Tag Archives: Quality

Self-Insured Employers Fail To Adopt Medical Travel

When I began my writing, one of the ways I saw medical travel could be implemented into workers’ comp was through employers who self-insure.

There are not that many companies who do self-insure for several reasons, one of which is the administrative costs and extra hoops they would have to go through just to get approval from state regulators to be self-insured. This is something most small employers will not do. More on what I think about this later.

Today, Irving Stackpole, President of Stackpole & Associates (a LinkedIn connection of mine), wrote an article in the International Medical Tourism Journal (IMTJ) about why US employers have failed to adopt medical travel benefits.

For the sake of transparency and honesty, I have never met Irving, but have had discussions with him a few times on LinkedIn in some of the groups we have in common. I have met his co-host of his radio show, Elizabeth Ziemba, when we both attended the 5th Medical Tourism and Wellness Business Summit in Reynosa, Mexico in November 2014.

In his article, Irving mentions that while some small employers such as HSM (who I have written about in earlier posts), Hannaford Supermarkets, the Casino and Hotel of the Blue Lake Rancheria Tribe in Northern California, and IDMI Systems have added medical travel to their health plans, he does not know of any large employers who have.

When I attended the 5th World Medical Tourism & Global Healthcare Congress in 2012, large employers such as Disney Institute, American Express, and Google sent representatives to speak at the Congress. If they attended, then surely their companies must be involved in some degree with medical travel? What did they discuss? Certainly not the weather (Hurricane Sandy was right outside the hotel).

But I digress, yet again.

According to Irving, six percent of firms offering fully-insured plans reported that they intend to self-insure because of the ACA. So, he is correct in that not many companies are self-insured.

However, Irving also states that it is estimated that the average self-funded plan covers between 300-400 employees, and that 59% of them in the US self-fund as part of their health plan.

And he goes on to say that many small companies are looking to self-fund to reduce their share of the cost burden, but that because small employers are not able to assume the same risk levels, stop loss rates are rising. This pressure, he adds will serve as a limitation on the expansion of self-funded health insurance into the smaller market.

Irving concludes that there are four reason why large self-insured companies would add an additional medical travel benefit to their insurance plans:

  • Current implementation of the ACA has distracted or absorbed attention of insurance markets, including self-insured companies. Many companies are wrestling with far issues of how many employees will be included/excluded, potential penalties, and avoiding fines under the ACA;
  • Self-insured plans are exempt from many of the more costly and burdensome requirements of the ACA as long as they don’t make significant changes, therefore they are careful about keeping their plans unchanged;
  • Reinsurance, or stop loss coverage may be limited for plans offering a medical travel benefit, and;
  • There is no history of outcomes , evidence or actuarial models to support the case among employers for a disruptive change such as international medical travel. Reports suggesting cost savings and quality outcomes are not yet supported by evidence.

One other factor Irving suggests as to why many employers have avoided medical travel is because many find it necessary to contract with a third party administrator (TPA) to collect premiums, manage membership enrollment, claims adjudication and payment. These TPA’s are sometimes referred to as providing “Administrative Services Only” contracts or “ASO” contracts, where they provide typical third party administration services, but assume no risk for claims payment.

Because of these contracts, Irving says that while economic logic suggests that self-funded employers should be interested in high quality, lower cost destinations, it is necessary to convince both the benefits manager and the TPA/ASO  of the value of being a destination provider, and the low risk associated with accessing international medical travel.

Okay, now it’s my turn.

“Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.”

Muhammad Ali

While everything Irving wrote about appears to be factually true at the moment, and I cannot dispute what he says, the fact that employers have been unwilling to pursue medical travel is more complicated than the reasons he gives above.

True, the ACA has many things in it that may or may not seriously impact health care and the health insurance industry, but what he does not mention is that many of the things holding employers back pre-date the enactment of the ACA, and are more concerned with keeping health care the purview of those along the supply chain who profit the most from the system we have created, and not concerned with providing people either under health insurance or workers’ comp, with the best medical care possible, at the lowest cost, no matter where it comes from.

TPA’s and ASO’s and ERISA, and many other mechanisms such as stop loss insurance, and risk avoidance, etc., are mere barriers to the implementation of medical travel into both health care and workers’ comp.

Using my oft-time quoted analogy of going to the Moon, imagine if the baby steps we took to get there such as the Mercury, Gemini and early Apollo programs were not baby steps to the Moon, but actually barriers set up so that we are thwarted every step of the way to getting there or to go even further, such as landing humans on Mars. Don’t you think there would be people just like Irving who would say that it cannot happen?

That is why I quoted the late Muhammad Ali. For a poor black kid from Louisville, he sure had a better understanding of what can be than most folks who did not grow up like he did.

But this does not let the medical travel industry off the hook. I said so in my post, “Ensuring Patient Safety: Making Sure Medical Tourism Puts Its Money Where Its Mouth Is“.

But it is not just the industry itself that needs to come clean. Foreign governments and their travel ministries, the medical travel facilities, the providers, and the facilitators must present hard evidence that better quality and lower cost is possible, and so that when some of the dire predictions of the impact of the ACA are fully realized, or the US health care system collapses of its own weight (see my post, “Colorado “Single Payer” in Health Care Industry’s Sights“), medical travel as an alternative will become more acceptable to US employers, large and small, and not just for health care, but for workers’ comp as well.


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.

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A Simple Friday Morning Health Care Philippic – (With Apologies to Simon & Garfunkle)

Health Affairs blog today posted an article about the new rules CMS released on Wednesday that would establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These policies were established by the latest, permanent ‘doc fix,’ the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

My writing this morning is not about the proposed rule, the Quality Payment Program, the Merit-based Incentive Payment System (MIPS), or the Alternative Payment Models (APM’s).

But rather, it is about something I first encountered during my first MHA class on Health Care Quality. Reading the assigned readings in the one textbook we were given, I noticed that throughout the last several decades, CMS has released and created many rules, programs, models, and whatnot, that made my head spin. No doubt that is what the good folks at CMS intended, because these rules, programs, models, schemes and “solutions” have only seemed to make the American health care system more complex, confusing, bureaucratic, wasteful, idiotic, and expensive.

When supporters of the current challenger in the Democratic Party presidential primaries say that their candidate will give them free health care, do they really understand and realize how much of a house of cards the entire system is, and one that will collapse if given enough time?

How so, you ask? Well, if you know of any other human-devised system that is so top-heavy, so convoluted, and so complex that the sheer weight of its rules, regulations, laws, programs and models will cause it to collapse, let me know, because the US health care system is the only one I see.

What those who advocate Medicare for All don’t realize (I am one too, but I realize what is at stake), is that even with all of this complexity, people are profiting from the ever continuing releasing of proposed rules, programs and models, and that to simply do away with them is equally as bad as letting it collapse, but at least when it does collapse, we can start all over again and provide the single payer system they want.

Yet, if we scrape it now, those who just got health coverage will lose it, those who never had it will never be able to afford it, and the entities that profit from it will work day and night to prevent the scraping of their “golden goose”.

I don’t have all the answers, but I know this, too many rules, programs, incentives, models, schemes, etc, etc, and so forth, only makes things worse, not better. I don’t remember learning about other nations’ health care systems being so top-heavy and so complex, and maybe, in the final analysis, is why their systems work, and ours does not.

When an American citizen goes abroad and needs medical care in a country such as France (I read one person’s account of what they experienced), the bill they received after treatment was only a few dollars, not hundreds or thousands. Why is that? Maybe because they don’t have a CMS screwing it up.

Maybe it’s because their doctors don’t wave expensive watches in the faces of their patients, or describe their recent safaris where they shot some endangered species in Africa because they were wealthy and believe they have the right to do so, as a Midwestern dentist did last year to a prized lion.

I also remember that during the run-up to the enactment of the ACA, many senior citizens demanded that the government keep its hands off of their Medicaid, and that they did not want some government bureaucrat to make health care decisions for them and their families. Who do they think makes these decisions in health insurance companies? Do they know any corporate “bureaucrats”, or do they think that because they work for a private company, that they are not part of a bureaucracy?

I’ll end this philippic here, but it makes me wonder why we haven’t gotten wise to the fact that too many cooks, too many rules, etc., only make things worse, not better. We need to wake up and join the rest of the industrialized world.


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.

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.

Five Reasons I Believe in Medical Travel for Workers’ Comp

Throughout the past three years, I have written much about why I believe medical travel should be implemented into workers’ comp, and have often used various issues in both health care and workers’ comp to drive home my message.

Yet, lost in all of the text and the sentiment behind it, is the real reasons I believe in medical travel for workers’ comp. This article will explore these reasons.

First, it has been shown by myself and others, that surgical costs for common workers’ comp injuries are less expensive in many medical travel facilities in Latin America than what is the average cost for those same surgeries in the US. And we also know, that the domestic costs can vary wildly even within the same city, let alone the same state, or in a neighboring state.

Second, medical care in these medical travel facilities are equal to, or better than the care received domestically, and many of the physicians were trained in the US or in Europe, so the medical care is up to Western standards, and may even exceed them in certain treatments and with regard to certain disease modalities. Employers would thus get back employees who are ready, willing and able to work after recuperating in pleasant surroundings.

Third, medical travel for workers’ comp will allow the middle and working class to gain a better understanding and appreciation of foreign cultures and people, especially in this political campaign cycle where one leading candidate is disparaging our southern neighbors and those from the Middle East, as well as many others. While my idea for medical travel is limited to the Western Hemisphere, nonetheless, having such a better understanding and appreciation for our Latin neighbors will lead to less demonizing of people from Latin American countries.

Fourth, it will allow workers to see the world that belongs to all of us, not just to the rich and wealthy. Allowing medical travel in workers’ comp will make it easier for better people to people contact, which will improve the views foreigners have of Americans, and vice versa, and will lead to the fifth reason:

Fifth, taking a step towards world peace, because as new technology makes air travel faster from the US to other regions, the more people will be able to travel abroad and see those parts that are too far away and too expensive for the average working person. This will bring the world closer together than any social media applications can ever do. And that is a good thing.

As I have said before, it will not be easy, and will take a lot of work, especially to change outdated laws, regulations, rules and statutes written nearly a hundred years ago, but if enough people work at it, it is possible that such change can and will happen. We just need the will to make it so.

Health care delivery varies a LOT – and there’s your opportunity

So, medicine is a science right? If it is, then the delivery of care should be consistent across the country for patients with identical conditions, right. Absolutely not. That’s the quick takeaway from a terrific panel this morning at WCRI; … Continue reading →

Source: Health care delivery varies a LOT – and there’s your opportunity

Joe Paduda, blogging from the Workers’ Compensation Research Institute’s (WCRI) annual conference in Boston, has shined a light on where medical travel providers can prove that their lower cost, high quality medical care can produce better outcomes for both patients (injured workers) and their employers.

If what Joe says about a huge variation in medical care delivery across geography – why medical care for identical conditions for the same type of patient varies greatly from place to place is pervasive, fascinating, and, more to the point, driver of low quality and high cost care is true, then it would provide an opportunity for international medical providers to stress in their marketing that they do not have different kinds of treatment for the same type of patient, no matter where the medical care is received.

The rest of his article should give international medical providers a better understanding of how to attract not only patients (injured workers), but their employers and insurance companies.

Proving that, for example, disc replacement provides a better outcome than spinal fusion and is lower cost in your facility outside the US, will go a long way to convince both patients and employers and payers of the efficacy of medical travel.

Knowing that there is such a wide discrepancy in delivery of care across the US for the same type of patient and is responsible for lower quality and higher cost is a strength the medical travel industry can exploit.

What do you think?

Ten Facts About Medical Travel

Maria Maldonado has put together a list of ten facts about medical travel that people in the workers’ comp world should know about.

While it is true that there have been serious medical issues abroad, the same medical errors can and do occur right here at home. One particular one that stuck in my mind some years ago was a patient at a hospital in Tampa who had the wrong body part removed.

Also, there may be some who question whether the JCI’s accreditation is sufficient enough to justify patients going abroad, but absent any other reputable institutions, the JCI will have to suffice as a starting point or floor to which any such future institutions will have to better.

Here is the link to Maria’s post:

https://www.linkedin.com/pulse/10-things-you-should-know-medical-tourism-maria-maldonado?trk=hb_ntf_MEGAPHONE_ARTICLE_POST

An Open Letter to the Latin American Medical Tourism Community

Today marks the one-year anniversary of the creation of FutureComp Consulting, and this past October 29th was the three-year anniversary of the creation of my blog, Transforming Workers’ Comp.

In the three years that I have been writing my blog, I have attended three medical tourism conferences, two in Florida, and one in Mexico in November of 2014, where I gave a presentation entitled, “Barriers, Obstacles, Opportunities and Pitfalls of Implementing Medical Tourism into Workers’ Compensation.”

At these conferences I have met many people from Latin America and have told them of my idea for transforming workers’ compensation in the US by sending patients to countries in the region.

To date, not one person I met at these conferences, nor anyone who has read my blog and is from that region has contacted me to offer their support and services to make this idea a reality.

And when I discuss the issue with Americans, especially those in the workers’ compensation industry, their response has been to call it a stupid and ridiculous idea, and a non-starter.

They have also suggested that medical care in your region is not up to American standards, despite the fact that I have pointed out to them that outcomes here are not guaranteed, and that mistakes can happen in local hospitals as well.

Here is a sample of a typical response from someone in the workers’ comp industry:

“Honestly, medical tourism for injured employees will not work. We are already challenged daily when injured employees leave the country and we have to provide them with care outside of the US. I hear you but it’s a stretch. We can’t get good outcomes here I hate to think what would happen when we send them somewhere else. The laws are much too complicated to garner the intended result.”

Early in my blogging, I wrote the following article based on some comments made on social media that I included in a virtual dialogue, “Point/CounterPoint: A Virtual Dialogue on the Merits of Implementing Medical Tourism into Workers’ Compensation”.

In the presentation I gave in Reynosa, I said that there is a lack of knowledge about the quality of medical care abroad (so-called “Third World medicine”) and that American harbored negative attitudes towards medical care abroad, as well as the conceit known as “American Exceptionalism” whereby only American doctors know how to practice medicine and only American hospitals are qualified to offer care.

However, not all Americans are like that; in fact, one lawyer representing injured workers had knee surgery in Costa Rica, and had such a great experience, he wants his clients to have that too.

In my presentation, I laid out six major barriers and obstacles to implementation, but in writing this letter now, I want to say to the Latin American medical tourism community, that there is a seventh barrier and obstacle, and that is your inability to market and defend your medical services to the American insurance industry, and most specifically, to the workers’ comp community.

That has been one reason why I have been writing about this for so long. In many of my articles, I implore you to do something about this. I even said this in Mexico when I said that you had to go after the market; the market will not come to you.

Just so you don’t think I am some crazy gringo, Norte Americano, here are some of the articles I have written that does exactly that:

The Stars Aligned: Mexico as a medical tourism destination for Mexican-born, US workers under Workers’ Compensation

Lower Cost, High Quality Health Care is Nearby

Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation

Far in Front of the Crowd

Muy por delante de la multitud

E PLURIBUS UNUM: Latin American and Caribbean Immigration, Workers’ Compensation and Medical Tourism

Why Medical Tourism for Workers’ Comp is an idea whose time has come

Questions, Questions — How Medical Tourism Can Become a Real Alternative in Health Care and What it Means for Workers’ Compensation

More Questions, Questions: A Call for Answers from the Medical Tourism Industry

Más preguntas, preguntas: Una llamada para obtener respuestas de la industria del turismo médico

Finally, next week was supposed to be when I was going to give a second presentation in Mexico, this time in Puerto Vallarta, but for personal reasons, I had to back out.

This is the presentation I was going to give that outlines the challenges facing workers’ compensation, and what the medical tourism industry needs to do.

So my challenge is to you, Latin and Central America. Are you going to market your services to this industry, and will you defend your medical care as equal to, or better than the care we get in the US?

What about price and transparency? Will you share data with industry leaders skeptical of your better medical care, or are you going to allow them to call you “carnival barkers”?

I am willing to work with you. You know how to reach me.