Tag Archives: Knee Replacement

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.

Top 10 Orthopedic Hospitals by Procedure

Last year, Christmas Eve, to be exact, I wrote a short post about the top ten hospitals for total knee replacement under $50,000.

This year, I’d like to expand on that and discuss the top ten orthopedic hospitals outside of the US for such procedures as Arthroscopy (knee or shoulder), Disc Replacement, and Rotator Cuff Repair.

The website I linked to in my post last year, Archimedicx.com, is the same website I used now to illustrate the difference between costs in the US and elsewhere in the world.

This website is by no means the definitive source of such information. There are other websites that provide similar prices and are only ballpark figures, not actual quotes, or firm prices. Archimedicx’s website will give you a quote once you have chosen from among a list of hospitals you searched for, depending on what procedure you want to have.

I have limited the discussion here to only the three I mentioned above, as arthroscopic procedures for both knees and shoulders, resulted in the same hospitals being displayed.

The price range column indicates those hospitals who charge the amount stated or less, as the website allows an individual to choose the price range they want.

In the table below, the quality score is the ranking algorithm that generates a unique quality score for each procedure in each analyzed hospital (on a scale of 1 to 5). For the sake of clarification, a certain hospital can have different quality scores, depending on the procedure or treatment in question.


Table – Top Ten Orthopedic Hospitals by Procedure


For each procedure examined, there were at least a few hundred other hospitals that one could look at, but I only wanted the top ten, as you see, ranked by quality scores. There are no doubt other hospitals on the website that may score better on other websites, or can provide these procedures for far less than they do.

The idea here is to point out that the US is more expensive than others, and as the following chart shows, we are dead last in terms of care.


But it is sad that Americans do not realize this and do what the other countries in that chart have done, provide health care to all.

It is also sad that our system for treating on the job injuries also does not allow people to seek medical care outside of their states or the country. Only two states do that, Washington, and Oregon, but as I’ve said before, there have been exceptions.

Now with a new administration seeking to destroy the social safety net and the ACA, we may see more case shifting and more crowded ER’s and not enough medical personnel to treat them.

And for what?  The commodification of health care for those who can afford it, and for the profit of those who pay for it.

Tug-of-War Over Ailing American Knees: What the Medical Tourism Industry Should Know

Total knee replacements in the US is growing, according to an article today in Kaiser Health News.

660,000 are performed each year, and will likely grow to two million annually by 2030, as reported by Christina Jewett. Knee surgeries are one of surgery’s biggest potential growth markets, and one that the medical tourism industry needs to be aware of.

Ms. Jewett described how an orthopedic surgeon from the Bronx, underwent his own knee surgery in a Seattle-area surgery center performed by a friend of his. The surgery began at 8 am, and by lunch, the doctor was resting in his friend’s home with no pain and a new knee.

Medicare is contemplating whether it will help pay for knee surgeries outside of hospitals, either in free-standing centers or outpatient facilities. Several billions of dollars are spent every year by Medicare for knee replacements, so what may be a bold experiment, may soon be more standard.

However, this issue is dividing the medical world, and the issue of money is just as important as the issue of medicine, according to Ms. Jewett.

Some physicians are concerned that moving surgeries out of hospitals will land vulnerable patients in the emergency room, but proponents say it will give patients more choice and better care. In addition, they contend that it will save Medicare hundreds of millions of dollars.

An “overwhelming majority” of commenters, Ms. Jewett states, said they want to allow the surgeries out of hospitals, as specified in recent rule-making documents.

Even if a policy change is made, according to the article, Medicare would still pay for patients to get traditional inpatient surgery. There would be a huge shift in money, the article reports, out of hospitals and into surgery centers.

Medicare could save hundreds of millions of dollars if it no longer paid for multiple-day stays in a hospital, and investors at outpatient centers could profit greatly, as well as some surgeons, especially those who have an ownership stake in the facility.

An open question remains as to whether this shift is beneficial for patients. Patients on Medicare tend to spend nearly three days in a hospital, and forty percent also spend time in a rehabilitation facility for further recovery.

Data from 2014 suggests that Medicare patients are taking advantage of the post-operation support at hospitals and aftercare centers. However, it is unclear what the percentage of eligible patients would choose outpatient care.

Of equal concern to patients are the financial consequences, and here is where the medical tourism needs to pay attention, because even though less care is given, outpatient procedures require higher out-of-pocket costs.

Medicare covers inpatient procedures 100%, with no co-payment, but outpatient procedures require a 20% co-payment, which could easily add up to thousands of dollars for knee surgeries.

One surgery center in California advertises a knee replacement surgery for $17,0300, and those who support the change in policy believe that a strict criteria should be used by doctors to choose which patients are good candidates for outpatient surgery.

All this began in 2012, Ms. Jewett states, when Medicare first considered removing the surgeries from its “inpatient only: list. At that time, many doctors and hospitals protested, calling the proposal “ludicrous” and “dangerous”, and Medicare abandoned the idea.

Another objection cited research that showed that patients who received such surgeries as outpatients were twice as likely to die, and that even one-day stays were twice as likely to need follow-up surgery.

A panel recommended that Medicare remove the procedure from the “inpatient only” list in August, but if they make a change, it will not go into effect for a year or so later.

It is quite obvious to this writer what you in the medical travel industry need to do, but then again, when did you ever listen to what I say?

Colombia as Medical Travel Destination for Workers’ Comp Surgery

Here is an item I nearly deleted permanently about a construction worker who went to Colombia (the country, not the university) for a double knee replacement.

While the article was written by a medical facilitator (kind of like a broker), it nevertheless outlines the reasons to consider and to offer medical travel as an option to injured workers like Edward, even before they need double surgeries.

If a worker such as Edward injures his knee early in his career as a construction worker, or whatever job he has, then the need for replacement would be mitigated if a proactive stance was taken and he received knee repair so that total replacement would not be necessary.

However, even if there is no proactive repair taken, at the time the employee needs the surgery, and files a comp claim, then he can be offered the option to go to a place like Colombia or elsewhere.

Here is the link to the article:



I am willing to work with any broker, carrier, or employer who is sick and tired of being bled by the Wall Street vulture capitalists and the entire medico-legal system known as workers’ comp, to save money, and to provide the best care for their injured workers or their client’s employees, while at the same time, helping to break the monopoly of the American health care cartel.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Knee Surgery in Costa Rica — A Less Expensive Alternative


Richard’s Note: This is probably the last blog post I will write in 2013, so let me take this opportunity to wish all of my readers a very Happy Holiday, and a very Happy New Year. Let’s hope that 2014 will be a year in which medical tourism takes its rightful place as an alternative to high cost, low quality health care. One more thing, 2014 will be the centennial year of the beginning of the First World War, a war in which the leading nations of the world at that time, blundered into, and which ultimately led to an even greater disaster, the Second World War. As globalization brings us closer together, let us remember that one hundred years ago, much of the world was backward and underdeveloped, and being exploited by all major powers; yes, even the ‘good ole USA’, so my hope is that one day, travelling to another country for health care will be as commonplace as going to another city here at home.

Last week, I had a meeting with the C.E.O. of Costa Rica Med Connect, Russell Cuciak. Russell connected with me on LinkedIn in response to my last blog posting. As we are both in South Florida and live in Palm Beach County, we had the chance to talk by phone on a few occasions before arranging a meeting in his office in Boca Raton.

Russell told me that he has been sending patients to Costa Rica for about two years now, and has been very active in taking a hands-on approach towards his clients’ care, which was in evidence during our meeting when he called a former potential client who had weight loss surgery in Florida, instead of in Costa Rica. The client had lost a significant amount of weight from the surgery, but since Russell followed up with him even though the client did not seek his care in Costa Rica, it proved to me that Russell stands by those who come to him for his services, whether they use them or not.

His patients are sent to the CIMA Hospital in Escazú, or its more formal name, San Miguel de Escazú, the capital city of the canton of Escazú in the province of San José in Costa Rica. It is also the name of the district that includes the city, a subnational entity with 14,815 inhabitants. Escazú is 9 kilometers from the national capital of San Jose, which is in the center of the country between the Caribbean Sea and the Pacific Ocean.

Over the past couple of decades Escazú has become an expatriate enclave: several embassies have their residences located here, including the residence of the US Ambassador and the British Ambassador. The past few years have seen a significant influx of newly arrived foreigners from North America, South America and Europe. It is home to many bars and restaurants, especially those of the more chic (and expensive) variety. Rents and prices reflect this and Escazú is the most well-known upscale location in Costa Rica. Here, one can find English movie theaters and even a luxurious country club. There are also many fine restaurants and dining areas in this part of town, with an excellent nightlife. Banks, pharmacies, shops, grocery stores and even an 18-hole championship golf course can be found here, along with one of the biggest and most modern shopping malls in Central America, Multiplaza.

For those of you who have read my blog article, No Back Alleys Here: Medical Tourism Hospitals, Clinics and Networks in Latin America and the Caribbean, you will remember that CIMA — Centro Internacional de Medicina, was one of the hospitals I listed in Mexico, particularly the one in Chihuahua.

I asked Russell to give me a ballpark figure of what the cost of knee replacement surgery would be in Costa Rica, and he quoted me a figure of $13,000, which includes everything except the airfare and hotel. He told me that several of the resorts in the area cater to specific patients having surgery at CIMA, so that there is a resort for patients recovering from plastic surgery, a resort for patients recovering from orthopedic surgeries, etc. It was explained to me that these resorts allow his patients to be around other individuals like them so that they do not feel uncomfortable. One particular hotel, the Holiday Inn, which is next to the CIMA hospital, takes all patients, and has special medical rooms for them.

The cost for a room in some of these resorts are anywhere from $25 a night to $250 a night, so with the cost of surgery for a knee replacement of $13,000, adding the airfare and accommodation would add another $2,000 or $3,000 to the total cost, which when compared to costs in the US of the same procedure, could be double or triple that, depending on the hospital’s bill, the surgeon’s bill, the anesthesiologist’s bill, etc.

Russell told me that in 2012, 40,000 Americans went to Costa Rica for medical tourism. As I said in my No Back Alleys Here piece, Costa Rica is one of the “rising stars” of medical tourism, and Russell’s company is one of at least a half a dozen that I know of, if not more, that are capitalizing on those 40,000 medical tourists.

During our conversation, I discussed what I found in my research paper about the barriers to implementing medical tourism into workers’ compensation, and with medical tourism in general, was the issue of legal liability. Russell told me that he carries $1 million in liability insurance, and I gave him some names of insurance companies that provide medical tourism insurance that I found on my smartphone while talking to him.

I told him of my difficulty in getting the workers’ compensation industry interested in my idea for medical tourism, and he asked me why I thought that the insurance companies had not jumped on this. I told him that there are many people in medical tourism who are asking the same question, and the most logical answer was that it is not on their radar.

We spent more than an hour and a half talking inside and outside his office, and we hope to be able to drum up more interest for medical tourism with individuals, employers, and insurance companies, both in health care and in workers’ compensation.

As uncertainty with the ACA continues, and as the cost of health care keeps rising, despite the drop in health care spending, traveling to a medical tourism destination such as Costa Rica, will become a viable option not only for health care patients, but for workers’ compensation as well. HAPPY NEW YEAR!


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