Tag Archives: Transparency

The Stench of Fraud, Continued

In The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System, I briefly mentioned the plight of one individual, who I called “Ms. X”.

I called her that because her case is still winding through the medico-legal system in her state, and I do not want to prejudice her case, or add to her woes by embarrassing her, even though she herself is bringing light to her situation by using all resources available to her,

But I felt that once I mentioned her in my previous post, it was alright to expound on the subject of fraud, and discuss her case without identifying her personally.

According to her own words to me [bracketed below] and in her correspondence to others, this is how her nightmare began:

I am an injured worker who was maimed by the medical providers in the insurance carrier’s network of medical providers. Mine is a long story that began December 12, 2011 when I was hurt at work.

[A herniated lumbar disk from working in a sitting position in excess of 65 hours one week and during that week, picking up boxes of banking and files from time to time. I began to feel discomfort in my lower back, went home, took it easy over the weekend, went back to work on Monday, worked for approx. an hour or hour and a half, got up, went to the copy machine, made my copies, bent over to pick them up and then that is when the disk herniated.]

On the day that I was hurt at work, the human resources manager told me that she was going to call the insurance carrier to find out what to do or where to send me. When she returned, she wanted me to sign a “release letter”. I had just gotten that job on November 16, 2011. I got the message that someone there didn’t want me to file a WC claim by virtue of the effort to induce me to sign a release letter. I needed that job and hoped that my back would feel better. I didn’t sign a release letter but I did write a letter indicating that I was hurt at the copier but that I didn’t want to go to their Doctors. I asked if I could go home. At some point, the HR manager gave me a couple of Advil and water for the pain. I had gone home from there – Monday, 12/12/2011. By Thursday, 12/15/2011, my back did not improve, so I placed a call into the HR Mgr. and said that I need to see their Doctors… the HR Mgr. responded by saying something to the effect “Why, you don’t have any money to go to your own Doctor?” (Not verbatim). I was taken aback by this. She knew I was hurt at work. She continued by saying, “We have a release letter signed by you!”. I responded by saying something to the effect that I never signed a release letter. We argued… and so on.

She goes on to say in her correspondence that:

…former employer who fired me less than 3 months after I filed a WC injury. On the very day that I filed a WC claim, my employer placed an ad on Craigslist to replace me. I didn’t learn until sometime in May 2012 that my former employer lied to the insurance carrier about the circumstances of my injury and what I had said. For the record, I was hurt at work and due to the working conditions and surroundings, including my desk and number of hours that I had to work, 65-66 hours the previous week. Our office had very little storage, therefore, myself and the other Escrow Officer, had to pack up boxes of files for closings and banking. We lifted these boxes weekly and sometimes daily due to the lack of space.

Because of what has happened to me, I have been upfront with Doctors outside of the workers comp system. At one of the Doctors, a pain management Doctor that I went to see in early 2014 – March or so, one of the female investigators that I had seen near my apartment on prior occasions (or was her twin) showed up and was placed inside a room before I was, I arrived first, was placed inside the room next to her. During that visit to the Doctor after being placed in the room next to the investigator, the receptionist from the front desk asked me several times if I did recreational drugs and had I ever done recreational drugs. Clearly, a continued effort to create a negative review of me and/or my history. Another Doctor who I visited to get a referral to an orthopedic Doctor insisted that what I describe does not happen. She said that there are no instances in the US of a person being forced under anesthesia. Further, she said that I was delusional and that I should see a psychiatrist, and that the pain that I have is psychologically driven and not real pain.

She was given three epidurals, and this is what happened to her after the first epidural, which went without incident:

I was forced under anesthesia for simple lumbar epidurals. At the 2nd epidural procedure, after objecting to anesthesia, I was told I had no choice, that it was the policy of the surgery center (_____ ___ Outpatient Surgery Center) that all patients must undergo anesthesia. I awakened from that with severe neck pain and slight left arm pain. My Doctor had injected my neck, left side of my spine, left leg with some sort of chemical that tingled and popped like Alka Seltzer. In fact, the tingling went from my lower left lumbar down my left leg all the way up my back and felt like a popping sensation in my head. I was there to receive a lumbar steroid epidural injection and “trigger point shots” in the left side lumbar area.

The next epidural procedure, I made it clear I that I did not want to be placed under anesthesia not only on the phone (a day prior to the procedure) but also before the procedure in pre-op and I re-stated the same in the operating room for everyone to hear. I restated that I was to get a local pain blocker (just as I had during the first lumbar epidural). Instead, my Doctor abruptly shoved the needle into my back without any pain blocker whatsoever. I could feel the needle going through the textures of my back (not precisely or with care into the spinal area where the disk is). My head flew up as I screamed “Wait!” or “Stop!”. He would not relent! As my head hit the operating room table (where a towel and prop to lay my head was), he moved the needle inside me to the nerve in my back next to my spine and held it against the nerve! The pain was so excruciating that I bit into the towel that was for my head to rest on and screamed with the towel in my mouth. Pure agony! He would not stop! I had no choice once again but to give into anesthesia. When I awakened, I thought to myself, Oh my God, they didn’t! I had injuries now throughout my back, neck, shoulders and arm. I could feel the nerves firing all over my back and next to both sides of my spine from the injections of some sort of chemical (the Alka Seltzer feeling again) that over the coming months, burned and corroded the ligaments in my spine, tendons and muscles in my back. It felt as though I was being burned from the inside out. PAIN from burning, PAIN from damage and maiming! I can now and then could feel that some of the tissue/muscles were pushed away from my spine creating the feeling of divots or holes on both sides of my spine. I could feel what seemed to be a muscle pushed away and hanging down on to the right mid side of my person. The ligaments that are in my neck and run up into my skull feel damaged, sore. My spine felt “chiseled” in specific areas most prominently in the top of my back and neck and the bottom near the lumbar sacrum area. I now have instability in my spinal column. I can feel the vertebrae in my spinal column moving not in sync with the other vertebrae…

There is a lot more detail to her case that is beyond the scope of this blog to address, but I am sure my readers have gotten a clear idea of what she has gone through. As a former Claims Examiner and Claims Administrator for a wrap-up insurance program, I have never seen, nor heard of such abuse inflicted upon an injured worker.

This poor woman, who was just doing her job, was taken advantage of by a broken, corrupt and dysfunctional workers’ compensation system that makes the injured worker seem like the guilty party, when it is the providers and legal system who are guilty of injuring and maiming the worker.

To illustrate just how they are characterizing this woman, here is another part of her correspondence regarding an attempt to make her out to have a psychological problem:

The insurance carrier and/or it’s attorneys are working hard to impair my credibility. Several attempts to have me include a psych claim ,since I finally realized that I was being maimed, have been made. Even the AME has placed a notation in his last report that is false – saying that I have ongoing psychological “???”. For the record, I haven’t any history of psych issues. This is a lie that is meant to bode well in favor of the defense. I have never before had a psychological condition. I did mark on a form that I was depressed but that was due to the pain! Not anything else.

In my insurance career, I came across another poor soul who suffered from depression due to the pain he suffered as a result of his injury. At the time, I was the No-Fault Claims Supervisor of the NY office of an automobile insurance company that insured Black Car limousines (Owner and Owner and Another). A Coptic Christian gentleman from Egypt cried in my office before he was seen by our medical consultant. Recognizing that my job was to limit the amount of money we paid to this individual, I did speak to our consultant just prior to the examination. It was the least I could do for this person. So reading what Ms. X has written does not surprize me in the least.

A letter Ms. X forwarded to me from a defense attorney even stated that her epidurals were harming her and not helping. This letter was part of a plan to get her to settle for a few thousand dollars. The lawyer’s text is as follows:

Additionally, the applicant appears to not be benefitting from the treatment, in fact, the treatment by both the employer’s physician and your physician [addressing claimant’s former attorney] appears to be harming rather than helping the applicant.

She also stated in her correspondence that she discovered that:

…some of my medical forms, surgery reports, paperwork had been falsified, changed over and above my signature and due to the anesthesia form (copy handed to me) was marked differently than the first page that I signed and more.

Finally, to make matters worse, she received a letter from a law firm representing her workers’ comp primary physician, demanding her to cease and desist from making false and libelous statements on the internet about their client. From what I understand, this is the physician who the defense attorney said above was harming her. It is no wonder that by mistreating Ms. X this workers’ comp doctor prompted her to take the actions she did to warn people about his conduct.

As I mentioned in the last post on this subject, Ms, X would have been homeless if it was not for her sister. She was subsequently fired from her job as a Manager of her department by her employer after filing the workers’ comp claim.

The events and actions discussed by Ms. X and disclosed here by me, further elaborates just how much the stench of fraud and abuse in the system has become unbearable. These words that I have quoted are but a small part of the whole story Ms. X has told people about, but it is clear that there is something rotten in the state of CA, if not in the state of Denmark, paraphrasing Shakespeare. And we all know that when something is rotten, the stench is overpowering.

Yet, the medico-legal system is arrayed against Ms. X, and the end result, I am afraid will be that she loses, and her work comp settlement will be liened against by the primary physician’s attorney, or the case will be decided in the insurer/employer’s favor, and Ms. X will be unable to go back to work, and will be forever marked as someone who brings attention to herself and not in a positive light. And furthermore, she may be marked as having a psychological issue, when in reality, she is only trying to get the proper treatment for her herniated disk. This psychological defense strategy smacks of something the Soviets used to do to political dissidents.

One gets the feeling that even though the Soviet Union is no more, we are more like the Soviet Union and other authoritarian states, in that the individual is powerless against the power and prestige of physicians, hospitals, lawyers, the courts, and other medical providers, and the system itself.

If ever there was a more clearer case of why we need to transform workers’ comp from the broken, corrupt and dysfunctional system I have been describing these past two years, this case is it.

How different Ms. X’s life would have been if she had gone to an honest and reputable treating physician, received the proper medical treatment, and if necessary, gotten back surgery to repair her herniated disk, even if she received the surgery from her employer or insurance carrier in another country, as a medical tourism option.

And how different her life would be if she did not have to be threatened with a lawsuit from a shyster law firm that is representing a shyster physician, as well as being misrepresented by bad attorneys, so that I had to ask someone I knew if he could help her. There is a saying, “a fish rots from the head down”, and in this case, the stench of the fish called ‘Workers’ Comp fraud’ is taking down the entire system.

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What A Long Strange Year It’s Been – My Year as a Medical Tourism Blogger

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Introduction

Today marks one year that I began my blog on medical tourism and its implementation into workers’ compensation.  From the beginning, I did not have any idea if my blog would be successful, or if it would be a complete failure. One year in, with over 8,000 views, and less than 100 followers, the jury is still out, so it remains to be seen where the blog goes in the next year.

Yet, just this month, on October 7th, I had 233 views (highest ever) and 205 visitors. But one thing is certain; I have had a very interesting time writing it, and have made some wonderful connections both in the medical tourism industry and out of the industry, from all over the world. But I have also had some rather disappointing experiences as well. This post then is a look back and maybe a look forward to another year of blogging, hopefully more rewarding, both career-wise and financially than this year coming to a close has been.

Why I started the Blog

I started the blog for three reasons: One, I had just attended the MTA Congress in Hollywood, Florida three days earlier, after they had published my White Paper on their website. The White Paper was too long for their online magazine, so they asked me if I would not mind it if they published as a White Paper. When I said yes, they eventually invited me to come to the Congress free of charge, for which I was very grateful, since I was unable to spend that much money to participate. After the Congress was over, I had learned from a few industry sources and two legal experts, that the MTA copyrighted my paper without my written permission, so I had one of the lawyers find me a template so that we could use to send them a letter asking them to either remove the copyright, and remove the Editor-In-Chief’s name from it, or remove it altogether and let me know in writing. They did remove the paper, but I had to find out for myself when I went to their website.

The second reason I started the blog was because of my MHA degree (Masters in Health Administration) which I received a year earlier, and for which I wrote the term paper that was the basis of the much longer White Paper. My Health Law class required a paper on a legal topic in Health Care, and since I had neither a legal background, nor a health care background, I went out to social media to find a topic. The first topic suggested to me did not yield much information and was not a good research subject, so again I went out to social media, and a lawyer in CA gave me the idea to write about the legal barriers to implementing international medical tourism into workers’ compensation. She helped with getting legal cases and some of the editing of the original paper, as well as some of the work expanding it into the larger White Paper. I was unsuccessful in getting any legal journals to publish it, so that is when I turned to the MTA.

The third and most important reason why I began my blog was to explore new avenues of employment in either medical tourism or in workers’ comp, or even health care. I did this because I felt my workers’ compensation and insurance experience, which consists of work in Auto No-Fault, Risk Management and Insurance Data Processing with regard to claims, brokerage and statistical reporting of workers’ compensation claims and policy data, would be valuable to organizations in those industries. Unfortunately, due to the economic downturn and jobless recovery, many companies have curtailed their hiring, and many are just filling jobs that require a finite set of skills and background that I do not possess. I have made connections both before my degree and after with executives in many companies, and in many parts of the US, but have gotten little or no response to my inquiries.

My career has been somewhat broad and varied, depending on the nature of jobs available at the time, but they have given me an insight into the world of insurance in general, and the world of workers’ compensation in particular, so after attending the Congress, and meeting different people from other countries, and hearing one company’s experience as a self-insured employer utilizing medical tourism for their employees on their health care plan, I thought that it might be possible to do the same for those employers who are self-insured for workers’ compensation, as well as those who purchase workers’ compensation insurance in the insurance market.

A Brief Review of Past Posts

My first post, on October 29, 2012 was a recap of what I learned at the Congress and what I thought about medical tourism as a viable alternative to high cost medical care in the US. The post, entitled, What I Learned at the 5th World Medical Tourism & Global Healthcare Congress, and Why It Matters to the Workers’ Compensation Industry, also discusses the three cases I cited in my paper which involved some form of medical tourism; either domestic medical tourism, or cross-border medical tourism,( i.e., Mexico), from CA and FL.

The third post I wrote was a shortened version of my White Paper, called Medical Tourism and Workers’ Compensation: What are the barriers? Here, I attempted to get the workers’ comp industry interested in the idea by giving them the highlights of my original paper. Almost immediately after I began blogging, my posts were picked up by other blogs and newsletters in the health care and medical tourism industries, and I am thankful for their faith in me as a blogger that they continue to do so.

As a further inducement to get some interest in the idea of implementing medical tourism into workers’ comp, I created a fictional case study about a self-insured employer who is self-insured for both health care and workers’ comp, but whose Risk Manager was unaware of how much money he could save if he followed what the Employee Benefits Manager was doing on the health care side with medical tourism. In the case study, A ‘Case Study’ in Implementing Medical Tourism into Workers’ Compensation, three workers sustained injuries while working at a job site and needed surgery that would have cost the company thousands of dollars. The Risk Manager told the Employee Benefits Manager about this, and learned that the company was sending its workers to countries in Central America for less expensive health care with better quality outcomes, and the Benefits Manager suggested he do the same with the injured workers.

The one topic that I have written the most about in the past year was about the impact of immigration reform on workers’ compensation, and subsequently, on medical tourism. The following posts were written because I came to believe that Latin America and the Caribbean was the most logical region of the world to pursue medical tourism, since it is so much closer to the mainland US and the workforce here is increasingly Latino and Caribbean.  These are the four posts:

The Stars Aligned: Mexico as a medical tourism destination for Mexican-born, US workers under Workers’ Compensation, Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation, Immigration and Workers’ Compensation: Round Two, Testimonial on Medical Tourism in Mexico.

The last post was supposed to be followed by even more testimonials, and may still be, but it will have to wait until after this one is posted. Finally, I decided that I should acquaint the workers’ comp industry with some of the medical tourism facilities that had booths at the MTA Congress, so I wrote the following post from literature I gathered during the last two days when the Exhibition Hall was open. No Back Alleys Here: Medical Tourism Hospitals, Clinics and Networks in Latin America and the Caribbean, simply listed the hospitals and clinics by country and listed the hospital’s websites, where available. It would be up to the reader, I felt to check them out.

What I have learned About Medical Tourism – The Good, the Bad, and the Ugly

My experience writing the blog has educated me about the medical tourism industry, even though I do not actually work in it at present. Perhaps being an outside observer gives me an honest and forthright perspective that many inside the industry don’t have, but in my email conversations with some of them, they are already aware of the nature of the beast, as it were, so here are my thoughts about the industry —the Good, the Bad, and the Ugly (with apologies to Sergio Leone, but not to “Mr. Talks-to -empty-chairs”).

The Good

In the past year, I have met some very nice and dedicated people who want to provide patients with quality health care, at affordable prices, plus a little extra on the side. Whether it was at the MTA Congress last October where I met people from Mexico, Guatemala (Belgian, actually), Australia, Singapore, China, Canada, Finland and the US, or online through my blog or my LinkedIn profile, I know that the medical tourism industry has very good promoters and patient advocates.

Many of the online connections I have made are in India, which is the primary destination for medical tourism. But there have been other connections made all across the globe from Europe, the Middle East, East Asia, Africa, and some from Latin America and the Caribbean. This proves to me that medical tourism is a growing and dynamic industry that will continue to grow, provided that it attracts the same kind of people I have connected with over the past year. Yet, as we shall see below, there is a grey cloud and a dark cloud over the industry, which threatens its long-term sustainability and growth…the bad and the ugly sides of medical tourism.

The Bad

Any industry and any business in that industry must be able to not only justify its existence, but to prove its value and worth to the customer, and medical tourism is no exception. So, it has been disheartening to me that I have been unable to get exact cost figures for certain surgeries that are common to workers’ compensation from some medical tourism facilities in Latin America and the Caribbean, as I described in my post, If You Have to Ask…Fuggedaboutit!.

In that post, I said that transparency on costs was vital if the medical tourism industry wanted to pursue business in the American workers’ compensation industry, because employers, insurance companies, and third party administrators will want to know up front if this is really a less expensive alternative to high-cost surgery in the US. I even cited surgical costs from some countries in the region, and some costs from Asian countries that I originally cited in my White Paper. These last figures, I have been told by some people are not accurate and therefore, are only a guesstimate of the actual costs.

In addition, I have been told that figures on the number of Americans going abroad for care are inflated, often because they count expatriates who are living and working in those countries as patients, besides those who actually did travel abroad for treatment, so again here is another area where transparency is needed.

Finally, as I point out in my post, Ensuring Patient Safety: Making Sure Medical Tourism Puts Its Money Where Its Mouth Is, patient safety and quality are also important areas where transparency must be observed if the medical tourism industry is to be more than just a rich man’s game. You have to prove to all stakeholders in the care and treatment of patients, and even the patients themselves, that you have equal or better quality outcomes than what is available in the US, and that patient safety, like costs and numbers of treated patients, are presented upfront and clearly to all interested parties. Failing to do so will only drag down the growth of medical tourism, and may even give it a black eye from which it may never recover.

The Ugly

As in any endeavor, individuals are bound to find detractors who critique and even attack you for your beliefs and for your efforts. I am no exception to that, and have received my share of critiques and attacks during the past year. I answered these critics in the following two posts, The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible and is not a Pipe Dream, and Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation.

I am not going to rehash this issue here again, but only bring it up as one part of what I see as the ugly side of medical tourism. There is too much personal animosity among certain individuals and organizations, especially in an industry that is still in its infancy. And while I have accepted an apology from one of my critics, there are still some ugly and vile behaviors that have been perpetrated against well-meaning and decent people who just want to grow this industry from the bottom up, instead of from the top down. There is no reason why people have to be nasty to each other, there is enough business on this planet of seven billion to go around.

Any organization that purports to represent the interests of an industry at large, and whose executives claim to be reputable spokespersons for that industry, must not engage in childish and unprofessional behavior that casts doubt on the individuals involved, the organization they belong to and the industry as a whole.

Holding fancy conferences around the world and charging big numbers only to see a handful of attendees actually paying and the rest being invited or begged to attend, does not suggest a healthy and vibrant industry, nor does it show that the leading organization promoting that industry is a trustworthy and honest one.

What I have not gotten from both industries

Medical Tourism industry

Perhaps it is because many in the industry have a background in general health care, or perhaps it is because they have experience in the travel, wellness and resort industries, that many of the people who have connected with me are not familiar or aware of what potential the US workers’ compensation market can be. I have received many offers of partnerships with these individuals, but I have to point out to them that I am not a doctor, I am not a medical tourism facilitator, nor do I have any other business that would partner with them in such an endeavor, and therefore, cannot refer patients to them.

Naturally, I thank them for considering me, but given that many of them are in Asia, and I am focusing on Latin America and the Caribbean, there is no reason for me to explore it. I would, however, like to hear from some organization or company doing business in that region who is seriously considering entering a new market such as workers’ compensation, given the increase in the Hispanic and Caribbean workforce in the US. That region has many “rising stars” in the medical tourism world, and can be very lucrative if the right people recognize its potential.

In addition, the newsletters and blogs that have re-posted my posts have for the most part, not generated much feedback or comments, and I wonder if anyone besides the publishers and their staffs are reading them. My own blog publishing site, WordPress.com, has garnered me nearly 10,000 views since I began blogging, but again, the response has been rather weak.

Workers’ Compensation industry

As I stated above, the most important reason why I began the blog was to simply find a job in the workers’ compensation industry after spending two years in school getting my MHA degree and looking for work after the recession and jobless recovery following the events of 9/11, the housing bubble that burst in 2007, and the financial collapse of 2008. The problem that I and many others are facing is that the industry is shrinking and companies are being bought by either their competitors, or by private equity firms, such as what just was announced recently when a company called Apax Partners bought One Call Care Management (OCCM), a workers’ compensation services company in a multi-billion dollar deal.

In May, I had lunch with one of OCCM’s Regional Sales Directors who shares my idea about medical tourism and workers’ compensation, and who thought we might be able to put something together that would address his clients’ concerns about the high cost of surgery. His company provides transportation, translation, home care equipment and medical devices to the work comp industry, and even has an in-house travel agency, which would make them the ideal medical tourism facilitator for workers’ compensation patients.

After several phone calls that ended without any further action on our parts, I decided to contact the top management of his company, even sending my White Paper and resume to the Chairman of the company and the President and CEO. That was back in September, and one month later, I have not heard from either of them.

I learned recently that because of this deal, it is unlikely that the President of the company will do anything with my idea. That seems to be the case with many other companies, and why I have gotten no traction with my idea from anyone else in the workers’ comp industry. When I post my blog posts on social media, it is like they are falling on deaf ears, or in this case, blind eyes. They seem to more concerned with being bought up, dealing with the opioid issue, or the physician dispensing issue (which is related to the opioid issue), or they just don’t see this as a viable alternative because they are too conservative and too cautious, and too willing to do the same things over and over again and expect different results. That, as I said before in a more recent post, is The Definition of Crazy.

Predictions

Making predictions nowadays is a little like knowing what Ted Cruz is going to do next for an encore; they’re unpredictable and designed to make the person doing so look good, so to spare you and me from any embarrassment, let me just add that health care is changing, and the direction that it takes will depend a lot on what has already happened, and what is currently happening, especially in light of the problems with the ACA rollout earlier this month.

But my recent post, Ten Years On: One Person’s View of Where the Medical Tourism Industry will be a decade from now, spells out some of the things that may influence the direction medical tourism takes in the future. Hospital costs, outpatient costs, consolidation of hospitals, cost to employees, immigration reform and technology will all play a role in determining the direction medical tourism takes in the next ten years and beyond.

Conclusion

As I begin a new year of blogging, I am grateful for the opportunity to provide my readers with new knowledge and insights to different topics, ideas and issues that affect not only workers’ compensation, but all of health care, medical tourism included. I hope that my writing has made many of you stop and think and look at things in a different light. I also hope that you have been entertained by my writing, as far as a serious subject can be entertaining when it pertains to human life.

But most important, I hope that this next year will provide with me everything I had hoped the last year would have; a new position, recognition of my idea as a viable alternative to high cost health care for workers’ compensation, and greater opportunities to personally interact and meet so many of the people engaged in the medical tourism industry around the world.

Here’s to a better blogging year!

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Thank you so much,

Richard

“The Price Is Right?” – Taking the Guesswork out of Medical Tourism Pricing

Back in May, I wrote a post entitled, “If You Have to Ask…Fuggedaboutit! “, in which I described the difficulty I had in trying to get pricing information from facilities in Latin America and the Caribbean, and why transparency was needed if medical tourism was ever going to be implemented into workers’ compensation.

David DePaolo this week posted another wonderful piece on that very topic, medical transparency. His article, “Medical Transparency: Resistance is Futile”, was a commentary on a video posed by a video blogger named John Green, on YouTube that asked the question, “Why Are American Health Care Costs So High?”

 

The reason, David suggests that costs are higher here, is because they can charge whatever they want to, and people will pay it.

According to John Green, there is no central pricing controls as there is in other countries, consumers will pay whatever is charged because they don’t know any better, and because, as I’ve said before, there is no transparency in pricing, both domestically as John and David state in the video and article, and in medical tourism.

David goes onto state that it makes sense that health care pricing should be a factor in medical care decisions, and he points to a news article from WorkCompCentral that discusses this with regard to a surgical facility in Oklahoma.  These decisions are usually made, David says, when there is time to make an informed judgment about a procedure, which is usually most of the time, especially in medical tourism.  [Emphasis added]

Some medical businesses are beginning to advertise their prices, according to David, and it is causing a debate in certain medical circles. The Surgery Center of Oklahoma is one of those businesses that have posted its prices and a bidding war has begun with other facilities in that state.

As far as general health care is concerned, David says that pricing transparency is gaining momentum, but as we have seen in medical tourism facilities, such transparency is anything but transparent.

The state of North Carolina passed a law requiring hospitals to provide prices for 140 common procedures and services, and the federal government published the billed charges for the 100 most common procedures for inpatient services, including spinal fusion.

While much of what David and I have been discussing so far is related to general health care costs; as for workers’ compensation, the issue of price is meaningless, David points out, without knowing the quality of the care provided, meaning outcomes. Again, this is where medical tourism fails to be transparent, because it claims on the one hand to be less expensive, but won’t tell you how much, nor will they tell you what their quality outcomes really are, only that they are better than what is found in the US. Man may not live on bread alone, but medical tourism shouldn’t live on faith alone either, it has to have facts and data to back up its claims, the data must be reliable, and they have to be transparent.

In workers’ compensation, much of the decision making is not incumbent on the patient/injured worker, so that price is not their concern, as it is not their money.  These decisions are often left to physicians, insurance companies or claims administrators, attorneys, the state, or the employer; therefore, the patient/injured worker only decides if they are going to undergo a particular procedure.

There is no reason, David says for the patient/injured worker to not know how much is being charged for a service or a product before the actual purchase of the service or product.

The only thing that a patient/injured worker would be concerned about is the quality, because it is their body that is going to be operated on, so naturally they want to know that the outcome will be successful. You’d want to know that the spine surgery you are about to get is going to leave you either paralyzed or will allow you to walk again, right?

Education about quality, the doctor/patient relationship, easy and available data that can be interpreted, as well as choice in providers (even medical tourism providers) will make a difference, according to David.

Transparency will be good for the ultimate health of the medical industry and workers’ compensation, which has been my argument all along, and as consumers get used to seeing prices before making decisions about procedures, the more that pricing will become a factor in choice.

Once that happens, David believes, those competing on prices will start publishing outcomes and quality measures, and there will be competition based on outcomes. It is a matter of culture, and both the culture of the medical tourism industry and the workers’ compensation industry must change. Not to do so will be very costly and very dangerous for those who pay for health care and those who receive health care.

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If You Have to Ask…Fuggedaboutit!

th (1)

Trans·par·en·cy: the quality or state of being transparent. Origin:  Medieval Latin trānspārentia. Source: Dictionary.com

Transparency, a simple enough word, one that conveys the idea that something is transparent, clear, understood, can be easily recognized and seen; yet, a word that the medical tourism industry, and the health care industry at large has so far failed to grasp. This lack of transparency is clear, or rather transparent to anyone who has tried to figure out the cost differentials for treatment procedures from one part of the US to another, let alone from one country to another, for the same procedures.

This is the dilemma I have been encountering for some time as I have been writing this blog. I have tried to approach several of my contacts in the medical tourism industry to get information on certain surgical procedures such as hip, knee, spinal fusion, carpal tunnel, and other occupational-related surgeries so that those in the workers’ compensation industry in the US can compare apples to apples, oranges to oranges, as best as possible, given the number of hospitals in the Caribbean and Latin America region that cater to medical tourism. Unfortunately, I have run into difficulty getting this information for a variety of reasons.

One reason is that some of my contacts are busy with their own affairs to get such data from the hospitals, and then forward it on to me. I quite understand that, and can appreciate that if it was me, I, too would be too busy to do so. But in the case of one of my contacts, who has been more than generous with her time and assistance, we have been frustrated by bureaucracy, politics, and turf battles between hospitals in the same group, and in the same country.

It should be a simple thing to quote a price for a particular surgical procedure such as a hip replacement or a knee replacement. Even if it is an average of a range of prices, it is still better than guessing or taking it on faith that medical tourism destinations are less expensive than US hospitals, with or without the cost of airfare, accommodation and other expenses factored in. For example, in one of my earlier posts, I included the following table to compare hip and knee surgeries costs in Colombia, Costa Rica and Mexico with that of US costs.

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How accurate are these figures is anyone’s guess, but at least when you look at the four countries listed, there is a discernible difference in cost, not only between that charge in the US, but between the three Latin American countries as well.

To further illustrate what I mean, and to show that transparency of prices is not limited to the Latin American region, the next table, which I cited in my white paper on medical tourism and workers’ compensation, shows price differentials between the US, India, Singapore and Thailand, and includes airfare and accommodation for two.

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As the Center for Medicare and Medicaid Services (CMS) recently did here in the US with hospital charges for spinal fusions, so too should the medical tourism do the same for all procedures, at all hospitals and in all countries. Spinal fusions at the top 10 American hospitals range from $269,846 to $471,121, and overall, between $19,000 and $470,000.

It should not be so hard to find out the same kind of information from a hospital in a country that is establishing itself as a major medical tourism destination. While the American workers’ compensation industry only accounts for 2% of the health care market in the US, that market in and of itself is pretty large, and should not be ignored, especially as the American workforce is getting more and more Hispanic, and in particular, in states like Arizona, California, Colorado, Florida, Nevada, New Mexico, and Texas, as well as other states in the union with a growing Latino presence.

So, transparency, a simple word that can be defined simply as the state or quality of being transparent, clear and understood, needs to be the most important idea when any country or hospital in that country wants to pursue medical tourism business, no matter if it is from private individuals, group health care plans, or workers’ compensation insurers and employers covered under that insurance or by self-insured coverage. Transparency needs to be transparent.