to invite me to the next event or fam tour, to do so. Please let me know in advance what you are willing to pay for, and give me enough time to make arrangements for traveling with my medical condition, as traveling outside the US is somewhat problematic, depending on where it is, and other factors that might prevent me from doing so.

And again, Don’t Shoot Me, I’m Only the Messenger.

 

Medical Travel/Health Care Thought Leader Seeks Employment Opportunities

Medical Travel/HealthCare Thought Leader and Blogger, seeks part-time, remote employment opportunities. I am willing to speak, write, and collaborate on projects to bring about greater participation of patients to global medical travel facilities.

I am not a physician, nor do I have clients to refer to you. 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)

Am. Chamber of Commerce Seals Medical Travel Collaboration Agreement

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.

Source: Am. Chamber of Commerce Seals Medical Travel Collaboration Agreement

Cayman Islands Hospital Delivers Lower Cost Care

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:

  • Hospital was built at a cost of $700,00 per bed, versus $2 million per bed in the US. Building has large windows to take advantage of natural light, cutting down on air-conditioning costs. Has open-bay intensive care unit to optimize physical space and required fewer nurses on duty.
  • NH leverage relations with its suppliers in India to get similar discounts at HCCI. All FDA approved medicines were purchased at one-tenth the cost for the same medicines in the US. They bought equipment for one-third or half as much it would cost in the US.
  • They outsourced back-office operations to low-cost but high skilled employees in India.
  • High-performing physicians were transferred from India to HCCI. They were full-time employees on fixed salary with no perverse incentives to perform unnecessary tests or procedures. Physicians at HCCI received about 70% of US salary levels.
  • HCCI saved on costs through intelligent make-versus-buy decisions. Ex., making their own medical oxygen rather than importing it from the US. HCCI saved 40% on energy by building its own 1.2 megawatt solar farm.

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.

An Old Story Resurfaces

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.

About HSM

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/

S**thole Countries and Medical Travel

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.

Ashley Furniture and Medical Travel, part 1

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.