In an effort to combat rising drug prices, one Utah health insurer will pay its members to travel to Mexico to fill prescriptions for certain expensive drugs, according to The Salt Lake Tribune.
Note: No matter where you come down on the issue of immigration and the undocumented, this process of rounding up men, women and children needing medical care is reminiscent of the tactics carried out not only by the Gestapo during the Nazi period in Germany, but every other authoritarian regime in history. We should be better than this. We are better than this.
Hospital staff are on the front lines in the fight against a growing threat to their patients’ health: fear.
Richard’s Note: The episode of The Doctors TV show mentioned below is not a complete episode. There are multiple videos on the website of the show. It will take some patience to watch them all. Sorry for the confusion.
While channel surfing, I came across the Fox program, The Doctors. They were investigating botched surgeries performed as part of a medical travel experience. One woman died as a result of an uncertified physician and facility; the other woman cannot have plastic surgery on her posterior again after a botched Brazilian butt lift.
The woman who died was the aunt of one of the audience members.
Here is the video of the episode that aired today. I suggest the industry leaders watch this.
All parties responsible for medical travel must do a better job of policing and cleaning up the industry. This cannot keep happening without anyone doing anything about it. That is why it is not seeing an increase in patients going overseas. It’s your fault, so take responsibility. CLEAN UP YOUR ACT.
On the heels of my recent post, Free Medical School Tuition Could Solve Physician Shortage, comes a new article about the shortage of general surgeons.
Friday, Reuters Health reported about a new study in the US that projected that the shortage of general surgeons in the US will get worse as the number of doctors entering the workforce fails to keep pace with population growth.
The study’s researchers predicted shortages based on their estimates of population growth by 2050, and by the number of medical schools and hospital-sponsored general surgery trainee positions.
- By 2050, there will be a deficit of 7,047 general surgeons nationwide
- That is higher than the shortage of 6,000 they predicted a decade ago based on the pace of population growth and new surgeons entering the job market at that time.
The lead study author, Dr. E. Christopher Ellison of Ohio State University, was quoted as saying, “Leaders in surgery have predicted a pending shortage in the general surgery workforce for more than 10 years.”
Dr. Ellison also said that, “the impact of the general surgeon shortages on patients is measured in the timeliness of care and the consequences of delays in care.”
The study was published in the journal Surgery, and the researchers noted that there should be about 7.5 general surgeons for every 100,000 people, to maintain acceptable access to surgical care.
According to the study, the number of general surgery resident positions and the number of residents completing their training has been rising in the US, but these increases have been insufficient to maintain the ideal number of surgeons for the population.
The authors stated, that if anything, the projected shortage is an underestimate.
Dr. Ellison: “We have not considered the impact of the aging population on the surgeon’s workload…Patients 65 years and older are more likely to need general surgery services, and as that segment of the population increases, there will be a corresponding increase in the demands for general surgeons.”
Ellison also added, that because most general surgeons practice in metropolitan areas, the impact of the shortage will be more keenly felt by rural communities.
The researchers assumed, in calculating the projected shortage, that some young trainees would choose subspecialties like vascular or transplant surgery, instead of general surgery. They assumed, also, that general surgeons would work for 30 years before retiring.
Two possibilities can be reached from the findings of the study: one, it is possible that the researchers have over- or under-estimated how many general surgeons will enter the profession each year and how many years they will remain on the job; and two, it is also possible that population growth estimates might change again, altering the shortage projections.
Dr. Anupam Jena, a Harvard Medical School researcher and a physician at Massachusetts General Hospital said the following: “Because there are fixed high costs to developing a general surgical practice in a more remotely populated area, we observe fewer practices in these areas. I wouldn’t call this a shortage per se, but I do think it’s a problem that as a society we need to figure out solutions to.”
Dr. Jena was not part of the study. Two solutions offered by Dr. Jena, however, were identifying ways for rural patients who need surgical care to be promptly evaluated and treated at medical centers several hours away, or it might involve encouraging graduates of both American and foreign medical training programs to work in remote parts of the country.
I’ve discussed the projected shortage of physicians in the past, but this is the first time, a specific specialty of physicians has been studied for a projected shortage specifically. And as in the past, I have suggested that medical travel could alleviate the shortage, especially in workers’ compensation.
Either we follow the suggestions of Dr. Jena and others, or we consider looking abroad for the solution to a growing problem — a shortage of general surgeons.
Just over four months ago, I published an open letter to the medical travel industry.
To date, I have had no response to my letter of December 14th, nor have I been invited to attend any of the conferences that have been held since, or will be held in the future, and I just learned of one at the end of this month in Washington, DC.
By that time, I will have been writing this blog for five and a half years, and still on a daily basis, my posts get at best, less than fifty views, and on most occasions, not even twenty.
I have posted them to LinkedIn, Twitter, and have re-posted them several times, and yet, each time, I get a few clicks added to the ones previously received.
I am putting my heart and soul in this and not receiving any compensation, although I should. So would it hurt if the industry paid a little more attention to my writing and to me, in lieu of actual remuneration?
As a friend we all know once said to me, “What am I? Chopped Liver?”
I am not doing this to stroke my ego, nor am I doing it because I have nothing better to do. I am doing it because I care. I am in the process of reading a fascinating book on the real reasons health care in the U.S. and elsewhere is undergoing major changes that have affected the delivery of health care, it’s cost, quality, efficiency, and its efficacy.
The least any of you could do is acknowledge my efforts and pay me some courtesy. Is that too much to ask?
I’ve met some of you in the past seven years since I began this journey, but I’d like to meet more of you. And I am sure you would like to meet me. I am funny and am a great person to know.
What say you?
Thank you very much.
If you thought I had abandoned talking about workers’ comp and medical travel, guess again. It was on the back burner waiting for the right time to come forward once again.
This time, it is due to one of my LinkedIn connections, Arlen Meyers, MD, MBA. Dr. Meyers is the President and CEO at the Society of Physician Entrepreneurs.
Dr. Meyers published a medical traveler’s check list which he calls his “7 C’s”. He advises medical travelers to complete the checklist before going abroad for medical care.
For those of you in comp who have been skeptical about the practicality and efficacy of medical travel, this checklist is intended to prove that what medical travel really is, is not some quack form of medicine or third world medicine in some dump of a hospital or clinic.
Here is Dr. Meyers checklist:
- Credentials: Check the quality of your surgeon and the facility where they intend to do your surgery. Be sure the hospital or ambulatory surgery center is accredited by a recognized accreditation organization. The table stakes for the surgeon are licensure in the state or country, board certification and a lack of repeated malpractice or disciplinary actions. Harder, if not impossible, to find will be a record of the surgeon’s outcomes for a given procedure, so you will have to rely on referral from a trusted source or recommendations. Online site reviews do not reflect quality of outcomes.
- Cost: How and how much will you be expected to pay for your operation? If something goes wrong, who is responsible for paying future care? What will be covered and what won’t? Is there insurance, for example medical evacuation in case of a dire emergency, you can buy to help defer some of the risk? Bundled payment i.e., a fixed price for specifically defined episode of care, is becoming more common.
- Continuity of care: In the best case, a doctor at home will help you to find a surgeon away from home and will accept you back as a patient once you return home. However, many surgeons are reluctant to do that so be sure you have a plan for continuity of care when you get home. Find out who will take care of you if, and when your surgeon is not available. If something goes wrong during a procedure in an ambulatory surgery center, where will you be transferred for care? Be sure you understand where you should go for emergency care when you get back home and whether your insurance company, if applicable, will cover the cost.
- Care coordination: Leaving home can involve not just medical issues, but travel and hospitality issues as well, e.g., customs and immigration forms, translation services, hotel and flight arrangements, and accommodations for companions or family members.
- Companion: Be sure you travel with a trusted, reliable companion or family member who can help and support you during your postoperative recovery. Another option is to hire a trained medical profession, like a nurse, who will accompany you on your trip for a fee.
- Continuity of data: Be sure you obtain a copy of your medical records, discharge summary and operative note. Do not rely on the surgeon transmitting the information to your doctor back home. Medical records are not interoperable in the best of circumstances and, most likely, sending reports and forms from a distant place will be a hassle, inefficient and expensive.
- Contraindications: Here are some medical conditions that are contraindications to flying.
This is not some slick marketing tool created by a medical travel facilitator or promoter. This is a reasoned, carefully constructed checklist written by a medical doctor advising potential patients of foreign medical providers and facilities what to do, what to look for, and what to expect when going abroad for medical care.
Those of you who have criticized my idea in the past, and you know who you are, should be aware that there are real professional people who strive to do the right thing, even if that means that they or their domestic colleagues lose patients to fellow physicians and facilities in other countries. Dr. Meyers did not have to do this for his sake; he did it for the sake of the patient. Which is something you should be doing, instead of doing the same old thing repeatedly and expecting different results.
It is high time workers’ comp opened up and let the sunshine in. The patients will be the better for it.
Many of you have probably thought that going abroad for medical care after passage of ACA was a thing of the past, or that the idea that workers injured on the job would go abroad was a “stupid, ridiculous idea and a non-starter”, have forgotten that medical care in the US is the most expensive in the world.
But the simple, undeniable fact is that we spend too much on medical care and get very poor results and outcomes, while other countries spend far less and get better outcomes.
Why are we so stubborn? And why hasn’t the workers’ comp world realized that they are fighting an uphill battle to lower costs every time they come out with some new strategy or cost containment measure that never lives up to its promise industry-wide?
Sure, there are individual cases where these companies save money for a particular client, but overall, the cost of medical care for workers’ comp still rises, even if that rise is slow at times, or appears to have shrunk, only to rise once again the next year, as seen in the NCCI State of the Line reports.
An article yesterday in Salon.com said that traveling abroad for medical care simply makes more sense — even regular teeth cleaning is four times more expensive in the US than it is in Mexico.
One of the first procedures mentioned in the article involves a Minnesota couple who went out of the country for an in-vitro fertilization (IVF) procedure. On her fourth trip to the Czech Republic, it finally worked, and she got pregnant. The procedure in the US would have cost them between $12,000 and $15,000.
While IVF is not something that workers’ comp would cover, the fact remains that procedures cost far too much in the US, and in the case of IVF, only have a 29% success rate, according to a CNBC report cited in the article.
An estimated 1.7 million Americans traveled abroad for care in 2017, according the Josef Woodman, CEO of Patients Beyond Borders, and author of the same titled book. In my seven years of studying medical travel, Josef Woodman’s name has figured prominently in many articles and forums of discussion on the subject.
The article goes on to say that that is 10 times more than the 2008 estimate from Time magazine.
Some of the top destinations for medical care are: India, Israel (always go to a Jewish doctor first), Malaysia, Thailand, Taiwan, South Korea (unless that little twerp up north gets an itchy trigger finger), and Turkey.
However, there are other, more accessible destinations closer to home like Mexico, Costa Rica, Panama, etc.
Typical operations are orthopedic or spine surgery (are you listening work comp world?), reproductive operations, cardiovascular and eye surgery.
For example, a coronary artery bypass graft (CABG) in the US costs an estimated $92,000 (you could buy a couple of nice cars for that amount), whereas in India, the same operation would cost $9,800.
A total knee replacement (are you still listening ,workers’ compsters?) cost around $31,000 in the good ole US of A, but in Thailand, costs around $13,000. Tell me how you can save that much on a knee replacement using any of your so-called cost saving schemes?
These same operations in Costa Rica would cost 45 to 65% less than in the US, and would not require such long flights from most parts of the US. What are you waiting for? Save some money, I guarantee your insureds will love you for it.
Malaysia would be 60 to 80% less, but why go there when you can go to Costa Rica?
According to Woodman, medical tourism (travel) is a Band-Aid for the country’s dysfunctional health care system.
Woodman told Salon, “I don’t think you can penetrate this with philanthropy. It’s gonna be baby steps all the way. But in the meantime, medical tourism is a really important option.”
Woodman also said he did not like the term “medical tourism” because it is not a vacation. You may have noticed that I use the term “medical travel” instead. It is travel for medical purposes, and if there is tourism component to it, it is incidental to the reason for going in the first place.
Patients who cannot afford dental work, IVF or orthopedic surgery in the US, Woodman said, should consider travelling abroad. If their operation or treatment is expected to cost them $6,000 out of pocket, they will save money — even with the plane ticket.
Oh, by the way, that Minnesota couple spent, get this, only $235 for the IVF, not including flights. With such reasonable cost savings, it would be a no-brainer for workers’ comp to do the same.
But some people are stupid, ridiculous, and non-starters in my book.