Tag Archives: Employee Benefits

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/

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Ashley Furniture and Medical Travel, part 2

As promised last month, here is the Spotlight article from Medical Travel Today.com about Ashley Furniture’s foray into Medical Travel for their employees.

In case you missed it, here is the link to part 1 of the article.

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.

ARAWC Strikes Again: Opt-out Rolls On

“Just when I thought I was out… they pull me back in.”

Michael Corleone, Godfather, Part III

Source: https://www.pinterest.com/Mamzeltt/famous-movie-quotes/

When Michael confronts Connie and Neri in the kitchen of his townhouse, he warns them to never give an order to kill someone again (in this case, it was Joey Zaza), and goes on to state that when he thought he had left the mob lifestyle, they pull him back.

Thus, is the case with opt-out, as I discussed in my last post on the subject.

Kristen Beckman, in today’s Business Insurance, reminds us that opt-out, like the Mob, is pulling us back into the conversation.

As I reported last time, a bill in Arkansas, Senate Bill 653, pending in that state’s legislature’s Insurance & Commerce Committee since the beginning of March, proposes an alternative to the state system.

Ms. Beckman quotes Fred C. Bosse (not Fred C. Dobbs), the southwest region vice president of the American Insurance Association (AIA), who said that the bill is an attempt to keep the workers comp opt-out conversation going.

Mr. Bosse said that the AIA takes these bills seriously (good for them) and engages legislators to dissuade progress of such legislation the AIA believes could create an unequal benefit system for employees. (They haven’t drunk the Kool-Aid either)

Arkansas’ bill is the only legislation currently under consideration, but a state Rep in Florida, Cord Byrd (there’s a name for you), a Republican (it figures) from Jacksonville Beach, promoted legislation last year, but never filed it.

South Carolina and Tennessee, where bills were previously introduced within the past two years has gone nowhere.

And once again ARAWC rears its ugly head. For those of you unfamiliar with ARAWC, or the Association for Responsible Alternatives to Workers’ Compensation, it is a right-wing lobbying and legislation writing group based in Reston, Virginia. (see several other posts on ARAWC on this blog)

A statement ARAWC sent to BI said that these bills are beginning to pop up organically to model benefits that companies have seen from Texas’ non-subscription model. (Organically? That’s like saying mushroom clouds organically popped up over Hiroshima and Nagasaki)

Here’s a laugh for you, straight from the ARAWC statement:

Outcomes and benefits for injured workers have improved, employers are more competitive when costs are contained and taxpayers are well served by market-driven solutions,” They further said, “We recognize that each state is different and that the discussions at the state level will involve varied opinions.”

Of course, we cannot really know if injured workers are benefitting, or just being denied their rights, and it seems that opt-out is only to help employers and taxpayers get out of their responsibility to those who sustain serious injuries while employed.

In another post, the notion that Texas’ system could serve as a model for other states was outlined in a report by the Texas Public Policy Foundation (don’t you just love the names of these reactionary groups?)

Bill Minick, president of PartnerSource, praised the report, according to Ms. Beckman, and said that competition has driven down insurance premium rates and improved benefits for Texas workers. (That’s what he says, but is any of it true, I wonder? I doubt it.)

ARAWC has listed a laundry list of benefits they say responsible alternative comp laws could provide:

  • Better wage replacement
  • Reduced overall employer costs
  • Faster return to work
  • Fewer claims disputes (yeah, because they would be denied)
  • Faster claim payouts
  • Faster closure (well, when you deny claims, they can be closed faster, duh!)

It is good to know that the AIA is critical of the report, and that in their opinion, it is unworkable to allow employers to adopt a separate, but unequal system of employee benefits.

And as we have seen with the defeat of the AHCA, leaving a government-sponsored program up to market-driven forces is a recipe for disaster that should not be repeated in workers’ comp, no matter what flavor the Kool-Aid comes in.

Fam Tours for Self-Insured Employers

The subject of medical travel for self-insured employers is one that this blog has rarely discussed from the point of view of the medical travel facility.

Previous posts here have discussed a possible scenario for medical travel by self-insured employers under workers’ comp, the experience of one company that did so for its employees under their group health plan, and why self-insured employers are failing to adopt medical travel, as well as other posts that briefly mentioned self-insured employers.

Yet, at no time has this reviewer, in the position of content writer, ever discussed how the medical travel facilities can market their services to potential self-insured customers.

A new book by Maria Todd, her sixteenth in fact, does exactly that. Organizing Medical Tourism Site Inspections for Self-Insured Employers is a well-written manual for medical travel facilities seeking to highlight the services they offer by hosting site inspections, or more colloquially known as “fam tours,” or familiarizing tours.

Note: This writer had participated in only one fam tour to medical facilities when I spoke at a medical tourism conference in Mexico in 2014.

Knowing the Customer

Dr. Todd’s book focuses on the ways medical travel facilities can know their customers by knowing which self-insured employers are more likely to develop a medical travel program for their plan beneficiaries, and the criteria the Plan Administrators will look for to engage their services and the conditions under which such travel is possible.

One example given is if flying time to a medical tourism destination is less than three hours by plane. For American workers, who have US passports, longer distances would eliminate travel to parts of Asia, the Middle East, parts of South America, and Russia. Such locations would be possible if the employees were working there or nearby, and they were the closest facilities available.

She also discusses what will attract multinational employers who have workers around the world to select facilities that can handle industrial accidents, as well as general health and rehabilitative services. Some employers may be self-insured for their domestic employees, but purchase an insurance cover called an International Private Medical Insurance, or “IPMI.”

Selling Solutions

To educate hospital executives and managers on how to sell solutions to Plan Administrators, Dr. Todd includes a chapter on a topic she says executives and managers often do not consider important.

The chapter focuses on what not to say or do when conducting a site inspection. You, as the seller might consider certain areas of your facility important to highlight, or is one that you take pride in, but may not be something your guests are particularly interested in.

One such area is Accreditation. Not knowing abbreviations for accrediting organizations such as the Joint Commission International (JCI), or what the big deal is about accreditation, is something the executives and managers need to be aware of beforehand and to be prepared to explain why it is important.

Proper accreditation will go a long way to ease their minds over deciding to use that facility, and being presented with an unfamiliar or disreputable accreditor, or one whose certificates are not worth the paper they are printed on, is something to be aware of also.

Another area of concern when hosting a site inspection is scientific presentations. It is quite possible that some of your guests may be physicians and nurses who will benefit from seeing such presentations, but for those Plan Administrators who are not medical personnel, such tours maybe considerably boring, if not completely too technical for them to comprehend.

Technology Tours

A similar mistake made is taking business-focused guests to see the technology the facility has installed and uses. Dr. Todd recommends they create a spreadsheet of the expensive equipment they have and write a short blurb about each.

Her main point is this: Plan Administrators are seeking three things: transparency, good value, and superb, culturally-sensitive customer service.

Other areas to avoid on Fam tours

The Emergency Department, laboratory, radiology and imaging department, cardiac catheterization lab, and the PET/CT, and PACU’s are a waste of time, per Dr. Todd, and may even disturb the patient’s privacy and recovery.

Final five chapters

The final five chapters deal with developing relationships, the contracting and provider network criteria (where to get preliminary data, contract terms and payment agreements, and avoiding payment hassles with the right language), the basics of ERISA (ERISA fiduciary responsibilities, self-insurance plan sponsorship not limited to the US, and government employers pay for healthcare services outside of their countries), how to prepare for site inspections, and lastly, rate proposals.

Closing

Dr. Todd’s book is a must for any self-insured employer considering a medical travel program for their beneficiaries. For those employers who self-insure for general health care, this book provides them with the knowledge they need to have to explore doing so. For those self-insured employers who self-insure for workers’ comp, this too is an important book.

The likelihood that the Affordable Care Act will be repealed or replaced, with something worse, or with nothing at all, grows stronger every day now. Once that happens, premiums will rise, and alternatives such as medical travel will seem much more plausible and cost-effective.

While this book was written from the perspective of the seller of healthcare services, purchasers of such services, either domestically or internationally, can benefit from reading it. Not knowing what to look for will only cost you time and money and be harmful to the health of your plan and your employees. I highly recommend this book to you.

RESISTANCE IS FUTILE!: What is the reason behind Medical Tourism’s Rejection?

My friend, Maria Todd, PhD, noted International Expert on Healthcare & Health Tourism Business Strategies & Operations, Business Owner, Author, and Speaker, has written a very cogent and to the point article challenging American hospitals on why they eschew inbound medical tourism.

For the uninitiated, inbound medical tourism, or travel, refers to foreign patients traveling to the US or other countries for medical care from their home country.

A case in point was the late, and not lamented, Shah of Iran who was allowed to come to the US for treatment of his cancer, and which led to the taking hostage of our embassy staff, destroying what was left of one presidential administration, and secretly aiding another to win the election, and thus look good in the eyes of the American people, only some time later to that administration selling arms to Iran for other hostages, the cash then used to support the Contras in Nicaragua.

But I digress.

As the Shah had money, he was welcomed with open arms, but Maria wonders why other American hospitals, knowing that they will receive cash, still refuses to seek out inbound medical tourism as an alternative source of revenue.

According to Dr. Todd, “It is estimated that the USA is the 3rd most popular destination for inbound medical tourism from other countries, but the practice of traveling for health has been a “thing” in the USA for more than 100 years.

Corporations such as Pepsico, Lowe’s Home Improvement, Boeing, WalMart and many other corporations, she writes, with self-funded health plans under ERISA, have the freedom to contract with any hospital, anywhere in the world without going through a managed care network, but can’t because the hospitals with lots of value to offer simply don’t seem interested enough to talk to them.

She wants to know why not? In order for her to find the answer to that and other questions, she is asking her colleagues in healthcare business development and business administration who are executives at leading healthcare institutions and well-equipped ASCs across America: “Why do you eschew medical tourism business?

This question, and the others that she poses in her article, also relate to outbound medical tourism as well.

Why do employers, insurance companies, the domestic health care industry, which is beset by so many problems and potential shortages and inefficiencies, as well as the entire workers’ compensation industry eschew medical travel for non-work-related illnesses and diseases, and work-related injuries requiring surgery?

I’ve written about this many times before. I have cited American Exceptionalism, racism, xenophobia, greed, ignorance of the quality of medical care abroad, and many other factors, but as Maria points out for US hospitals turning down cash patients, employers and carriers can save money by looking outside our broken and dysfunctional medical care system under workers’ comp.

It’s high time the US joins the rest of the world, and allows our citizens the freedom to go wherever they want for medical care, no matter what the cause, or condition that prompts them to seek medical care that is high quality, and will save money for their employer, and provide them an opportunity to see the world that also belongs to them.

Not to do so is tantamount to enslavement to a corrupt and rigged system that benefits unscrupulous physicians, pharmacies, pain management centers, and other workers’ comp service providers, and harms injured workers.

Medical travel will happen. Resist at your peril.

Opt-Out A Boon to Employers, Not So Injured Workers

Employers opting out of workers’ comp in Texas are reducing costs, but more study is needed on how non-subscription affects injured workers, according to Stephanie Goldberg of Business Insurance.

Ms. Goldberg reports that a study released last week by Alison D. Morantz of Stanford Law School, found that the overall cost per claim is about 49% lower in the non-subscription environment, which is largely due to declines in medical and wage replacement costs.

The study also found, she writes, that despite no significant decline in frequency of claims, that more serious claims involving replacement of lost wages are about 33% less common among non-subscribing employers.

For the study, Ms. Goldberg adds, Ms. Morantz recruited 15 large multistate companies that operate homogenous facilities nationwide, and compared outcomes in traditional workers’ comp versus opt-out for each company from 1998 to 2010.

The study found also that the frequency of nontraumatic injuries declined about 47% with opt-out coverage.

It could be that nonsubscribers are better at screening out nontraumatic claims under one of the many exclusions that private plans typically contain,” said Ms. Morantz.

Meanwhile, Ms. Goldberg wrote, a nontraumatic injury that is covered may be denied if it is not reported by the end of the employee’s shift, or within 24 hours.

Thirteen of the fifteen employers in the study have “good cause” provisions that allow a claims administrator to determine if there was a good reason the claim was made late.

Finally, Ms. Morantz said that, “the biggest unanswered question is how these plans affect the welfare of workers.

As I reported yesterday in two posts, “Texas State House Seeks to Change Rules for Workers’ Comp” and “Workers’ Comp Opt-Out Goes Under US Microscope“, there are a lot of unanswered questions surrounding the effect opt-out will have on the injured worker.

Those who support opt-out expansion really don’t care about injured workers; they care about saving money for employers (i.e., profits that go back to the investors or to the top executives). They are also diametrically opposed to giving workers any benefits, and would prefer that workers’ comp had never existed, along with unemployment insurance and health insurance.

Those who see through the smoke and mirrors of opt-out know what the world was like before workers’ comp laws, and they don’t want to go back to those days, and whether or not they really are concerned with the welfare of workers, or just say they do, I am afraid that they may not be able to stop this move on the part of opt-out proponents.

But federal oversight would be welcomed to prevent going back to the bad old days before Triangle, which happened 105 years ago tomorrow. Marty McFly went back to the future, these guys in opt-out want to go back to the past.