Tag Archives: Health Care Costs

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/


Medical Travel for Americans is Alive and Well

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.

GOP Tax Reform: Say Goodbye to the Middle Class

As a student of American Social history, I am acutely aware that for much of the 241 years of the Republic, the majority of the American people were not what we today would call “Middle Class.”

In fact, they were cash poor, dirt farmers, tradesmen, owning very little except what they could carry on a horse, mule, or in a wagon as they migrated west in search of better opportunities.

Until the New Deal, the Middle Class as we know it did not exist in such great numbers. True, there was a middle class in the cities and towns of the East Coast and Midwest, but most of them were descendants of immigrants from the 17th and 18th centuries, and rose steadily into the middle class as the nation’s economy shifted from a mercantile to an industrial economy in the first half of the 19th century.

Consider the following quotes from three US presidents regarding the power of money and corporations. You will notice that none of them are wild-eyed radicals in the least.

“I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial by strength, and bid defiance to the laws of our country.”

Thomas Jefferson

“Mischief springs from the power which the moneyed interest derives from a paper currency which they are able to control, from the multitude of corporations with exclusive privileges… which are employed altogether for their benefit.”

Andrew Jackson

“I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country. Corporations have been enthroned, an era of corruption in high places will follow, and the money-power of the country will endeavor to prolong it’s reign by working upon the prejudices of the people until the wealth is aggregated in a few hands and the Republic is destroyed.”

Abraham Lincoln

So it is no surprise that the Republican Party is ramming down the throats of the American middle class, a tax reform bill that will effectively wipe out the remaining members of the middle class, and redistribute the wealth to those making over $75,000 and those at the very top, the oft-mentioned 1%.

My fellow blogger, and unsuccessful Democratic candidate for County Legislator in upstate New York, Joe Paduda, wrote a very potent analysis of the GOP tax scam legislation. Yes, I did call it a scam, but that is not my word. Others have used it in the past few days in an effort to derail and stop it from passing.

Besides destroying the middle class, it will as Joe points out, bankrupt the health care system. Then we will have to go all the way to a single-payer system just to get the whole thing working again.

Here is Joe’s piece in its entirety:

The tax bill’s impact on healthcare or; If you like your cancer care, you can’t keep it.


The GOP “tax reform” bill will directly and significantly affect healthcare. Here’s how.

It removes the individual mandate, but still requires insurers to cover anyone who applies for insurance. So, millions will drop coverage knowing they can sign up if they get sick.

How does that make any sense?

Here’s the high-level impact of the “tax bill that is really a healthcare bill”:

The net – healthcare providers are going to get hammered, and they’re going to look to insured patients to cover their costs.

The real net – The folks most hurt by this are those in deep-red areas where there is little choice in healthcare plans, lots of struggling rural hospitals, and no other safety net.  Alaskans, Nebraskans, Iowans, Wyoming residents are among those who are going to lose access to healthcare – and lose health care providers.

Here are the details.

According to the Commonwealth Fund, “repeal would save the federal government $338 billion between 2018 and 2027, resulting from lower federal costs for premium tax credits and Medicaid. By 2027, 13 million fewer people will have health insurance, either because they decide against buying coverage or can no longer afford it.”

Most of those who drop coverage will be healthier than average, forcing insurers in the individual market to raise prices to cover care for a sicker population. This is how “death spirals” start, an event we’ve seen dozens of times in state markets, and one that is inevitable without a mandate and subsidies.

For example, older Americans would see higher increases than younger folks. Here’s how much your premiums would increase if you are in the individual marketplace.

So, what’s the impact on you?

Those 13 million who drop insurance, which include older, poorer, sicker people, will need coverage – and they’ll get it from at most expensive and least effective place – your local ER. Which you will pay for in part due to cost-shifting.

ACA provided a huge increase in funding for emergency care services – folks who didn’t have coverage before were able to get insurance from Medicaid or private insurers, insurance that paid for their emergency care.

From The Hill:

[after ACA passage] there were 41 percent fewer uninsured drug overdoses, 25 percent fewer uninsured heart attacks, and over 32 percent fewer uninsured appendectomies in 2015 compared to 2013. The total percent reduction in inpatient uninsured hospitalizations across all conditions was 28 percent lower in 2015 than in 2013. Between 2013 and 2015, Arizona saw a 25 percent reduction in state uninsured hospitalizations, Nevada a 75 percent reduction, Tennessee a 17 percent drop, and West Virginia an 86 percent decline.

If the GOP “tax bill” passes, hospital and health system charges to insureds (yes, you work comp payer) are going to increase – and/or those hospitals and health systems will go bankrupt.

What does this mean?

It means we of the middle class had a very good run, but the ruling class has spoken, and they want us to disappear, or at least shrink to the point that we become unimportant to their pursuit of greater wealth. Why else would the donor class of the Republican Party, the Koch Brothers, the Mercer family, Sheldon Adelson, and the rest of their donors threaten members of Congress with no more funds for their re-election if they fail to pass this bill?

There is a word for that, it’s called Extortion. And we are the sacrificial lambs.

No Paradox

Sometimes, the solution to a problem is staring you right in the face, but you refuse to see it because you are blinded by your perceptions, your beliefs, or the distortions others have placed in your mind by lies and falsehoods spread about the real benefits of the solution, or the downsides.

Case in point, the question of single-payer health care in the US. The health insurance industry and their lobbyists and defenders in Congress have done a great job poisoning the minds of many Americans against the idea of single-payer, whether on ideological or economic grounds.

Yet, many of these same Americans are getting some form of government-sponsored health care, either Medicare, Medicaid, Tricare, or health care through the Veterans Administration. So, it was striking that before the enactment of the ACA, many Tea Party protesters shouted or carried signs that read, “Keep your hands off of MY Medicare!”

What they did not know or realize, was that it wasn’t THEIR Medicare, but the government’s Medicare. They were ones receiving the benefits.

So, it struck me this morning when I read an article by Tom Lynch of the Lynch Ryan blog, Workers’ Comp Insider.com.

The article, The American Health Care Paradox: A Lot Of Money For Poor Results, compares the US health care system with the health care systems of the OECD nations (Organization for Economic Cooperation and Development).

The OECD has 35 members, of which the US is one, and was formed in Paris in 1961. They promote policies that will improve the economic and social well-being of people around the world. It also performs annual comparative analyses of issues affecting its members.

Health care is one such issue, as is life expectancy, infant mortality, obesity, and death rates from cancer, among other health care-related topics.

But regarding health care, as Tom reports, on a per capita basis, we spend 41% more on health care than our wealthy nation peers in the OECD, and 81% more than the entire OECD average.

The following graph indicates amount of public versus private funding of health care among the OECD nations, as well as the OECD average. The light blue bars indicate private funding; the dark blue bars indicate public funding.

OECD Health Care Funding — 2015

According to Tom, while our public funding (Medicare, Medicaid, etc.) is comparable to many of the other countries in the OECD, private funding in the US is more than 100% greater tham Switzerland, and 300% greater than the OECD average.

Life expectancy:            US: 78.8 years (76.3 men, 81.2 women)
UK: 81 years (79.2 men; 82.8 women)
Japan: 83.9 years (80.8 men; 87.1 women)

Infant mortality:          US: 6.1% (per 1000 live births) 45% higher than UK at 4.2%, and 265%                                                higher than Japan’s at 2.3%.

Obesity and overweight rate is exceeded only by New Zealand. Finally, the rate of death from cancer per 100,000 people is 188, Mexico’s is 115, Japan’s is 177. But we lead the world in smoking cessation (whoopee!). So, I guess we can all breathe easier now than the rest of the world, especially the third world where so many start smoking at a very young age.

Into this discussion, Tom throws the current Republican tax plan, which he rightly says will throw 13 million people off of health care, and see $25 billion cut from Medicare.

Tom says that fixing health care will take time and a lot more money, and he is skeptical that the GOP tax scam will do that.

Duh! Of course it won’t. That’s the whole point of the tax scam and the umpteenth attempts to scuttle the ACA. They don’t believe in health care as a right for all Americans. It is in their DNA as Libertarian Conservatives. They are not Republicans, at least not like the two Republican presidents who tried to get health care passed, Theodore Roosevelt and Richard Nixon.

No, they want the money for their fat cat donors. They even said so publicly and bragged about it. And if all those votes to repeal and replace ACA didn’t convince you that they are fundamentally opposed to any government-sponsored health care, except their own, then you are blind.

The solution is staring you in the face on the above chart, Every other OECD member nation spends more publicly for health care than we do privately, and we are getting bad outcomes. Why is that? It is because health care is not like other consumer goods, and therefore should not be funded or marketed by private companies.

It is long past the time we should follow suit and do what every other OECD country has done, create a single-payer, improved Medicare for All system and stop fooling ourselves that the private market works. It does not, and the proof is in the metrics on cost, life expectancy, infant mortality, obesity and cancer deaths, etc.

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.

Fallout of the End of ACA Subsidies

Joe Paduda today gave a very succinct and clear-minded assessment of the fallout of the ending of the ACA subsidies, also known as Cost-Sharing Reimbursement (CSR) payments.

Here is Joe’s article.

It makes perfect sense that what the Orange man said yesterday will do more damage to health care than his false and misleading pronouncements of the past year that the ACA is failing and doing harm.

It is you, sir, who are doing harm. To the poor, to minorities like those in Puerto Rico despite your morning mea culpa, to African-Americans and Latinos,  to women, to international agreements and organizations,  and to our credibility with our allies and adversaries.