Tag Archives: Medical Travel

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

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Cayman Islands Hospital Delivers Lower Cost Care

This morning’s post by fellow blogger, Joe Paduda, contained a small paragraph that linked to an article in the Harvard Business Review (HBR) about a hospital in the Cayman Islands that is delivering excellent care at a fraction of the cost.

Joe’s blog generally focuses on health care and workers’ comp issues, and has never crossed over into my territory. Not that I mind that.

In fact, this post is a shoutout to Joe for understanding what many in health care and workers’ comp have failed to realize — the US health care system, which includes workers’ comp medical care, has failed and failed miserably to keep costs down and to provide excellent care at lower cost.

That the medical-industrial complex and their political lackeys refuse to see this is a crime against the rights of Americans to get the best care possible at the lowest cost.

As I have pointed out in previous posts, the average medical cost for lost-time claims in workers’ comp has been rising for more than twenty years, even if from year to year there has been a modest decrease, the trend line has always been on the upward slope, as seen in this chart from this year’s NCCI State of the Line Report.

The authors of the HBR article asked this question: What if you could provide excellent care at ultra-low prices at a location close to the US?

Narayana Health (NH) did exactly that in 2014 when they opened a hospital in the Cayman Islands — Health City Cayman Islands (HCCI). It was close to the US, but outside its regulatory ambit.

The founder of Narayana Health, Dr. Devi Shetty, wanted to disrupt the US health care system with this venture, and established a partnership with the largest American not-for-profit hospital network, Ascension.

According to Dr. Shetty, “For the world to change, American has to change…So it is important that American policy makers and American think-tanks can look at a model that costs a fraction of what they pay and see that it has similarly good outcomes.”

Narayana Health imported innovative practices they honed in India to offer first-rate care for 25-40% of US prices. Prices in India, the authors state, were 2-5% of US prices, but are still 60-75% cheaper than US prices, and at those prices can be extremely profitable as patient volume picked up.

In 2017, HCCI had seen about 30,000 outpatients and over 3,500 inpatients. They performed almost 2,000 procedures, including 759 cath-lab procedures.

HCCI’s outcomes were excellent with a mortality rate of zero — true value-based care. [Emphasis mine]

HCCI is accredited by the JCI, Joint Commission International.

Patient testimonials were glowing, especially from a vascular surgeon from Massachusetts vacationing in the Caymans who underwent open-heart surgery at HCCI following a heart attack. “I see plenty of patients post cardiac surgery. My care and recovery (at HCCI) is as good or better than what I have seen. The model here is what the US health-care system is striving to get to.

A ringing endorsement from a practicing US physician about a medical travel facility and the level of care they provide.

HCCI achieved these ultra-low prices by adopting many of the frugal practices from India:

  • Hospital was built at a cost of $700,00 per bed, versus $2 million per bed in the US. Building has large windows to take advantage of natural light, cutting down on air-conditioning costs. Has open-bay intensive care unit to optimize physical space and required fewer nurses on duty.
  • NH leverage relations with its suppliers in India to get similar discounts at HCCI. All FDA approved medicines were purchased at one-tenth the cost for the same medicines in the US. They bought equipment for one-third or half as much it would cost in the US.
  • They outsourced back-office operations to low-cost but high skilled employees in India.
  • High-performing physicians were transferred from India to HCCI. They were full-time employees on fixed salary with no perverse incentives to perform unnecessary tests or procedures. Physicians at HCCI received about 70% of US salary levels.
  • HCCI saved on costs through intelligent make-versus-buy decisions. Ex., making their own medical oxygen rather than importing it from the US. HCCI saved 40% on energy by building its own 1.2 megawatt solar farm.

And here is the key takeaway:

The HCCI model is potentially very disruptive to US health care. Even with zero copays and deductibles and free travel for the patient and a chaperone for 1-2 weeks, insurers would save a lot of money. [Emphasis mine]

US insurers have watched HCCI with interest, but so far has not offered it as an option to their patients. A team of US doctors came away with this warning: “The Cayman Health City might be one of the disruptors that finally pushes the overly expensive US system to innovate.”

The authors conclude by stating that US health care providers can afford to ignore experiments like HCCI at their own peril.

The attitude towards medical travel among Americans can be summed up by the following from Robert Pearl, CEO of Permanante Medical Group and a clinical professor of surgery at Stanford: “Ask most Americans about obtaining their health care outside the United States, and they respond with disdain and negativity. In their mind, the quality and medical expertise available elsewhere is second-rate, Of course, that’s exactly what Yellow Cab thought about Uber. Kodak thought about digital photography, General Motors thought about Toyota, and Borders thought about Amazon.”

Until this attitude changes, and Americans drop their jingoistic American Exceptionalism, they will continue to pay higher costs for less excellent care in US hospitals. More facilities like HCCI in places like Mexico, Costa Rica, the Caymans, and elsewhere in the region need to step up like HCCI and Narayana Health have. Then the medical-industrial complex will have to change.

Hospital Outpatient Payments Rising — Again

The Workers’ Compensation Research Institute (WCRI) released a study today that indicated that hospital outpatient payments were higher and growing faster in states with percent-of-charge-based fee regulations or no fee schedules.

This study is an annual study that compares hospital payments for a group of common outpatient surgeries in workers’ compensation across 35 states from 2005 to 2016.

According to WCRI’s executive vice president and counsel, Ramona Tanabe, “Rising hospital costs continue to be a focus for public policymakers and system stakeholders in many states.”

The study found that states with percent-of-charge-based fee regulations had substantially higher hospital outpatient payments per surgical episode than states with fixed-amount fee schedules.

Percent-of-charge-based states were 30 — 196% higher than median of the states with fixed-amount fee schedules in 2016.

States without fee schedules also had higher payments per episode; 38 — 143% higher than the median of fixed-amount states in 2016.

Lastly, WCRI found that hospital payments per episode in most states with percent-of charge-based fee regulations or no fee schedules, grew faster than states with fixed-amount fee schedules.

The study also compared payments for workers’ comp with Medicare rates for the most common group of surgical procedures across states. The following chart highlights the variation in the difference between average workers’ comp payments and Medicare rates. The variation was as low as 38%, or $2,012 below Medicare in Nevada, and as high as 502%, or $21,692 above Medicare in Alabama.

Source: WCRI

So, what does this mean?

It means that hospital outpatient payments for the most common group of surgical procedures in Workers’ Comp are not decreasing, and are likely adding to the slow, but steady rise in the overall total average medical cost for lost-time claims, a development I have followed for some time now with the release of NCCI’s State of the Line Reports.

This is not the first time I have discussed this topic, and probably won’t be the last, as I keep reminding you that surgical costs for most common workers’ comp surgeries are a fraction of the cost here in the US in countries that provide medical travel services.

If this study is right, wouldn’t you rather pay for a surgical procedure in Costa Rica, for example, that costs $12—$13,000, than paying $21,692 in Alabama? Eighteen out of thirty-five states listed on the above chart have higher payments than the median of 100. This represents 51.4% of all the states examined in the study. Just more than half.

And this idea of medical travel is stupid, ridiculous, and a non-starter? Ok, keep shelling out more money for hospital outpatient procedures. After all, it ain’t your money, is it?

To download this study, visit WCRI’s website at https://www.wcrinet.org/reports/hospital-outpatient-payment-index-interstate-variations-and-policy-analysis-7th-edition.

In-bound Medical Travel and Immigration

U.S. Domestic Medical Travel.com published the following article this morning that discusses the impact of in-bound medical travel on an individual’s immigration status.

http://medicaltraveltoday.com/spotlight-renata-castro-founder-of-castro-legal-group/

Follow-up to My Open Letter to the Medical Travel Industry

Just over four months ago, I published an open letter to the medical travel industry.

To date, I have had no response to my letter of December 14th, nor have I been invited to attend any of the conferences that have been held since, or will be held in the future, and I just learned of one at the end of this month in Washington, DC.

By that time, I will have been writing this blog for five and a half years, and still on a daily basis, my posts get at best, less than fifty views, and on most occasions, not even twenty.

I have posted them to LinkedIn, Twitter, and have re-posted them several times, and yet, each time, I get a few clicks added to the ones previously received.

I am putting my heart and soul in this and not receiving any compensation, although I should. So would it hurt if the industry paid a little more attention to my writing and to me, in lieu of actual remuneration?

As a friend we all know once said to me, “What am I? Chopped Liver?”

I am not doing this to stroke my ego, nor am I doing it because I have nothing better to do. I am doing it because I care. I am in the process of reading a fascinating book on the real reasons health care in the U.S. and elsewhere is undergoing major changes that have affected the delivery of health care, it’s cost, quality, efficiency, and its efficacy.

The least any of you could do is acknowledge my efforts and pay me some courtesy. Is that too much to ask?

I’ve met some of you in the past seven years since I began this journey, but I’d like to meet more of you. And I am sure you would like to meet me. I am funny and am a great person to know.

What say you?

Thank you very much.

Richard

 

The Seven “C’s” of Medical Travel: What Workers’ Compsters Need to Know

If you thought I had abandoned talking about workers’ comp and medical travel, guess again. It was on the back burner waiting for the right time to come forward once again.

This time, it is due to one of my LinkedIn connections, Arlen Meyers, MD, MBA. Dr. Meyers is the President and CEO at the Society of Physician Entrepreneurs.

Dr. Meyers published a medical traveler’s check list which he calls his “7 C’s”. He advises medical travelers to complete the checklist before going abroad for medical care.

For those of you in comp who have been skeptical about the practicality and efficacy of medical travel, this checklist is intended to prove that what medical travel really is, is not some quack form of medicine or third world medicine in some dump of a hospital or clinic.

Here is Dr. Meyers checklist:

  1. Credentials: Check the quality of your surgeon and the facility where they intend to do your surgery. Be sure the hospital or ambulatory surgery center is accredited by a recognized accreditation organization. The table stakes for the surgeon are licensure in the state or country, board certification and a lack of repeated malpractice or disciplinary actions. Harder, if not impossible, to find will be a record of the surgeon’s outcomes for a given procedure, so you will have to rely on referral from a trusted source or recommendations. Online site reviews do not reflect quality of outcomes.
  2. Cost: How and how much will you be expected to pay for your operation? If something goes wrong, who is responsible for paying future care? What will be covered and what won’t? Is there insurance, for example medical evacuation in case of a dire emergency, you can buy to help defer some of the risk? Bundled payment i.e., a fixed price for specifically defined episode of care, is becoming more common.
  3. Continuity of care: In the best case, a doctor at home will help you to find a surgeon away from home and will accept you back as a patient once you return home. However, many surgeons are reluctant to do that so be sure you have a plan for continuity of care when you get home. Find out who will take care of you if, and when your surgeon is not available. If something goes wrong during a procedure in an ambulatory surgery center, where will you be transferred for care? Be sure you understand where you should go for emergency care when you get back home and whether your insurance company, if applicable, will cover the cost.
  4. Care coordination: Leaving home can involve not just medical issues, but travel and hospitality issues as well, e.g., customs and immigration forms, translation services, hotel and flight arrangements, and accommodations for companions or family members.
  5. Companion: Be sure you travel with a trusted, reliable companion or family member who can help and support you during your postoperative recovery. Another option is to hire a trained medical profession, like a nurse, who will accompany you on your trip for a fee.
  6. Continuity of data: Be sure you obtain a copy of your medical records, discharge summary and operative note. Do not rely on the surgeon transmitting the information to your doctor back home. Medical records are not interoperable in the best of circumstances and, most likely, sending reports and forms from a distant place will be a hassle, inefficient and expensive.
  7. Contraindications: Here are some medical conditions that are contraindications to flying.

This is not some slick marketing tool created by a medical travel facilitator or promoter. This is a reasoned, carefully constructed checklist written by a medical doctor advising potential patients of foreign medical providers and facilities what to do, what to look for, and what to expect when going abroad for medical care.

Those of you who have criticized my idea in the past, and you know who you are, should be aware that there are real professional people who strive to do the right thing, even if that means that they or their domestic colleagues lose patients to fellow physicians and facilities in other countries. Dr. Meyers did not have to do this for his sake; he did it for the sake of the patient. Which is something you should be doing, instead of doing the same old thing repeatedly and expecting different results.

It is high time workers’ comp opened up and let the sunshine in. The patients will be the better for it.

Tariffs Threaten U.S. Health Care

The petulant man-child occupying the White House is proposing to impose a 25 percent tariff on Chinese products and ingredients, according to a report in the New York Times on Friday.

Some of the products and ingredients are essential to health care in the U.S. such as pacemakers, artificial joints, defibrillators, dental fillings, birth-control pills and vaccines.

In addition, dozens of drugs and medical devices are also among products targeted for the tariff. Some of them are in short supply, and dangerously so. They are epinephrine, which treats allergic reactions, and others like insulin, whose price rising has led to public outrage.

This proposed tariff has unsettled the medical device and supply industries, since a growing number of products and their components are manufactured in China.

The manufacturing of medical equipment has shifted from throwaway surgical gloves to more complicated products like MRI scanners.

An International Trade Commission in January, the Times reported, said the fastest growth in China’s medical device industry has been in sales of orthopedic devices, plates, and screws, made mostly of titanium and used for surgery and sports medicine.

One analyst, the Times continued, estimated that 12 percent of medical devices imported to the US come from China, which amounts to $3 billion a year.

A report this week by RBC Capital Markets, the article mentioned, estimated that if the tariffs took effect, this could cost the medical device industry up to $1.5 billion each year. Some of these higher costs would result in higher prices for those devices, and would affect baby boomers, who are the biggest recipients of hip and knee replacements.

This no doubt would be a boon to the medical travel industry, from the US to countries not imposing tariffs on Chinese products, or not.

Greg Crist, spokesperson for AdvaMed, the device members trade group, said its members were “disappointed because this action threatens to affect the health and well-being of American patients and those around the world, the Times article added.

While it is unclear if the tariffs would be enacted, companies have until May to lobby the administration for changes. But the man-child ratcheted up the pressure by threatening to levy tariffs on an additional $100 billion in imports.

However, analysts said that it was unclear if the tariffs would have an effect on the drug industry, even though China is a leading exporter of raw pharmaceutical ingredients, according to the article.

“We don’t see much impact,” said Umer Raffat, a pharmaceutical industry analyst for Evercore ISI on Tuesday to investors.

This is so because many generic drugs that contain Chinese ingredients are manufactured in places like India and would not be subject to the tariffs.

Yet, one trade group has sounded the alarm, the article indicated. They said that the tariffs could exacerbate the issue of health care costs as the administration is pledging to lower drug prices.

Lastly, there are two drugs on the list of 1,300 Chines exports: epinephrine and lidocaine, which are in short supply in their injectable form.

“Things are so bad right now with the injectables, we don’t need anything else to pile on, to possibly make things worse,” said Erin R. Fox, a drug-shortage expert at the University of Utah.

She also said that the tariffs could exacerbate the shortfalls of generic injectable drugs, the decades-old products that are the mainstay of hospitals and have long been in short supply due to manufacturing problems and disruptions in supply.

For some widely used products, it is unclear, according to the article, how American consumers would be affected. Insulin is one example; however, all three companies that sell insulin in the US, Lilly, Sanofi, and Novo Nordisk said they did not import insulin from China.

Whatever happens with the tariffs, the effect they would have on health care here and around the world is uncertain. However, it would be prudent for those in the health care industry, the medical travel industry, and the workers’ comp industry to be aware and act accordingly to provide their patients with the drugs and devices they need.