Lou Cornacchia, M.D., President and CEO, Doctations

Creating a truly shared electronic health records (EHR) system has been a goal for many in the healthcare industry for many years. Dr. Lou Cornacchia, CEO of Doctations, has created a web-based integrated community where patients and multiple physicians can instantly access key information related to the patient’s healthcare. Unlike traditional software, Doctations is the first true platform for Internet healthcare.

Medical Travel Today recently spoke to Dr. Cornacchia about Doctations and how it overcomes some of the limitations of traditional EHR software and technology.

Medical Travel Today (MTT): Tell us what drove you to create Doctations?

Lou Cornacchia (LC): Actually, there were a couple of things.
First, I am a surgeon and physician, and I treat patients in a wide range of venues ranging from affluent neighborhoods in Long Island to impoverished communities in Brooklyn.

I came to realize that there are tremendous inefficiencies in the way electronic records were working and being handled.  

For instance, in lower income populations, software is a big problem. There’s both a lack of a technology infrastructure and technology required to achieve the efficiencies necessary to deliver good healthcare.

In addition, I had the experience at a relatively young age of having my wife die of breast cancer.  Throughout the experience, we went from doctor to doctor with no cohesiveness in the treatment plan and process. As we went from one institution to the next, things just got worse. There was very little communication. My wife was a doctor, and I was a doctor, and I thought, ‘Gee, if we can’t do this, how can the average person without the insider understanding do it?’ It really was a wake-up call for me.

Two years after my wife died, I started this project. 

MTT: It seems the biggest differentiating feature between Doctations and other electronic medical records (EMRs) is the Internet aspect. Is that correct?

LC: Yes. Doctations leverages the speed and efficiency of the Internet to its fullest. In order for a true sharing system to work, it has to be built around the Internet. The Internet simply affords the power to communicate and collaborate in the process of solving medical problems.

Before I started this project, I wrote my own EMR billing system in the early 1990s to run my office. That experience revealed a lot of the shortcomings of traditional software. I realized then that we needed to leverage the Internet so that everyone could get involved.

The Web is unlike any other technology in its ability to truly empower and enable the patient-doctor relationship.

The phone is a poor solution to patient-doctor communication as both parties need to be available at the same time.

As for e-mail, some doctors simply don’t trust it -- and rightfully so because it’s not secure. Plus, it doesn’t enter the doctor’s daily workflow. There are extra steps involved in adding it to the workflow, and you can imagine how difficult it is to squeeze more into the day.

But with the Internet, there are good and logical reasons for making it part of the workflow.  

Allow me to provide a bit more background on how we reached that conclusion. We spent a tremendous amount of time examining and mapping out workflows and even organized a number of focus groups. From there, we put together a series of advisory boards representing the interests of patients, physicians, legal counsel, the business office, and billing and collections.

We recognized that in order for anything we developed to work and be adopted, it had to work for all these constituencies.

So we put together these boards—and let me add, they’re truly working boards: a group of 25 patients meets once a month; the doctors every two months; the legal board, which is made up of five attorneys, meets every one to two months. Those five attorneys, who participate fully gratis, include Health Insurance Portability and Accountability Act(HIPAA), medical, corporate, and malpractice attorneys. 

Through all the discussion, we recognized that the only viable solution is a truly comprehensive solution that extends itself to any physician in any venue.  That led to an analysis of technology looking specifically at how one software program could provide access to all venues.

We knew that it had to be designed front end and back end. Essentially, the back end is the engine in your car. The front end is the steering wheel and dashboard layout. We can make dashboards specific for any specialty or venue of practice while employing a constant back end to run the show.  

We looked to design it so that you can snap the back end on to any front end and still have it function. You can’t predict what any given office or setting is going to have for a back end so this was critical.  

That’s when the whole Internet opened up a world of possibilities for us. It offers that option. Everyone’s got access.  It provided a way of offering the technology without barriers to implementation.

MTT: What are your thoughts or plans on how you’re going to get people to adopt the technology?

LC: There is, and has been for some time, a growing trend in the government to produce a mandate on EMRs.

In the past, everyone said doctors won’t use it --  that we’re techno-phobes. To me, that’s a lot like going fishing, not catching fish, and blaming the fish. It doesn’t make sense. One of the problems with adopting technology is that the vendors didn’t have a checklist for implementation. We created one. We essentially ran five to six scenarios and found that software was all over the place. It didn’t work for everyone, and it stumbled when too many variables were put into it.

When that happened, the doctors saw no return-on-investment (ROI) in it. The cost factor was really secondary. The real issue was that it wasn’t solving the problem.

We’ve built a system based on the Internet, which of course offers the ultimate in scalability. And scalability means low cost – that’s why we can offer equivalent or better functionality and services to our doctors for far less than our competitors. And because it’s an Internet technology, it derives its power by connecting people.

That ties in well to what we believe is the key to all problems in healthcare. It’s really quite simple: whatever you do it must empower the doctor-patient relationship. If it doesn’t, don’t bother doing it.

Because if you succeed in creating a stronger bond that connects them in a professional and caring way, you can reduce the cost of healthcare dramatically and globally – nearly 30 to 40 percent -- and, you increase the quality of the care provided.

MTT: What potential applications do you see for people traveling abroad for medical care?

LC: I think the potential is enormous. For one, it provides a coherent record across continents. You don’t have one sitting in India and one in the United States. It’s all one and the same.

For example, you can scan or fax all of your medical records into our system today, travel to Belgium tomorrow, and provide a doctor in Belgium with access to all of your medical records in less than five minutes. And the doctor in Belgium doesn’t need to pay a penny -- he can sign up for a free account. And if you have any problems doing this, call our staff and we will help you online.  People should not travel without this “information insurance” in place.

Plus, Doctations facilitates communication between doctors or providers. If you go for a procedure and something goes wrong, suddenly that doctor needs more information on you than you may have brought in the hard files. With Doctations, they’ve got your whole history.   All of your electrocardiograms and other records are directly imported into the Doctations patient vault from other systems. You don’t have to hunt for information, and it takes literally no effort to get it.

MTT: Do you currently have any international partners?

LC: We’re currently working with a group in Brazil. We also have several collaborators in India with whom we’re in the early stages of discussion.

MTT: What, if any, obstacles do you see with the implementation for medical travel?

LC: As with anything new, it’s all about education and awareness. We need to make patients more aware that they can have the information, at no cost, available to themselves and to their doctors, both here and abroad. It’s certainly a lot easier than carrying boxes of medical records.

You also have the obstacle of a lack of cooperation between vendors in allowing integration. We’re designed to be interoperable – our software is the most interoperable way to do things because it is built from the ground-up to be true Internet software—what the industry calls an RIA–Rich Internet Application.

Microsoft’s focus has been on interoperability – that’s why we chose them as a development platform. Almost all the code has been written in Microsoft.net technology, which means we’re built to connect everyone quickly and securely -- and we do.

About Lou Cornacchia
Louis Cornacchia, M.D., is president and CEO of Doctations Inc. Dr. Cornacchia is a graduate of Columbia College (‘82) and New York University’s School of Medicine (‘87). He is a board-certified neurosurgeon with a practice in Nassau County, New York. The concepts underlying Doctations were developed by Dr. Cornacchia over a nine-year period of research and development. He is dedicated to improving healthcare by providing Doctations services for doctors and a portal called iMedicalHome for patients. He believes that technology can overcome many of the problems facing healthcare today, including soaring costs, physician discontent, and the medical malpractice crisis. Doctations is the first step toward that solution.

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PERSPECTIVES

Editor’s Note: This is the fourth and final part of a series of the economic influences affecting medical travel by Robin Elsham. Earlier stories can be accessed through the following links.

U.S. Debt Crisis Could Trigger Dollar's Collapse, Rapidly Altering Economics of Global Medtourism Industry   
 
By Robin Elsham  
  
As tumultuous as the past few weeks have been in global financial markets, worse yet may lie ahead.  In fact, the $700 billion U.S. financial system stabilization super-fund sought by Washington makes that more likely on one front. 
  
This possibility is of vital importance to the medical travel industry.  Should this train of events unfold, the impact on the medical tourism industry would be immediate and profound.  Longer term, the effect would be to alter the industry’s very economic fundamentals.  
  
Afterward, there may no longer be any financial incentive to travel in search of cheaper medical care.  Price-competitive destinations today might find themselves suddenly too expensive to compete.  Estimates of the number and profile of medical travelers by home country would need to be radically recalculated. The basic geography of the industry might need to be redrawn, as patient provider nations are transformed into price-appealing treatment destinations themselves. 
  
Far-fetched?  Inconceivable? 
  
So was the notion of $150-a-barrel oil a year ago.  Or that the problems in the U.S. subprime mortgage industry would engulf the whole housing market, much less imperil the U.S. financial system itself.  
  
Before this year, most talk and theorizing about the future of the global medical tourism industry involved extrapolating from existing trends. Attention focused exclusively on price arbitrage: showing the differences in surgery costs between Country A and countries B, C, and D, and projecting how many patients from A might be convinced to travel to B, C, or D for hospital or dental care once concerns about quality and safety were dispelled. 
  
That approach seems hopelessly naive now.   
  
The global financial turmoil of the past nine months shows that forecasting developments in the medical travel industry demand an understanding of forces shaping the international business environment. In absolute terms, factors like clinical outcome data, infection rates, and having a well-run international patient department are no less important today than a year ago.   But in relative terms, those factors have been superseded in order of importance by considerations of any destination’s long-term price competitiveness.  It makes no sense for anyone to invest time, effort, and money on entering this industry – as a service provider, care arranger, or care user -- unless that investment is rewarded over time. 
  
On that count, no factor has more potential to create havoc and wreck careful planning than a collapse of the U.S. dollar. Though that threat isn’t new, the chances of it occurring have increased greatly in the wake of the recent convulsions on Wall Street and the U.S. government’s response. 
  
For more than eight months, Washington sought to stem the rot by providing about $600 billion in guarantees and bailouts through a series of actions (i.e. $152 billion in taxpayer refunds to stimulate the economy; $29 billion to guarantee the bad debts of Bear Stearns; $300 billion provided to prevent foreclosures involving up to a half million homeowners, etc.) 
  
Yet rather than restoring market confidence, each action only deepened anxiety about the breadth and severity of the toxic-debt problem.  Increasingly, large financial U.S. financial institutions began to fail (Fannie Mae and Fannie Mac, AIG), requiring even more gargantuan bailouts -- with no end of the crisis in sight.       
  
The effect of the bailouts announced so far will be to vastly inflate U.S. international borrowing. Given the negative U.S. savings rate, all the money needed to finance these bailouts must be borrowed, pushing U.S. public debt to a staggering $11.3 trillion under even best-case scenarios.  (For example, Washington estimates the bill for the latest rescue package at $700 billion, yet acknowledges that's only a crude guesstimate. The true scale of the bad-debt securities to be purchased isn't known, and estimating what they'll fetch when sold over time is impossible.  Historical precedent, however, gives cause for great concern. The cost of the federally-run Resolution Trust Corp. clean-up of the savings-and-loan mess of the 1980s was initially estimated at $50 billion. The bill ultimately came to $160 billion.)      
  
What is clear is the danger posed to the dollar. This massive additional borrowing, coming on top of an already staggering run-up in debt over recent years by a country with a now dangerously shaky financial system, could trigger a collapse of the dollar. This could happen if foreign investors trigger a new dimension to the U.S. debt crisis by finally balking at funding U.S. borrowing. The fear is a few foreign central banks holding huge amounts of Treasury bills will begin selling them to stem losses if they begin dropping in value. Should that happen, what begins as even a trickle of selling could rapidly swell to a flood. That would cause the dollar to plummet in value -- and probably the collapse of the dollar-centric global financial system.  
  
The dollar would lose its role as the global reserve currency and would probably be replaced by a basket of other major currencies.  Many globally traded commodities like oil would also no longer be priced primarily in dollars, causing their cost in dollars to soar. 
  
For any global market like the medical tourism industry, the short-term effects of such a major change in a pillar of the international trading system would be wholesale confusion and disruption.  With time, patient flows may resume, but with altered traffic patterns, showing the effects of how big changes in exchange rates of key currencies have changed global commerce.      
  
The dollar’s collapse would certainly diminish the financial appeal for Americans of traveling abroad for medical care.  In quick order, the outflow of patients from the primary source of customers for many medical tourism operations would contract sharply.    
  
No other economic factor has more potential to quickly and greatly alter the fortunes and future of the global medical tourism industry. 
  
Robin Elsham is the managing director of Patients With Passports Corp., an international healthcare arranger based in St. Paul, Minnesota. He can be contacted at robin.elsham@patientswithpassports.com

• Changes in air travel certain to cause major changes in medical tourism industry
• Inflation's Threat to Medical Tourism
• Adopting a Global Perspective

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How Would Obama and McCain's Healthcare Proposals Impact Medical Travel?
 
By Amanda Hayes-Kibreab and Natasha Bellroth, Global MD
 
Today, more than 48 million Americans are uninsured, and millions more learn they are underinsured when they become sick.  America spends more than $2.3 trillion, or 16% of GDP, annually on healthcare costs.  By the year 2016, U.S. Department of Health and Human Services forecasts that health spending will be $4.3 trillion or 20% of GDP.

Though America spends more than any other country on healthcare, it is ranked 37th in overall quality among the world's healthcare systems by the World Health Organization.  According to the Organization for Economic Cooperation and Development, healthcare spending accounted for 10.9% of the GDP in Switzerland, 9.7% in Canada and 9.5% in France, all countries ranked higher than the U.S.

A recent Wall Street Journal-NBC Survey reported that the cost of healthcare is Americans' number one economic concern.  Growing numbers of underserved patients are turning to healthcare delivery alternatives such as traveling to foreign hospitals for necessary treatment.  While the medical travel phenomenon started with cosmetic surgery, successes have emboldened patients who need joint replacements, cardiac surgery, spinal fusions and bariatric surgery to reach beyond America's borders for alternatives.  At the same time, health insurers and employers are noticing the opportunities for cost savings by outsourcing and the ability to reach new markets with tailored healthcare products.   

Republicans and Democrats agree that current trends in healthcare are not sustainable.  Not surprisingly, both presidential candidates, Senators Barack Obama and John McCain, have proposed equally radical remedies for America's broken healthcare system.  Though neither candidate addresses medical travel specifically, their healthcare plans suggest the likely impact on the medical travel market.

McCain's Healthcare Plan

Sen. McCain would ask Americans to take on greater personal responsibility for their healthcare choices and rely on market forces to meet today's healthcare challenges.  According to Sen. McCain, increased competition and less government involvement will improve the quality of health insurance with greater diversity among plans, lower prices and portability. 

Specifically, Sen. McCain would seek to make insurance more available by increasing variety and affordability of private plans.  The Senator's revolutionary idea is to eliminate the tax break that workers receive from employer-sponsored health plans, treating the benefit as taxable income, offset by a new tax credit of $2,500 for individuals and $5,000 for families.  If the tax credit is more than the amount a person spends on healthcare premiums, the excess can be placed in a health savings account.

Sen. McCain believes that people who are covered by employer health benefits consume more healthcare services than is necessary.  Presumably at least some of those excess services that can be redirected to the uninsured population.  Putting patients in control their health spending will encourage competition among providers and insurers, reduce costs and improve the quality and portability of coverage.

Sen. McCain has proposed several policy initiatives to lower healthcare costs.  These include: (1) greater competition in the pharmaceutical market; (2) improved systems for chronic disease prevention and management; (3) coordinated care among providers to render better outcomes at lower cost; (4) improved access through walk-in clinics in retail outlets; (5) use of information technology; (6) reforming the Medicaid and Medicare payment systems to pay for diagnosis and prevention but not treatment made necessary by preventable medical errors or mismanagement; (7) anti-smoking programs; (8) state spending flexibility; (9) tort reform to reduce frivolous lawsuits; and (10) improved transparency with better public information on treatment options, doctor records, outcomes, quality of care, costs and prices.

The Impact of Sen. McCain's Plan on Medical Travel

The impact of Sen. McCain's healthcare plan is to de-emphasize the employer-based health insurance system that currently covers 158 million Americans.  Sen. McCain's plan will likely encourage Americans to avoid taxation of health benefits and use their new tax credit to purchase health insurance on the open market.  Young healthy people would likely be the first to switch from their employer plans and find cheaper alternatives in the open market.  Conversely, sicker older workers may initially choose to stay with the security of their employer-based plans.  As the risk pool of employer-based plans becomes older, sicker and more expensive to insure, more employers will stop providing health benefits.  Eventually, all workers will likely move to individual health plans.

Due to its focus on competition and free market solutions, Sen. McCain's plan may encourage the medical travel market.  Thus far, medical travel has been a completely consumer-driven phenomenon.  By placing patients in control of their healthcare spending, and eliminating the tax incentive for workers to rely on their employers for coverage, patients will be encouraged to pursue treatment alternatives that maximize their healthcare dollars.

Let's use the average American family as an example.  The average employer-sponsored family health plan currently costs about $12,000 in annual premiums.  On average, employers contribute $9,000 and workers contribute $3,000 to pay the premiums.  Under McCain's plan, workers will be taxed on the employer's $9,000 contribution as income (as if the employer paid the $9,000 to the employee as wages), thereby eliminating the tax incentive for an employer-sponsored plan.  Instead, the family gets a $5,000 annual tax credit.

A typical high-deductible, low-premium family plan on the open market costs about $10,000 annually ($2,000 less than the average employer-sponsored plan).  Workers may use the $9,000 that their employer would have used to purchase coverage, (about $6,000 after taxes) and the $5,000 tax credit ($11,000 total) to pay for health coverage.  Money left over after buying health insurance can be put in a Health Savings Account.

Insurers are finding that high-deductible, low-premium plans incorporating foreign providers can be offered to previously uninsured markets.  These cheaper plans attract cost-conscious patients or patients with cultural ties to featured providers in Latin America and Asia.
 
Informed healthcare consumers will demand choice, transparency, high quality and reasonable prices from their providers and insurers.  Consumers who receive more complete information and better prices from foreign providers may be persuaded to go abroad for treatment.  McCain's plan encourages consumer-driven market responses.

Obama's Healthcare Plan 
 
The central tenant of Sen. Obama's healthcare plan is that everyone should have quality, affordable and portable coverage.  His plan reflects the philosophy that government should guarantee affordable healthcare to all Americans.  While Sen. Obama would mandate that every child be covered, he would seek to cover adults through a combination of employer and government programs.

Sen. Obama's healthcare plan encompasses two revolutionary initiatives.  First, Sen. Obama would require all employers to “pay or play.”  All employers, except small businesses, must either provide quality health plans to employees or contribute (a new tax) to the cost of a public plan available to all Americans.  The public plan would be similar to Medicare and provide coverage similar to that given to federal employees.  
 
Sen. Obama's second revolutionary idea is to create a National Health Insurance Exchange (“NHIE”) where insurers would sell coverage to small businesses and individuals.  To participate, insurers would have to disclose costs and benefits of various plans and the percentage of premiums that go to patient care as opposed to administrative costs.  The goal is to create a transparent market for health insurance that will improve quality, efficiency and value.

Notably, small businesses are exempt from Sen. Obama's “pay or play” plan.  Instead, small businesses receive a refundable tax credit of up to 50% on paid employee benefit premiums.  The Small Business Health Tax Credit is meant to incentivize small businesses to offer quality health plans without hampering their ability to compete in the global marketplace.

Sen. Obama also proposes that hospitals and providers be required to publicly report data on preventable medical errors, nurse staffing ratios, hospital acquired infections and disparities in care.  Transparency is required of both insurers and providers and is meant to help patients make better choices.  Finally, Sen. Obama's healthcare plan would allow Americans to purchase medicine from other developed countries offering safe products at lower prices.

The Impact of Sen. Obama's Plan on Medical Travel
The immediate impact of Sen. Obama's plan would be to bring millions of uninsured Americans into government sponsored managed care. Sen. Obama's plan may also encourage employers to avoid the financial risks of raising healthcare costs and opt to pay into the public plan instead.  Workers may get better benefits under the government's plan than their employers can afford.  If healthcare costs continue to climb unchecked, under Sen. Obama's plan, employer plans may disappear.

Under Sen. Obama's plan health insurers will need to look for ways to reduce the cost of covering the previously uninsured.   Medical travel offers quality treatment at a fraction of the cost of similar care in the U.S without sacrificing quality.  Some may argue that sending a patient abroad for care is itself a reduction in quality.  However, foreign providers can demonstrate international accreditation and credentials that rebut such criticism. 

Sen. Obama's 50% tax credit for small businesses may encourage medical travel.  Often small businesses operate in local, often demographically homogenous, communities.  People with cultural ties to provider destinations may be more likely to travel for care.  Small business and insurers can team up to offer customized plans that enhance care while reducing the cost.

In his calls for transparency, Sen. Obama's plan echoes the philosophy of medical travel.  Patients who travel for care demand information about surgeon success rates, infection rates, and nurse to patient ratios.  The information empowers patients to make informed decisions. American providers often resist collecting this information to avoid it being used against them in a malpractice lawsuit.  Sen. Obama's transparency initiative encourages consumer-driven demands for more and better information.

Notably, Sen. Obama calls for all health plans to resemble the coverage offered to federal employees.  The directive may limit the flexibility insurers need to introduce innovative cost cutting solutions like medical travel.  If the government decided that traveling abroad for treatment reduced quality, insurers would have to eliminate medical travel from plans.  Further, Sen. Obama has spoken out repeatedly against outsourcing.  Medical Travel is the newest form of outsourcing.  Given the reluctance of American doctors to embrace this trend in healthcare, it is unlikely that Sen. Obama would openly support medical travel.

Medical Travel and the Future

Side by side, Sen. McCain's healthcare plan seems to be better for the medical travel industry than Sen. Obama's.  Sen. McCain's focus on patient control of their healthcare spending and encouraging competition among providers and insurers is in line with the consumer-driven phenomenon of medical travel.  Sen. Obama's focus on universal coverage on par with that of federal employees suggests that it will be up to a government agency to determine whether medical travel meets baseline quality standards.  With Sen. Obama's plan, the future could hinge upon the outcome of that debate.

About the Authors
Medical travel experts Amanda Hayes-Kibreab and Natasha Bellroth help Americans access premium medical care from some of the world's elite surgeons at value-based prices.  Visit Global MD's website today at www.yourglobalmd.com and discover how Global MD can help you reduce healthcare costs and improve quality of care.  Call today at 800-903-5690 to speak with an expert Care Coordinator about how we can help you and receive Global MD's Free Guide to Medical Travel.

Copyright Notice © Copyright Global MD, Inc. August 2008

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INDUSTRY NEWS

Doctations Partners with PSC Info Group For Secure, Time-Sensitive Medical Billing Document and Information Processing

Doctations, Inc., developer of the DoctPatientNetwork.com, a unique Internet-enabled healthcare system providing doctors and patients with the comprehensive services required to run a medical practice and manage personal medical information, respectively, and the PSC Info Group, a worldwide leader in data management, printing and mailing technology, and online solutions, announced today they have entered a technology partnership.

The Doctations end-to-end solution provides physicians with the opportunity to: reduce overhead dramatically; increase clinical productivity even more dramatically; and improve the quality of care they deliver by integrating “best-of-breed” Internet services, which are provided at reduced cost to providers. Combining Doctations online medical system with PSC Info’s DATAExpress Healthcare service enables medical offices to provide on-demand electronic statement capabilities through a secure method to automate processing, printing and mailing patient statements, letters, and other time-sensitive patient communications. Practice managers can now rely on the PSC services to further reduce overhead, logistical and staff management time, and focus more of their energies on improving quality of care delivered by their medical organizations.

Doctations and PSC Info Group have entered a partnership that supplies Doctations’ customers with an on-demand way to reliably outsource billing and patient mailings. By creating an automated way to deliver document and billing services on demand, Doctations’ customers have a heretofore unequaled power to increase office productivity and efficiency, while significantly reducing the cost of services.  Doctations’ technology is collaboratively used by healthcare providers, patients, doctors, medical transcriptionists, and medical billers, providing a secure platform for Health Insurance Portability and Accountability Act (HIPAA) compliant communication and information exchange between patients, doctors, and healthcare providers. This partnership enables Doctations to bring PSC’s industry leading document and information management products, including its DATAExpress statement and letter outsourcing solutions and custom-designed products and services to doctor’s offices using Doctations across the country.

PSC Info Group provides leading edge document and information management services and business communications. PSC’s flagship product, DATAExpress, is a secure, state-of-the-art system for automating the production and delivery of statements, collection letters, invoices, and other time-sensitive patient communications.

DoctPatientNetwork.com includes a patient portal that provides secure collaboration between patients and their physicians. Doctations’ products include fully integrated services on DocPatient.com that securely connect healthcare providers, patients, doctors, medical transcriptionists, and medical billers using a secure platform for HIPAA-compliant communication and information exchange. The technology fits into existing electronic medical practice systems, requires no software purchase by the doctor or the patient, and uses world-class data security and password-protected gateways. DocPatientNetwork.com works with popular Internet browsers including Microsoft’s Internet Explorer, Safari, and Firefox, running on Microsoft Windows, Linux, or Apple systems.

About Doctations
Doctations™ Inc., is a company dedicated to creating innovative new, Internet-based means of transacting healthcare. The goal is to make healthcare more accessible to patients, and to substantially improve the process of generating medical documentation in all venues of healthcare: the physician’s private office, the physician group’s office, the ambulatory surgery center, and hospitals. For more information, please visit: www.doctations.com.

About PCS Info Group
Headquartered in Valley Forge, Pa., with additional processing facilities in Reno, Nev., PSC Info Group (www.pscinfogroup.com) is a worldwide leader in data management, printing and mailing technology, and online solutions that facilitate billing, collection letter, and other time-sensitive communications. For more information visit: http://www.pscinfogroup.com/flash_index/index2.htm

Medical Tourism Biz Opens in Toronto 
The IndUS Business Journal recently highlighted the opening of Starhospitals.net office in Toronto. Click here to read the complete story.

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DESTINATION

Robin Elsham is busy preparing for a trip to East Asia. We look forward to his upcoming first-hand reports from Korea and Taiwan. In the meantime, you may access previous stories at the following links.

• Guatemala
• New Zealand
• Monterrey
• Panama
• Philippines
• Malaysia

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MEDICAL SPOTLIGHT: Plastic Surgery

Cosmetic surgery was one of the original drivers of the medical travel market and continues to contribute significantly to the industry.
 
In the past few years, numerous companies have emerged worldwide offering all-inclusive vacation-and-surgery packages including travel, lodging, sightseeing, surgery, and professional fees.
 
Billed as “surgery safaris” and “surgical vacations,” these packages are helping to boost cosmetic travel to popular destinations including Argentina, Brazil, Costa Rica, Dominican Republic, Malaysia, Mexico, Philippines, Poland, South Africa, and Thailand. 
While no data exists on the exact number of people traveling abroad for cosmetic surgery, it is widely understood that the number is growing.  Procedures including liposuction, tummy tucks, breast augmentation, facelift, eyelid surgery, and nose reshaping are among the most popular.
 
Women appear to be the largest segment of the market, ranging in age from 35 to 50.
As elective cosmetic surgery is not covered by insurance, price continues to be a major factor in determining where a patient goes for a procedure. In some instances, the cost of an all-inclusive travel package is less than the cost of the procedure alone in the United States.

Country	Face lift	Liposuction	Tummy tuck
Mexico	4,900	3,900	4,700
Costa Rica	5,000	2,600	4,200
Thailand	3,600	2,600	4,400
NOTE: The above are typical cost of procedures. All prices are in USD and may vary depending on a patient's specific conditions, hospital chosen, and currency fluctuation. Courtesy of HealthBase

However, cosmetic surgery vacations are not without its detractors. The American Society for Aesthetic Plastic Surgery (ASAPS), the nation's leading organization of board-certified plastic surgeons specializing in cosmetic surgery, cautions consumers. The Society offer guidelines at its website (http://www.surgery.org/press/news-release.php?iid=457&section=news-safety) and urges consumers to contact The International Society for Aesthetic Plastic Surgery (www.isaps.org), which has also published guidelines at its website (http://www.isaps.org/mtourism.php?subsection=key), to find a qualified professional abroad.
 
According to the ASAPS, “Cosmetic surgery abroad can be a safe experience with excellent outcomes. However we strongly recommend that you do your homework in advance and be fully comfortable with the answers to the above questions before making any commitment of either time or money.”

In an effort to collect meaningful data on the industry, ISAPS has begun an aggressive survey campaign to reach the estimated 25,000 plastic surgeons around the world via ISAPS News. It is expected that the third and most recent survey will draw a response rate of more than 10 percent, making the findings statistically significant. The ISAPS plans to release the survey results in the organization’s November newsletter.

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WHAT YOU’RE READING: Foreign Body

#1 Best-selling New York Times Author Tackles Medical Tourism
Description from the publisher’s website (penguingroup.com):
Due in large part to rising costs of elective or specialized surgeries and complexities of insurance programs, many Americans are looking to foreign hospitals to serve their medical needs. As this trend continues to grow, international regulation agencies are beginning to research foreign hospitals, especially in popular destinations such as India, Singapore, and Thailand, to see how they measure up to the safety standards of U.S. hospitals. But despite the surge in research and resources, there is still much about medical tourism that is unknown and Robin Cook explores these mysteries in Foreign Body.

The feisty protagonist of Foreign Body, Jennifer Hernandez, is a fourth year medical student at the University of California, Los Angeles (UCLA) when she learns from a CNN newscast that her beloved grandmother Maria has died in a New Delhi hospital after what was supposed to be a routine hip replacement surgery. Desperate for closure, Jennifer travels to India; but when hospital workers become increasingly demanding that Jennifer quickly dispose of her grandmother's body --  and more patients begin to die -- she realizes there may be more at stake than she thought.
 
Like Robin Cook's previous works, Foreign Body is rich in detail and seemingly ripped from the headlines. He masterfully blends intrigue and medical fact, and forces us to examine the issues facing modern healthcare. The result is another pulse-pounding medical thriller from the man who invented the genre.

To read the prologue of the book, click here.

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UPCOMING EVENTS

3rd International RE+D Symposium
29-30 September, 2008
Hotel Grande Bretagne
Athens, Greece

Real Estate and Development magazine, in co-operation with the British Hellenic - Chamber of Commerce, are hosting at Grande Bretagne, Athens, the third International RE+D Symposium on September 29 and 30, 2008, entitled "Investing Opportunities in Greece and the neighboring countries."  Information about the conference is available at: http://www.ered.gr/conference/conference.html

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Trigram America and The George Washington University Launch Employer
Forums: Medical Travel 2008 and Beyond
 
WASHINGTON, D.C./CHICAGO, Ill.– September 26, 2008 – Together with The George Washington University’s (GW) School of Public Health and Health Services, Trigram America, LLC (www.trigramamerica.com), provider of consulting expertise and resources on medical travel to employers, health plans, and other benefits stakeholders, will co-sponsor a series of forums: Medical Travel 2008 and Beyond. The first forum will be held Tuesday, October 14, 2008, 9:00 a.m.-12:30 p.m. in GW’s City View Room, located on the seventh floor of 1957 E Street NW, Washington, D.C.

Leonard H. Friedman, Ph.D., M.P.H., professor of GW’s Health Services Management and Leadership, and Bruce Barwick, CEO of Trigram America, will welcome attendees and introduce keynote speaker Devon Herrick, senior policy analyst at the National Center for Policy Analysis and author of Medical Tourism: Health Care Free Trade.

The knowledgeable and experienced panel of industry thought-leaders will include:

• Cyndy Nayer, president, Center for Health Value Innovation, a not-for-profit (501c3) organization representing industry stakeholders committed to sharing the evidence that value-based health designs improve health status and reduce health cost inflation
• Tom Johnsrud, principal, Trigram America and Consultant to ParkwayHealth of Singapore
• Paul Brough, CEO, Pinnacle Health, first U.S. preferred provider organization (PPO) to introduce a medical travel benefit option

As a result of attending this seminar, participants will:

• Understand the options for high quality, low cost medical care in destinations outside the United States
• Learn about international accreditation organizations and benchmarks for quality and safety
• Explore initiatives for medical travel insurance
• Discover the experience of payers that are already offering a medical travel program
• Learn about the consumer experience abroad

Media sponsors include the leading employee benefits and broker publications Employee Benefit News and Employee Benefit Adviser.

Tickets are now available: $295.00 per person, with parking available at the University. To expedite registration, please visit http://trigramamerica.com/GWU/registration.pdf for a registration form and fax it to (202) 416-0075 or call (202) 416-0063 if you need any assistance.

About Trigram America LLC
Trigram America works with its clients to educate, assess and implement the best possible solutions for medical travel. We further client understanding of medical travel and medical tourism, evaluate the benefits, and create and implement programs to generate optimal savings and employee satisfaction. Visit www.trigramamerica.com

About The George Washington University’s School of Public Health and Health Services (SPHHS):
SPHHS was established in July 1997, bringing together three longstanding university programs in the Schools of Medicine, Business, and Education.  Today, more than 900 students from nearly every state and more than 35 nations pursue undergraduate, graduate, and doctoral-level degrees in public health.