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SPOTLIGHT

A conversation with Matthew Haddad, founder of Medversant Technologies, LLC, the leading provider of web-based health care practitioner management applications.

Matthew Haddad, founder and CEO, Medversant Technologies, LLC

Patient safety continues to be one of the top concerns for consumers considering traveling abroad for medical care. At this time, there is no single repository of information on the licensing and status of providers in the various countries offering care to medical tourists.

One individual who has been giving this fact some serious thought and consideration is Matthew Haddad, founder and CEO of Medversant Technologies, LLC, the leading provider of web-based health care practitioner management applications. The company’s Encompass TM technology is used across the country by hospital systems and managed care organizations to continuously monitor the status of their affiliated providers, thus increasing patient safety and reducing liability.

Medical Travel Today recently had the opportunity to talk with Matt about how the systems and technology his company implements might be applied to medical tourism in both the near and distant future. What follows is an excerpt from that conversation.

MT:First, tell us a bit about how you got involved in the data management side of health care.

MH: Certainly. I actually began my professional life as an attorney, mostly for commercial finance and mergers and acquisitions. I then had the opportunity to become part of a start-up involving home infusion therapy systems. In that business, you’re essentially operating a hospital without walls and that exposed me to the healthcare industry in a big way. I was working with providers, hospitals, pharmaceutical companies, insurers, patients… you name it. One thing that was very apparent to me was that the technology systems for healthcare were very challenged. There simply was no such thing as real-time information.

From that company, I moved on to buy a web-based medical billing company. I realized fairly quickly that billing was not where I wanted to be. The constraints of HIPAA made it difficult to create a shared platform that would be accepted by healthcare organizations.

The area of provider credentialing, however, seemed to have promise. While traditionally overlooked and neglected, credentialing was one of the most important processes that directly affected patient safety. Credentialing protects patients from unlicensed, sanctioned or otherwise unqualified providers.

The process was terribly inefficient. Providers constantly had to send the same extensive background information to numerous organizations over and over. These organizations, in turn, took it upon themselves to verify all this information manually, resulting in departments that seemed like one big sea of paper files and sticky notes. The chances of error or of the work just not getting done were high. This was a perfect example of an administrative process that could be streamlined by an automated, web-based application. This would improve information flow, increase efficiencies on all fronts, and enhance patient safety…it was perfect.

From all that, Medversant was founded.

MT:Tell us a bit about the types of clients you work with and the services you provide.

MH: We currently have clients in every state and Puerto Rico. We work with virtually any organization that’s involved in credentialing. Those include big insurance companies, hospital systems, surgery centers, nursing homes, dialysis companies, home health, imaging… you name it. What we do is provide continuous monitoring of their employees’ licensure and other credentials.

In the simplest terms, we access the information in a number of databases and run it against our clients’ files, warning of issues as they arise and providing real time updates. The information is all out there. We just simplify the match and merge process.

MT:What opportunities do you see in the world of medical tourism?

MH: Medical tourism is hugely exciting. The cost benefits are obvious on many levels. Plus, I see the industry as an opportunity to increase the quality of care globally, particularly since there are many skillful practitioners around the world who could potentially be accessed.

To ensure that the industry realizes its potential, we must create credentialing standards and a connected repository for all relevant information. Consumers want to feel comfortable making health care choices, especially when it involves traveling abroad. A systemized, centralized and accessible credentials record would help provide that comfort. Plus, current technology can ensure that consumers are able to access that information with ease.

Presently, consumers can access only very limited information about their providers in the US, but they may be able to obtain much more provider information internationally, because there are often fewer, if any, cultural and legal barriers to allowing access in other countries. This difference could ultimately benefit us all in terms of ability to vet our own providers.

MT:How feasible is the idea of establishing a common set of health care standards globally?

MH: Having a universal set of health care standards is a very realistic goal. We already have a precendent for that in the existing standards of international organizations such as the World Health Organization and the Joint Commission International. To take that further is just a matter of agreeing upon standards for our providers and facilities, then performing the credentialing to ensure that those standards are met. Countries that really want to grow as a medical tourism destination can help themselves by modernizing access to provider data through cost effective technology solutions such as Medversant’s.

MT:What about the technology end of things? Will that translate?

MH: Sure. You could use the same methodology around the world as in the US. It’s just a matter of linking up to different existing databases or perhaps even creating new ones. We currently do credentials verification for many foreign providers who provide care here in the U.S. It works.

MT: Matt, thank you for your time and for sharing your vision for the future of medical tourism and global care.

To learn more about Medversant, visit www.medversant.com. Matt Haddad can be reached at mhaddad@medversant.com

ISSUES AND ANSWERS

National Center for Policy Analysis: Global Competition in Health Care

In our last issue of Medical Travel Today, we featured an excerpt from the National Center for Policy Analysis (NCPA) Report on Global Competition in Health Care. An internationally known nonprofit and nonpartisan research institute, with offices in Dallas and Washington, D. C., the NCPA cited medical tourism as “one of the most promising solutions for our nation's soaring health care costs.”

In this issue, we feature an excerpt from the same report, focusing on the obstacles to health care globalization.

A complete copy of the 37-page report can be found at: http://www.ncpa.org/pub/st/st304

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Obstacles to Health Care Globalization

Health care globalization, including medical tourism and medical outsourcing, has the potential to lower costs and increase competition in the American health care industry. However, there are numerous obstacles to incorporating foreign health care providers into the U.S. health care system. Some of these barriers are the result of entrenched interest groups that do not want to compete with low-cost providers. Federal and state laws also create a number of obstacles to Americans seeking treatment abroad, including outdated laws supposedly intended to protect consumers that now merely increase costs and reduce convenience. Finally, state and federal regulations currently restrict public providers from outsourcing expensive medical procedures.

In addition, federal regulations make it difficult for private plans to offer financial rewards to enrollees willing to seek care abroad. This is significant because insurance pays the bills for most U.S. patients and surveys find that patients are unwilling to travel long distances for health care of the same quality they could receive at home unless they have a financial incentive to do so.

State Licensing Laws. Recent advances in information technology allow a radiologist to read X-rays from India just as easily as an American radiologist could read them from a home office. However, the practice of medicine is regulated by state medical boards, which generally require a physician to be licensed in the state where the patient receives treatment. Thus, state licensing laws prevent medical tasks from being performed by providers living in other states or countries. Foreign physicians also lack the authority to order certain tests, initiate therapies and prescribe drugs that American pharmacies can legally dispense.

States license and regulate physicians with the ostensible goal of maintaining the quality of medical care. 129 However, state medical boards are dominated by physicians and, like the boards governing other regulated professions, they tend to benefit the practitioners. 130 Besides stringent licensing requirements, these organizations suppress competition among physicians by declaring certain practices to be unethical. Medical societies have long opposed innovations that pose a threat to their autonomy or income. 132 And threats to hospital revenue or the ability of hospital systems to cross-subsidize uncompensated care generate considerable opposition.

Some restrictions on the practice of medicine have been removed in recent years, but many still exist. For example:

It is illegal for a physician to consult with a patient online without an initial face-to-face meeting.

It is illegal in most states for a physician outside the state who has examined a patient in person to continue treating the patient via the Internet after the patient returns home.

It is illegal in most states for a physician outside the state to consult by phone with patients residing in the state if the physician is not licensed to practice medicine there.

These laws make it difficult for American patients to seek care from doctors abroad via telephone and the Internet.

Restrictions on Collaboration among Health Care Providers. A physician practice in the United States could easily provide doctor visits in a traditional office, coupled with chronic disease management services from a foreign doctor and tests done at a convenient retail clinic when needed. Yet this scenario might run afoul of the so-called Stark laws. The federal Stark laws make it illegal for a physician to refer a patient for treatment to a clinic in which the doctor has a financial interest. It is also illegal for a physician to reward providers who refer patients to him, or to a hospital in which he has a financial interest. Unfortunately, laws meant to prevent self-dealing and kickbacks also inhibit beneficial collaboration between doctors and hospitals. For instance, the Stark laws could prevent a physician practice from referring a patient with a chronic condition to an affiliated disease management program (employing a foreign doctor) or prevent the practice from referring a patient needing minor treatment to an affiliated walk-in clinic.

By limiting compensation arrangements for referrals and collaboration, the Stark laws tend to result in rigid physician group practices that are not particularly convenient or economical for patients.

Lack of Follow-Up Care. Some procedures require follow-up care to monitor the healing process or remove stitches. In some cases, patients who have traveled abroad for medical procedures have problems finding a local physician willing to provide postoperative follow-up care. This is especially worrisome if the patient has complications. Liability for another provider’s work is a perceived risk to doctors providing aftercare — one reason some American physicians are loath to provide follow-up care to patients treated abroad.

Another reason for physicians’ reluctance to provide follow-up care is that patients treated abroad often lack insurance. Over the years, many doctors have assumed that health insurance is the only way for patients to finance medical care. Physicians may prefer not to treat uninsured patients (unless payment is made in advance) for fear they will not get paid.

Although lack of follow-up care is definitely a concern, many patients who have had surgery abroad report their regular doctor continued to treat them throughout recovery. Patients with a regular physician will likely fare better than those who are only seeking physician care for a short-term (postoperative) need.

Legal Obstacles. Employers and insurers could lower their health costs by sending employees abroad for treatment. However, there are important legal considerations. Plan sponsors must meet Employee Retirement Income Security Act (ERISA) fiduciary obligations in designing and managing employee benefit plans. According to some legal scholars, an employer that sponsors a health plan offering workers a financial incentive to travel abroad for treatment could have greater liability risks. The concern is that financial incentives might induce enrollees to accept substandard care when they otherwise would select the local hospital of their choice — although many health plans do just that by offering financial incentives for patients to choose hospitals in their networks. If health plans cannot offer enrollees financial incentives, patients are unlikely to consider medical travel.

Federal and State Government Plan Obstacles. Nearly half of all health care expenditures in the United States are paid for by government. This includes Medicare, Medicaid and health coverage for state and federal workers. It is hard to imagine significant cost savings occurring without involving the public sector.

Medicaid consists of 50 different state programs. State Medicaid programs near the border with Mexico could easily outsource some procedures abroad. Yet despite the potential savings for state taxpayers, none have considered taking this step. Medicare benefits are limited to the United States. This is a hardship on foreign-born workers who accrue benefits in the United States but want to return to their homelands to retire. This also forces the estimated 40,000 to 80,000 American retirees living in Mexico to pay out of pocket or return to the United States to receive care. Furthermore, Medicare requires significant patient cost-sharing, generally 20 per cent above the deductible. Medicare could reduce costs and allow seniors to share in the savings by waiving the cost-sharing requirements.

Joint Commission International Achieves Accreditation from ISQua

OAK BROOK, Ill., Jan. 3 /PRNewswire-USNewswire/ -- Joint Commission International (JCI) today announced its accreditation by the International Society for Quality in Health Care. JCI is a division of Joint Commission Resources, Inc. (JCR), a private, not-for-profit affiliate of The Joint Commission.

JCI is a global leader in health care accreditation and, since 1999, has accredited more than 140 hospitals in 27 countries. This external endorsement by ISQua is a milestone achievement that demonstrates the quality of JCI's accreditation services.

ISQua, a non-profit, independent organization with members in more than 70 countries, is known as the accreditor of accrediting bodies. Accreditation by ISQua provides assurance that the standards, training and processes used by JCI to survey the performance of health care organizations meet the highest international benchmarks for accreditation entities.

"I'm proud to announce JCI's accreditation by ISQua. It demonstrates the dedication and commitment of our Board, staff and surveyors to improving health care quality and safety through the process of accreditation, and it allows us to provide external validation of this commitment to our clients," says Karen H. Timmons, CEO, Joint Commission International.

Joint Commission International chose to pursue ISQua accreditation because:

-- It provides confidence and credibility through formal worldwide

recognition that an organization meets international standards specifically developed and tested for health care external evaluation bodies, and

-- It involves an impartial and independent review system.

Accreditation by ISQua was a two-part process that touched upon every aspect of how JCI operates. The first part of the process, completed in 2005, involved applying for accreditation, an evaluation of JCI's accreditation standards based on a set of principles created by ISQua, and a self-evaluation by JCI of its compliance with ISQua's standards.

The self-evaluation process included everything from the JCI accreditation application process to the deployment of surveyors to JCI's human resources practices, finances and quality improvement processes. JCI spent a year preparing the detailed self-evaluation report and other documents required for submission prior to the arrival of the survey team. The second phase concluded in July 2008 with the on-site survey.

For more information about JCI, please visit http://www.jointcommissioninternational.org or call 1.630.268.7400.