Tag Archives: Legal Issues

Medical Tourism Agencies and Facilitators: Legal Pitfalls and Risk Mitigation: A Case Study Analysis – SDCBA Calendar

This is an upcoming webinar led by the person who got me started in writing about medical travel, Kristen Montez, Esq. I think that anyone in this space should listen to what she and the other attorneys have to say on the matter.

I am paying her back for all her wonderful efforts on my behalf. Please pay me back by attending.

Thank you.

Your humble blogger.

List of upcoming SDCBA and legal community events including section, committee and division meetings, CLE and other events.

Source: Medical Tourism Agencies and Facilitators: Legal Pitfalls and Risk Mitigation: A Case Study Analysis – SDCBA Calendar

WA State Considering Telemedicine Legislation for WC

Legislators in Washington State are considering a bill, S. B. 5355, that would require the state’s Department of Labor & Industries to pay for telemedicine sert d require the department to provide access to telemedicine and reimburse providers for health care services provided to injured workers through such services.

The bill defines telemedicine as follows, according to the article, “the use of interactive audio and video technology, permitting real-time communication between the patient and the provider. ” It would exclude audio-only telephone calls (my White Paper mentioned this as a legal barrier to implementing medical travel into workers’ comp), fax messages, or emails.

Should this become legal, telemedicine services provided by hospitals, rural health clinics, physician offices, community mental health centers, and skilled nursing facilities would be covered.

This would have a profound impact on implementing medical travel into workers’ comp in Washington State, as this is one of two states that allows patients to travel outside the state or outside the country for medical treatment.

The Department of Labor & Industries has a page on their website called “Find A Doctor” where they list physicians in both Canada and Mexico, as well as the rest of the US, and when I began my research for my paper back in 2011, had a list of physicians in the following countries:  England, Germany, Honduras, New Zealand, the Philippines, Spain, Thailand and Ukraine.

As more states allow telemedicine services to be covered under workers’ comp, the day will come that getting surgery abroad, especially in the Western Hemisphere countries, will become reality, and will go a long way to lower costs and speed workers back to work, and relieve the stress to the health care system that repeal of the ACA will have on health care in the US.

Sad News

Learned this afternoon of the sudden death of my fellow blogger, David De Paolo. See the link below. Never met him, but readers here know that I have always reported what he wrote fairly and honestly, and even though my comments to him have not appeared in my posts, I respected him as a fellow blogger.

He will be sorely missed, as he was a regular fixture in many of my posts.

http://www.workerscompensation.com/compnewsnetwork/news/24272-david-depaolo-founder-of-workcompcentral-dies-at-56.html

 

ERISA, Stop Loss and Unintended Consequences

“The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were.”

John F. Kennedy

“Some men see things as they are and say why. I dream things that never were and say why not.”

Robert F. Kennedy

“It is not because things are difficult that we do not dare, it is because we do not dare that things are difficult.”

Seneca

Those quotes were included at the top of my June 19, 2013 post, “Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation” where I defended myself against the charge that I was offering “simplistic solutions” to medical travel and workers’ comp. In that post, and in “The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible and is not a Pipe Dream” I acknowledge that is won’t be easy, but there are ways to do it.

In my last post, “Self-Insured Employers Fail To Adopt Medical Travel“, I discussed the reasons given by Irving Stackpole for why US employers have failed to adopt medical travel into their corporate health plans.

In conversations with a noted ERISA and medical travel expert, I have been making the case that laws and regulations such as ERISA, Stop Loss, and other “barriers” erected decades ago, in order to address specific problems such as tort claims, aggregate claim losses, etc., have the unintended consequence of holding back the globalization of health care, which includes workers’ comp.

I have addressed the legal barriers in comp in my White Paper, and found that there were outdated federal and state laws and regulations, intended to protect consumers, actually increase costs and reduce convenience, restrict public providers from outsourcing certain expensive medical procedures, and that federal laws inhibit collaboration, while state licensing laws prevent certain medical tasks being performed by providers in other countries.

Let me state here that I, in no way, am advocating the removal of these laws and regulations. My chief argument is this: our best minds have split atoms, launched satellites and men into space, discovered cures for diseases plaguing humans for centuries, but to send patients to other countries for medical care is impossible, and not worth pursuing, smacks of cowardice or fear that it actually might save money and provide better care. Do we not have the best minds to figure out how to deal with these “barriers”, or are we too fearful and litiginous a society that we have given up accepting new ideas?

Every industry is being affected by two powerful forces today: globalization and automation. With globalization, jobs, plants and other forms of capital are moving across borders. With automation, jobs that were once held by humans and considered very dangerous, are being done by robots, and soon other jobs will be done by artificial intelligence.

Neither force can be stopped, and how we address the consequences of these forces is what many minds are working on right now. But to say that one industry is going to draw a line in the sand and say, “NO” and stop globalization from happening is either insanity or a deliberate attempt to profit from the maintenance of the status quo that many along the supply chain of medical care services, both within the general health care space and workers’ comp have carved out for themselves.

When I was in college, I studied International Relations, and back then, globalization was a word very few outside of academia ever heard. There was an organization created in 1973 by David Rockefeller and Zbigniew Brzezinski called the Trilateral Commission. Its purpose was to foster better cooperation between the countries in North America, Western Europe and Japan (the Trilateral countries) and their multinational corporations. In the ensuing decades, the Commission expanded the membership to the rest of the world, and globalization became a household word.

Coincidence? I think not, since the heads of major US, Western European, and Japanese companies were members, and so were many politicians, including a former peanut farmer from Georgia and most of his top administration personnel. Other politicians after him also have been members, from both sides of the political spectrum.

Their chief goal is to allow capital, goods and jobs to cross national borders, or to eliminate them altogether, and I doubt they expected the health care industry to stand in their way. These are men who generally get what they want, and damn the consequences. We see this in the breakup of the European Union, which many of them advocated for years, just like they advocated for NAFTA, CAFTA, the TPP, and other trade deals, and don’t give a fig about the impact they have.

So, it is important to realize that the only real thing preventing medical travel is what unintended consequences have on the growth and development of the industry. This is where the industry needs to focus its attention, not on slick advertising, but on hard work and cooperation to overcome these “barriers”.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

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.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

Florida State Supreme Court Upholds Law’s Validity

Following up on what I reported on earlier this week, the Supreme Court of Florida unanimously decided not to review Daniel Stahl v. Hialeah Hospital, according to Business Insurance’s Stephanie Goldberg.

In my previous post, I mentioned that the 1st District Court of Appeal had ruled that attorney fee schedules violated state law.

But the Court of Appeal also ruled back in March in the above referenced case, that the workers comp system was an adequate exclusive remedy, Ms. Goldberg said in her article.

The State Supreme Court accepted jurisdiction to review the decision, and said in its ruling that, “after further consideration and hearing oral argument in this case, we have determined that we should exercise our discretion and discharge jurisdiction.”

So for the time being, it would seem that Florida’s Workers’ Compensation law is constitutional, and until other cases that are pending are resolved (see my articles, “Constitutionality of Workers’ Comp Challenged: What that could mean for Medical Travel“, “Update on Constitutionality of Work Comp in Florida“, and “Advocacy Group Petitions Florida Supreme Court to Review Work Comp Constitutionality“), Florida’s injured workers will still have something to protect them.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

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.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Blog is now viewed all over the world in 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

Courts Striking Down Work Comp Laws

Coming back around to the constitutionality of aspects of the various state workers’ comp laws, an article by David De Paolo last week, suggested that rather than corporate America dismantling workers’ comp, it is the courts who are actually doing so.

David says that state supreme courts will be the ones doing the dismantling this year, piece by piece.

A week and a half ago, I wrote that the Oklahoma WC statute relating to the permanent partial disability deferral provisions of the state’s workers compensation statutes of 2013, was struck down in a 7-2 decision.

This decision was first reported in The Oklahoman.

And David also reported in the same article, that the 1st District Court of Appeals in Florida said that the state’s statutory limits on the payment of attorneys for injured workers was unconstitutional.

So while ProPublica and others rightly or wrongly accuse corporate America, the Koch Brothers, ALEC, ARAWC, the Illuminati, Martians, and anyone else we left out, it is the men and women who wear black robes who are striking down the workers’ comp laws in their states.

Is this a coincidence? Is this a vast conspiracy of right-wing jurists and those who put them on the bench? That is hard to say because we don’t know these people at all, who appointed them, and what their individual political motives are.

But if these decisions are any indication, the courts are ruling more in favor of injured workers, than their employers.

If you read De Paolo’s article and the cases linked to them, as well as the OK case, you will see that the courts are generally siding with workers.

What does this mean?

Well, it is too early to tell, but if these trends continue this year, 2016 may be the year the injured worker gets a little break. But we still have laws, regs, and rules in place that are holding back workers from getting the best health care available, at lower cost, no matter where that happens to be, even if it is not within the borders of their state or the country.

And that is something courts in the future will have to decide.

Trouble Ahead for Workers’ Comp

The Denver Business Journal today published an article by Steve Doss, VP of Commercial Lines at CCIG.

Here are the key takeaways from Conning, a Connecticut-based investment management company for the insurance industry:

  • Accident frequency has increased. A stronger U.S. economy has meant more inexperienced workers have joined the workforce, so high-hazard occupations like transportation and construction have seen increases in work-related injuries since 2012. For example, non-fatal work-related construction injuries jumped 9.5 percent from 2012 to 2013. Also, as older employees work longer, the number of accidents among those 65 and older rose 18.5 percent from 2012 to 2013.
  • Accident severity is rising. The Bureau of Labor Statistics reports that construction fatalities rose 5.6 percent from 2013 to 2015, and manufacturing fatalities rose 9.3 percent from 2013 to 2014. In addition, hospital and drug costs – the biggest expenses associated with workers’ compensation claims – are rising faster than inflation.
  • Evidence of cost-shifting. The Affordable Care Act may be driving physicians and hospitals to “leak” group health cases into the workers’ compensation system, where they can charge more for the same services than under a group health contract, according to Conning.

For those of you not familiar with workers’ compensation, and those of you who are, what each of the bullet points mean, in simple terms is this:

  • More accidents,
  • Degree of accident injury increasing and,
  • Cost-shifting is occurring.

Isn’t time to stop and realize that whatever programs are implemented, whatever analytical or predictive modeling techniques are utilized, whatever the so-called “experts” say is the cause of this or that problem, whatever so-called “reform” or work comp alternative is attempted, wouldn’t it be prudent to think outside the box, and outside the borders of your limited minds?

Schopenhauer said the following:

“Every man takes the limits of his field of vision for the limits of the world”

Those of you who will not listen to other ideas, no matter how far-fetched they may be, have limited your field of vision and taken them as the limit of the world. The world is globalizing, health care included.

Aerospace technology will very soon allow us to travel to any part of the world in under four hours. Don’t believe me? Ask Boeing why they are running commercials that tout that very same possibility.

Those who cite judges as saying no to medical travel must ask yourselves this question: Do doctors sentence people to death? (By that I mean execution, not natural death from disease or incompetence)

Those who say the laws won’t allow it, should know that laws can be changed, and laws written in the era of the horse and buggy should not dictate to the post-modern, jet-age, and soon-to-be sub-orbital space plane age. Would you like to live under the laws of Caesar or Charlemagne?

And finally, those who say the injured workers won’t go abroad to get better medical care, have you ever asked them, or are you just putting your words in their mouths?

Methinks you all doth protest a bit too much for the sake of injured workers and myself. Look in the mirror and ask yourselves why workers’ comp is failing. The answer is staring right back at you.

Satori Files For Bankruptcy: What that Means for Medical Travel

As reported last month by US Domestic Medical Travel.com, Satori World Medical, Inc., a company based in San Diego, filed for bankruptcy.

When news of this story broke, I inquired with my contact at US Domestic Medical Travel.com to learn what this meant for the patent Satori had taken out that had a chokehold on the growth and development of the medical travel sector, both domestic and international.

Her reply was that she was not sure, so I looked up what happens when a company goes bankrupt. Most of the information concerned companies who manufactured products and what happens to the patents to those products after a bankruptcy. The gist of what I found was that they transfer to the receivers/liquidators.

But since Satori’s patent is for an idea, and not a tangible asset like manufactured goods or inventory, I doubt the receivers/liquidators for this action would be willing to take this asset. What would they do with it?

So, instead of wondering, because that may be a fruitless exercise, let’s look at what the patent was all about, what it allowed and did not allow, and then you can decide how best to model your business plan going forward.

The Satori patent, trademarked as the “Health & Shared Wealth Program”, is actually two patents; the first, U.S. Patent 8160897, titled the “Satori Integrated Health & Financial Benefits System and Method” and U.S. Patent 8224668, a Continuation-in-Part to Patent No. 8162897.

They are part of a portfolio of other patents of intellectual property that regard the calculating and sharing of the dollar savings from a medical travel health benefit. The patents provided Satori with exclusive rights to the only permissible medical shared savings model in the medical travel industry.

I know what you all are thinking, how can anyone patent an idea such as this? Isn’t this restraint of trade, you may wonder?

Well, as I am not a patent attorney, nor an intellectual property expert either, I would think not, except that was the case before the bankruptcy.

As Satori’s own website states, the Health & Shared Wealth Program supports organizations by lowering their cost structure for health benefits by providing plan members with a highly-valued benefit option at no cost to the plan sponsor or members.

The parent patent, they continue, is a system and method that calculates the savings generated when a patient selects medical care outside the US.

It waves all co-pays, deductibles, and/or co-insurance, making the selection of outbound medical care a 100% medical benefit for the patient. In addition, it shares the savings between the patient and the insurer/employer.

I want to stop here in the explanation of the patent to tell you my idea, and why this patent seems to me to be a restraint of trade issue and a virtual monopoly.

My idea was to implement medical travel into workers’ compensation in the US, and along the way, after writing my paper on the subject, and this blog, I learned from other individuals that the best way to do so was to offer an financial incentive from the savings to the claimant/patient from either his employer or insurance carrier.

At the same time, I learned from one individual, that in order for this to be advantageous, the savings had to be greater than $5,000 for medical care received outside the US. So for example, if a knee surgery in the US cost $30,000, in order to convince an employer or insurance company of the efficacy of outbound medical travel, the cost of that knee surgery would have to be $25,000 or less.

How much the claimant/patient would receive and when and how they would receive it is a matter of discussion. It could be a percentage of the savings, a flat-rate of say, $2,000 or $2,500, or come from the overall settlement of the claim, but that could take years to realize.

Returning to the patent, the Health & Shared Wealth Program, Satori states, precludes certain entities such as medical travel/medical tourism facilitators (I bet you are hoping mad at this point; I sympathize), health plans, self-funded and fully insured employers, Taft-Hartley trusts (labor unions), unions, workers’ compensation carriers (this got me mad), municipalities, pension plans, etc., from offering any shared savings model similar to the one described above to their clients and/or plan members without written permission from Satori (now you must be steaming!!!!).

So, what does this mean? If Satori is out of business, we can all take a sigh of relief that now the wicked witch of the west (Satori) is dead. What comes next is up to you. Prior to the announcement, there were ways to get around the patent’s restriction. Now, that may not be necessary.

My suggestion is get yourselves some good IP attorneys to see if you are good to go, and if you are given the green light, adjust your business model and plan accordingly. You will only benefit from the fall of the house of Satori.

 

What Legalized Pot Will Cost Employers

Last May, I wrote a short piece, “California is Going to Pot“. It discussed the issue of whether medical marijuana will be allowed in workers’ comp.

Caroline McDonald, Senior Editor of the Risk Management Monitor and Risk Management magazine, wrote an article today about the cost to employers should more states legalize pot.

Ms. McDonald cited a White Paper from Quest Diagnostics that suggested that employers will face potentially costly litigation, as case law develops, and will face challenges to protect employees from injury and to comply with drug-free workplace requirements.

Quest reported that legalization has led to the production of pot-infused foods and gadgets, such as vape pens, and that these two modes of consumption will make it more difficult, if not impossible, to tell when employees are using on the job.

Ms. McDonald writes that as use of pot increases, so will injuries, accidents, mistakes, and illnesses, which will escalate the cost of the company’s liability, workers’ compensation, and health insurance.

She outlines five steps employers can take to protect themselves:

  1. Stay up-to-date with the changing legal landscape and adjust workplace policies accordingly.
  2. Remember that marijuana is still illegal under federal law.
  3. Join other employes to monitor state legislation and take action with legislators to ensure workplace protections are included in any marijuana laws.
  4. Educate your workforce about the danger it poses to children, families and the workplace.
  5. Challenge the notion that marijuana is medicine, or risk paying for it in your health insurance. No marijuana medicines being sold in states that legalized them have been approved by the FDA as pure, safe, or effective. Doctors cannot prescribe them and pharmacies cannot sell them.

Number five is not one that I would subscribe to, as I believe that it does help those with serious illnesses such as cancer and other rare and debilitating diseases.

So long as pot remains illegal under federal law, the FDA will not approve the use of it as a medicine, but that is what needs to change.

Yet, risk management personnel need to be mindful of the other steps, and generally, people who are using marijuana as medicine are not engaged in dangerous or harmful employment, to themselves or others. When you are that sick, working is one of the last things you are concerned with.

And advocates for legalized pot should be aware of the risks it poses not only on the workplace, but for the employee as well. Failing a drug test can get you denied work comp benefits, unemployment insurance, especially if they are terminated for cause being under the influence, and not to mention the legal hassles the employee will face.

 

 

 

 

 

SPOTLIGHT Interview – October 31, 2013

This is the original interview published on October 31, 2013 by Medical Travel Today.com.

Medical Travel Today (MTT): Tell us your position in the medical tourism industry, as well as your thoughts on integrating medical tourism into workers’ compensation cases in the U.S.

Richard Krasner (RK): Currently, I am a blogger, blogging about the implementation of medical tourism into workers’ compensation.

I first began looking into integrating medical tourism into workers’ compensation when I needed a topic for a paper in my Health Law class as part of my M.H.A. degree program in March of 2011. A lawyer who was working for a medical tourism facilitator company at that time, and who had written an article in a law journal about medical tourism, gave me the idea after my first topic did not pan out. She thought that the legal barriers to implementing international medical providers into workers’ compensation through medical provider networks was a good idea, and since I had a small interest in the subject of medical tourism, I submitted that as my topic to the instructor.

He gave me his approval and, as I started to do my research, I found many articles on medical tourism and nothing on medical tourism and workers’ compensation, so I knew my task was a difficult one. But as the point of the paper was to write about a legal issue and persuade people one way or the other, I felt that I could mention the lack of literature on the subject and perhaps open up dialogue in that area. I then found a roundtable discussion from the January/February 2008 issue of the journal Telemedicine and e-health.

In the discussion, I found something that I had been looking for, but had not expected in a medical journal: a validation from four of the participants for my idea to implement medical tourism into workers’ compensation. I made their discussion the centerpiece of my paper, and thus my argument in favor of implementation. They said essentially that they thought that medical tourism could work for non-emergent, i.e., non-emergencies or long-range issues, such as knee or hip replacement, chronic back injury and repetitive action injuries, and that it would not be a leading offering. That is when the light bulb went on, and I realized that it could be accomplished as an option for the injured worker to consider.

Initially, my research consisted of finding articles that discussed medical tourism in destinations, such as India, Singapore and Thailand, and my thought then was that it might be a stretch to send injured workers that far away, but that maybe it could be done. Later on, as I got more involved in medical tourism through my attendance at the 5th World Medical Tourism and Global Healthcare Congress in October 2012, and through conversations online with another lawyer, I realized that the best chance for this to happen was in Latin America and the Caribbean, and that given the rise of the Latino population in the U.S., sending patients home to their home countries for treatment would present no language or cultural barriers, and would allow friends and family in those countries to visit them during recovery, which will improve their self-esteem and improve their recovery time.

I have since come to believe that all injured workers could be offered this as an option, not just those of Latin or Caribbean origin.

MTT: How will the integration benefit individuals, health insurance companies, and the entire medical community, both domestically and internationally?

RK: I believe first and foremost that medical tourism will have its most important benefit on the individual because of some of the things I mentioned above, namely little or no cultural or language barriers to overcome between Spanish or English in most cases, or between Portuguese or other languages in the region. Also, as I said, their friends and families back home can visit, which would make their recovery more relaxing, more pleasant and would show them that the patient is not sitting at home just collecting a check. It would also give the patient greater self-esteem and speed recovery. Finally, by being treated in the better hospitals in the home country, a patient’s friends and family will see that their loved one is being cared for by the best doctors and at the best facility in their country.

I think the benefit for the health insurance company or, in this case, the workers’ compensation carrier would be that they will not have to pay for expensive procedures, such as hip or knee repair/replacement, shoulder surgery, spinal fusion surgery or carpal tunnel surgery. This is despite the fact that many states have fee schedules for workers’ compensation, which tells providers how much to charge the carrier for each procedure, and which may be less than the normal fees charged. Nonetheless, as the recent New York Times article indicates, the U.S. has the highest cost for healthcare, and it is not slowing down, nor has the average medical cost for lost-time workers’ compensation claims, as I have written about in my white paper and my blog.

I think for the entire medical community domestically and internationally, it will have several benefits, the first of which will be the realization that healthcare is globalizing and that it is no longer possible to consider that quality medical care is available only in the developed world. Second, it will lead to the development of international accreditation standards, quality standards and other standards that up to now have hampered medical tourism’s expansion and growth.

These standards will take time to be adopted and will be expensive to implement for the medical tourism facilities involved, as it has already been for the implementation of other standards and forms of accreditation, such as from the Joint Commission International.

Thirdly, it will have the benefit of bringing American patients to medical providers in other countries, those who otherwise would never be seen by foreign doctors except for those who have gone to foreign-born doctors practicing here in the U.S., whether in private practice or in a hospital setting. Fourth, and this is more of an issue with workers’ compensation cases, doctors abroad will be able to get broad experience treating work-related injuries that they have never seen, thus adding to their medical experience, and providing their fellow citizens with that experience should they ever require it.

Medical tourism will open up global healthcare to all inhabitants of this planet, not just those looking for cosmetic surgery, or procedures that are too expensive or unavailable in their home countries. It will certainly open it up to those who otherwise could not afford to travel out of their country for treatment.

MTT: What would you say are the steps necessary to take in order for medical tourism to be integrated into workers’ compensation effectively?

RK: First, there has to be a removal of all or many of the legal barriers that I mentioned in my white paper, as well as many others that I could not or did not mention. Also, there has to be some understanding on how the legal issues surrounding medical tourism can be solved such as malpractice, legal liability, privacy issues, medical records transfers, etc.

There are financial steps that need to be addressed, such as which currency the payments will be made in, any incentives to injured workers, referring physicians, treating physicians, destination hospitals, as well as travel insurance coverage for things not covered under workers’ compensation. And lastly there has to be a willingness on the part of employers and insurance companies, third party administrators, and lawyers to accept medical tourism as part of workers’ compensation. I have discussed this with several people recently through emails, and in the past six months since beginning my blog, and have written about this as well.

As the Chinese say, a journey of a thousand miles begins with the first step. An industry like the workers’ compensation industry in the U.S., which is concerned with issues, such as pain medication abuse, physician dispensing of drugs and dealing with cost-curbing strategies that have failed, must come to the realization that the journey for them must begin now — before costs skyrocket any further.

MTT: What can you see being potential deterrents in integrating medical travel benefits into workers compensation?

RK: First of all, let me say that I don’t have all the answers, and I cannot foresee all contingencies and problems associated with traveling abroad for care. But I do want to make this clear so that your readers will not think that I don’t know what I am talking about, or that they will think that integrating medical tourism into workers’ compensation will be easy and not fraught with difficulties and complications.

It will not be easy, there are and will be complications from flying after undergoing surgery abroad, just as there are if the patient was treated at the local hospital. I am not a medical person, so my knowledge of how patients will tolerate air travel after surgery or what complications will arise is beyond my experience. But I can say this: I don’t see a difference between a patient who traveled abroad for medical care as a private patient for cosmetic, body improvement or other forms of surgery usually associated with medical tourism and a patient who is traveling abroad for surgery as a result of an on-the-job injury. Yes, there are differences in the process of treatment and aftercare and recovery, but if the private patient can develop complications, so too can the workers’ compensation patient.

To answer the question then, I think deterrents include a lack of will, fear of lawsuits in countries with laws that do not favor the insurance company or the employer, malpractice insurance and legal liability that does not meet American standards, employee choice to stay at home, and pressure from special interest groups like doctors, hospitals, pain clinics, rehab facilities, trial lawyers, etc.

MTT: During a time of rapid healthcare reform, why do you think medical tourism hasn’t been connected to workers compensation already?

RK: Because there is so much uncertainty over the impact the Affordable Care Act will have, not only on healthcare, but also on workers’ compensation. In my research on that subject, I found that there will be little immediate impact, but down the line there will be, especially as more people get health insurance, and also because of the doctor and nurse shortage, which will affect both healthcare and workers’ compensation.

There are critics of the law who say it will raise costs, and then there are those who say it will lower costs, as some have already pointed out recently. But only time will tell who is right and who is wrong. Finally, I don’t think many in the workers’ compensation industry have ever considered looking abroad, except to plan their next vacation.

MTT: Is there anything else you would like to add at this point that you think is significant in terms of medical tourism, workers’ compensations and/or the integration of the two?

RK: Yes, as I said in my blog post, The Faith of My Conviction, what is needed is the will to do it, the courage to make it happen, the hard work to get it there, and the determination to bring the two industries together. I have had experts tell me that it won’t happen, but I pointed out right away in my post the discussion I found between the four medical professionals, and I believe that as medical professionals they have a better understanding of the issues involved than I do as a layman. I trust their judgment of the issue and defer to them for my belief that it can be done.

So who is right and who is wrong? I don’t know the answer to that, but I do know this: for 20 years, the average medical cost for lost-time claims has gone from around $8,100 to almost $30,000 with no decrease in cost, but with a slowdown in the rate of increase. Is that progress? Is that a sign that all other avenues tried have not succeeded? Perhaps it will take higher costs to wake people up to the reality that medical care, like all other goods and services, always goes to those places where the goods or services can be produced at cheaper cost with better quality.