---

SPOTLIGHT
Karen Timmons

Karen Timmons, president and CEO of Joint Commission International

In our last issue we featured Part One of a conversation between our publisher, Laura Carabello, and Karen Timmons, president and CEO of Joint Commission International. JCI is part of The Joint Commission, the leading accreditation organization for US hospitals. In this issue we continue the discussion, taking a look at credentialing options, the future of medical travel, and the opportunities and challenges for American providers.

MTT:There are a number of small groups currently attempting to set up some credentialing standards specifically for medical tourism. How does what you do complement these initiatives? Do you feel organizations should even consider or pursue these new standards?

KT: I believe it’s very important and it’s good that an organization seek external validation of the quality of its services—whether that is through accreditation, certification, ISO, etc. It’s a first step and I certainly think that patients and consumers should be encouraged to seek evidence of an organization’s willingness to comply with standards. I commend this and I believe that it’s very important that patients look for these validations of care standards.

MTT:There are Web-based credentialing services emerging right now in the United States. Are you aware of anything that is going on internationally at that level?

KT: Not for credentialing. Our standards require that an organization have primary verification of the qualifications of its medical staff. Its physicians and other healthcare clinicians have to have primary evidence that they have the credentials they indicated. They also have to be reviewed as far as the record of the quality of care that they have provided to ensure that they are qualified to provide the types of services that they’ve indicated they can.

We would ask an organization providing the information as to whether the physician is qualified to provide a specific type of service, such as bypass surgery. Basically, it’s the privileging services that you are allowing as opposed to credentialing.

MTT:If you had to look into a crystal ball, what would you say is the future of medical tourism?

KT: I think the world is very small — and this shrinking, if you will, is going to increase. I think we’ll see a day, and it may very well surprise us, that people will get onto a plane and travel around the world for their specific services. It will be very much accepted, and hospitals will become procedure-driven and very expert at certain procedures. They will be specialized to provide those procedures at a high volume with high quality, and as cost effectively as possible.

MTT:What do you think the opportunities are for US-based hospitals to partner with foreign hospitals?

KT: I think hospitals around the world can share best practices. I think as the healthcare industry becomes more global, there will be standardization of healthcare practices. People will want to access care from what is known as the “best” provider. Around the world, there is evidence that providers share a common goal to improve quality and safety. The sharing of these tenets on a global level is certainly helping to promote improvement.

MTT:Do you think American community hospitals or smaller hospitals should feel threatened by this whole medical tourism phenomenon?

KT: I think they should embrace it. I think it’s an opportunity for uninsured and underinsured American patients who might not have access to care to get care. And I also think there’s an opportunity for smaller hospitals to attract patients from abroad who come to the United States for care. For example, many Europeans come to New York, Boston and the East Coast for their care because of the favorable exchange rate.

MTT:Do you think the foreign hospitals will be able to continue to deliver the care at a lower cost?

KT: I think some of the foreign hospitals will be able to do this, especially those that are really positioning themselves as a heart hospital or are known for their care for knee procedures or hip procedures, and have really focused on how to deliver high quality care in a very efficient manner. They have worked very hard to achieve that.

MTT:Do you think that there will be any movement at all for malpractice insurance or any litigation in this arena for patients who have bad outcomes in foreign hospitals?

KT: Certainly, every country has different legal redress and there has been discussion at various conferences on whether or not there will be some sort of universal redress or common legal redress. I would assume third party payers and insurers will eventually offer some sort of protection even in the United States.

If a health insurance plan is sending a patient abroad, they will have to cover some of that. It would be different for an individual person who is deciding to travel on his or her own as to what type of legal redress they might have.

MTT:What should employers and health plans in the United States look for in a foreign care provider? Is the JCI seal of approval their go ahead to use that hospital? Should they be visiting them personally?

KT: I certainly think they can seek JCI accreditation, but they should be looking for some evidence of compliance with quality standards or indicators. And the patient should also be looking for evidence of quality.

MTT: Where would a consumer find this information?

KT: Consumers need to do searches on the Web and also speak to their primary care physician. Many doctors have colleagues living and practicing abroad. I think it is very important that there be continuity of care, so they should be seeking someone who might be able to provide not only the pre-care, but also post-care, and ensure that the portability of the medical record is there.

MTT:If you had to point to one or two countries as model destinations, where would you direct attention?

KT: I certainly think that there are several countries. India, as well as Thailand, Malaysia, and Singapore have certainly positioned themselves very intentionally as sites for medical tourism.

MTT:What about places like Mexico and Guatemala that are a little closer to home? How do they stack up?

KT: Certainly, each of these countries has a certain area that positions them as a strong choice. But again, I think it’s important for the consumer to look into what the organization is doing to demonstrate its commitment to quality and safety.

MTT:If you had to give a word of advice to Americans, whether it’s a health plan, an employer, or the consumer-patient himself or herself, what would it be?

KT: Research, research, research. Communicate with your primary care physician and understand what you are getting into.

PERSPECTIVES

MedicKey Launches Mobile Electronic PHR (Personal Health Record) Making Travel Safer

Portable Information Management Systems announced this month their plans to adapt their personal Electronic Health Record Key called “MedicKey” for personal and commercial use. This makes the portable key-chain-sized product the first of its kind to tackle the gap between hospitals or home physicians and the patient’s over-all care wherever they may need it worldwide.

According to Michael Bick, PhD, co- founder of MedicKey (medickey.com) and several other successful medical device companies, theMedicKey launch comes just as the nation’s need for Personal Health Records that can transcend limited facility-specific technology becomes increasingly unavoidable. “Each hospital has its own technology for record keeping and record organizing. Hospitals simply cannot conveniently relay patient’s records from facility to facility, and the result is duplicate testing, medical errors, and medication nightmares. If you are brought into a hospital, MedicKey can provide the staff with all your emergency contact information, your medications and/or allergies and cut down dramatically any testing that will delay your care. Going further, MedicKey allows each hospital, regardless of system technology, to upload new records easily to a patient’s MedicKey so that their MedicKey can be updated immediately. Once at home, the individual or home physician can quickly and easily view, add or edit medication details and notes regarding the care and procedures received.MedicKey becomes a lifetime tool for the individual to keep and communicate medical information as well as save themselves time and money in an emergency .”

“ The dysfunction in today’s care facilities keeping paper or proprietary records has never been more apparent than in the wake of Hurricane Katrina,” says Alexander Kowblansky MD FACEP, co-founder of MedicKey and Medical Director of the Emergency Department at Community Memorial Hospital (CMH) in Ventura, CA , “Providing patients with their own set of records is a must. Any individual on the road for business or pleasure should have their records with them in an updatable and universal format, and until now, this has not been possible. ”

MedicKey Personal Health Records® is a customized USB device, empowering the consumer to always have critical medical information with them, helping to guide healthcare providers in rendering the most prompt and appropriate care in any setting. MedicKey auto-launches on nearly any Windows®-based computer worldwide, requiring no special programs or internet access.

 

Global Medical Travels Announces
Affordable Health Care with HOSPITALMEmbership

CALGARY, April 03, 2008 -- Global Medical Travels (GMT), a medical travel consultancy, announces the launch of HOSPITALMEmbership, a yearly membership package that includes coverage of comprehensive medical services at a Western European Joint Commission International (JCI) accredited hospital. In addition to other services, HOSPITALMEmbership provides free coverage of medical expenses and in-patient accommodation.

As Medical Tourism expands throughout the globe, most people travel to Asia for medical services. Most of these packages offer just one option that covers only one procedure. Michael C. Douglas, partner of GMT, wanted to provide international travelers with trustworthy medical attention and more than just one option. HOSPITALMEmbership provides travelers with a choice between a Standard Membership and the Premium Level Membership at a JCI accredited institution. The Standard Membership covers one treatment abroad for those who don’t require more than one procedure. The Premium Level Membership covers multiple treatments, a comprehensive yearly health check-up worth $1,900 and insurance for an internal prosthesis, which usually costs around $15,000.

For those with a United States, Canadian or United Kingdom passport, there is no visa requirement for a short transatlantic flight to Western Europe, which makes gaining year-round access to an accredited hospital with Western medical standards an easier option than Asia.

"Our objective is to address the needs of over 130,000 citizens of the United States, over 18,000 Canadians, and thousands of patients from the United Kingdom who seek medical treatment abroad at affordable rates every year,” says Mr. Douglas. “Our motto is ‘No Patient Left Behind’ and we believe HOSPITALMEmbership will make it easier for patients to receive the professional care they need at reasonable prices."

Collaborating with the Cleveland Heart Foundation in the United States, HOSPITALMEmbership’s hospital welcomes over 135,000 patients a year, 50,000 of which travel from abroad. It employs over 1,700 personnel including 360 doctors, 700 nursing staff, and is ranked as the number one medical facility in Research and Development in Europe.

More information can be found at www.GlobalMedTravels.com or by contacting contact@globalmedtravels.com .

 

Palau president asks Luli Arroyo to help push tourism

By Lira Dalangin-Fernandez
INQUIRER.net

MANILA , Philippines -- In the country to promote his country's tourism potential, especially its famous diving spots, Palau President Tommy Remengasau had one person in mind to help him -- presidential daughter Evangeline Lourdes "Luli" Arroyo.

Speaking at the state luncheon hosted by President Gloria Macapagal-Arroyo in Malacañang Wednesday, Remengasau asked her if her only daughter could be a "tourism promoter" for Palau in the Philippines.

A diving enthusiast, Luli has been to various dive spots in the country and abroad, including Palau.

In her speech at the event, Arroyo acknowledged the island nation as being "one of the most attractive spots in the world for diving tourism."

Arroyo called for greater cooperation between the Philippines and Palau in the areas of tourism, air services, communications, health, and education.

"On our part, we also receive tourists from Palau, especially [for] medical tourism. [The] President, His Excellency, knows that my daughter Luli has been diving in Palau. But his sister and many other officials and prominent citizens of Palau have also been availing of the medical services here as medical tourists. So, we have a wonderful interaction of people between our two countries," Arroyo said.

Arroyo said it was important for countries like the Philippines and Palau to work together "because there are global forces in the world today that threaten the resiliency of our respective economies."

She said both countries are importing rice and oil, the prices of which have reached historic spikes lately.

"So we also have to work together to exchange ideas on how we can help the vast majority of the poor in our population cope with the more crippling spike in the price of rice," she added.

---

DESTINATION

Panama
By Robin Elsham  

Medical tourism may be a new industry, but it's got a long tradition in Panama. For nearly a century, the country's hospitals and doctors have been treating ill passengers from cruise ships and sailors from cargo vessels transitting the Panama canal.

Lying at one of the busiest trade crossroads of the world, Panama has 94 years of experience in providing global healthcare. It's been caring for sick travelers from throughout the world since the canal opened in 1914.

Panama has particularly strong appeal for English-speaking medical value travelers, especially from the United States. The reasons are again historical, and burnish Panama's attraction with a make-up that rival destinations will struggle to match or counter.

From its founding in 1903 in a coup engineered by the United States, until the end of the 20th century when Panama finally gained sovereignty over the canal, the development of Panama was influenced strongly by U.S. control of the country's greatest asset. The most profound and long-lasting influences stem from the long presence of tens of thousands of U.S. canal workers and military personnel.

In return for providing military backing in1903 for Panama's separation from Colombia and independence, the United States received control forever ("into perpetuity") of the canal zone, and rights to maintain military bases in Panama to defend it. The U.S. bases were closed in 1999, when Panama gained sovereignty over the canal under a 1977 agreement negotiated by Panamanian leader Omar Torrijos and then U.S. President Jimmy Carter.

The presence for so long of so many Americans in Panama had a huge impact on the development of the medical industry there. The legacies are key to understanding the special competitive appeal of Panama as a medical tourism destination.

The greatest legacy: no other healthcare hub has hospitals so thoroughly steeped in U.S. ways. Panama's private hospitals are extensively staffed and run by people who trained in U.S.-run institutions. Many received their initial training at Gorgas Hospital, a U.S.-government run hospital established over a century ago to care for canal company employees. Others have worked for decades for private hospitals in Panama accredited by the U.S. government to care for U.S. military base workers and canal company retirees. Maintaining those contracts required adhering to U.S.-set standards and procedures.

That experience will make Panama's private hospitals very attractive when private U.S. health insurance providers begin introducing globalcare plans, and searching the world for hospitals to provide care. In Panama, they'll find hospitals that offer plug-and-play service. While hospitals in other foreign countries might need to invest a lot of time and money implementing changes necessary to secure U.S. corporate contracts, Panama's private hospitals won't. They'd essentially only need to obtain JCI accreditation, which so far none have, but could without implementing lots of changes.

Panama 's best private hospitals are also filled with physicians who have trained at some point at hospitals in the United States. Many of these surgeons are U.S.-accredited, another big plus to U.S. institutional healthcare buyers. And these surgeons not only speak English fluently, but do so with an American intonation and manner, helpful in establishing an easy rapport with patients from the U.S. and Canada.

Panama 's location also makes it appealing. It takes just two-and-a-half hours to fly there from Miami -- not significantly longer than the time needed to fly to rival treatment destinations in Mexico or Costa Rica, and much less time than to fly to competing destinations in South America, Asia or Eastern Europe.

Panama has three hospitals of special interest to medical travelers.

Hospital Punta Pacifica is a 52-room facility built specifically to provide medical care to foreign patients. It's Panama's newest private hospital, having opened just two years ago, and the most under-utilized. As of March, it was operating at just one-third of capacity, a point of significance to foreign insurers. If insurers invest time and money vetting a foreign hospital to become an approved service provider, they won't want the set-up to sour because of flack from plan members, complaining about being repeatedly denied admission due to insufficient room.

HPP is likely to become busier if it succeeds in acquiring JCI accreditation. From its inception, HPP set its sites on becoming the first hospital in Panama to be JCI accredited, and has worked closely with Johns Hopkins Medicine International to achieve it. Hospitals cannot apply for JCI accreditation until they've been operating at least two years.

Johns Hopkins International (JHI) was an adviser to HPP from the blueprint stage, according to Guiliana Castro, the hospital's chief for international affairs. JHI now provides guidance in hospital procedures, practices and quality control; in preparing HPP to undergo the JCI accreditation process. A 10-person JHI advisory team visits Hospital Punta Pacifica every three months, to assess progress in 10 areas: quality assurance, infection control, environment of care, performance improvement, medical safety, credentialing, nursing, leadership and HR. The JHI advisory team tracks HPP's progress across more than 1,000 performance standards, according to Tita Barons, the HPP manager in charge of overseeing the entire accreditation process.

HPP was founded by a group of 20 doctors and four outside investors, including Dr. Camilo Alleyne, a former Panamanian minister of health. The founders initially planned to spend $18-20 million on building Hospital Punta Pacifica. The actual bill came to twice that amount, according to Dr. Salomon Dayan, one of the physician/investors.

Over 300 doctors and specialists are involved in treating patients at HPP, which has state-of-the-art equipment throughout the hospital.

The hospital is located in the upscale San Francisco district of Panama City, and just across the street from huge MultiPlaza mall. That sprawling development includes a Marriott Courtyard Hotel, where visitors to HPP can stay for $80 a night. It also houses an 8-screen Cineplex Theater, as well as branches of U.S. food chains Tony Roma's, Dairy Queen and Cinnabon.

Centro Medico Paitilla is another private hospital of great interest. Opened in 1975, CMP was one of two private hospitals in Panama approved to care for U.S. military personnel. The hospital lost a major source of patients when the bases closed in 1999, prompting interest now in attracting medical value travelers as patients. The hospital is currently operating at about two-thirds of capacity, according to Agnes Franqueza, the hospital's director of finance.

CMP remains one of two private hospitals in Panama chosen by the U.S. government to provide care to canal company retirees. The U.S. government pays for that hospital care.

Another factor showing the regard held for Centro Medico Paitilla: CMP is always on call whenever the U.S. president visits Panama. There are plaques in the hospital's entry lobby from the U.S. State Department, thanking CMP for its readiness to treat George Bush Sr. when he visited Panama in 1992, and Dubya when he was there in 2005.

CMP also has a long relationship with Hospital Corporation of America. HCA helped guide the start-up of Centro Medico Paitilla, and the current director of the hospital formerly worked for HCA., according to Ms. Franqueza.

Three hundred independent doctors have patient admitting rights to CMP, which takes special pride in the loyalty of its staff. Many nurses, technicians and other hospital staff have worked at CMP for decades, and the hospital has a very low staff turnover rate, Ms. Franqueza said.

Many Panamanians will tell you the country's finest private medical facility is Hospital Clinica San Fernando. It's certainly the most popular: the busiest and most crowded. Dr. Teodoro Mendez, the head of its international department, said the hospital operated at a daily average of 90 percent of capacity last year -- with many days when all 189 patient rooms were occupied.

One hundred of those rooms are private rooms, including 14 two-room suites that bill at $250 a night.

More surgeries were performed at San Fernando last year than at all other private hospitals in Panama combined, Dr. Mendez said. Nearly 7,000 surgeries were performed at the hospital last year, including many laproscopic procedures, he said. The three most common types of surgeries done at San Fernando are 1) orthopedic, 2) general surgery and 3) Ob-Gyn procedures, Dr. Mendez also said.

The hospital's radiology department too is the busiest in the country. Nine diagnostic and two interventional radiologists work in the department, which performed 65,000 studies of all types last year. A GE Infinia nuclear scanner was used to perform 3,000 exams. A 1.5 Tesla GE MRI was used to perform another 5-10 studies per day. Some 300-400 interventional cardiac procedures (e.g. implantations of stents, pacemakers, defribrilators) or stroke intervention procedures (embolization, coils) are performed per year, as well as 25-35 ultrasound exams per day.

The San Fernando hospital laboratory, which processes 450,000 tests per year, is pursuing certification through the American Pathologists Laboratory Accreditation Program, according to Gloria de Pinzon, who runs the lab. Ms. Pinzon, who worked at Gorgas Hospital for 27 years before moving to San Fernando eight years ago to bring its laboratory up to world-class standards, said the lab is expected to receive accreditation in 2009.

The lab employs 18 medical technologists, all graduates of 4-5 year university programs. Four staff are members of the American Society of Clinical Pathologists.

Hospital Clinica San Fernando also operates the largest blood bank in Panama, with 200-250 donors per month.

Patricia Lewis de Henne, the hospital's second highest-ranking executive, said San Fernando recently began the process of applying for JCI accreditation. Ms. Franqueza, the finance director at Centro Medico Paitilla, said that the hospital periodically had considered seeking JCI accreditation, but so far had decided not to do so.

Panama 's efforts to market itself as a medical tourism hub shifted into higher gear recently. Since mid-2007, the country's major private hospitals have attended international conferences and medical tourism seminars, with government officials in tow. The aim is to show that Panama's healthcare industry and government have come together to develop Panama as a global service hub, like the medical industries and governments have done so effectively in India and Singapore. This government/private industry effort in Panama isn't yet as well organized and supported as in those two Asian countries.

Sometime this year, Panama's Ministry of Tourism is expected to release a 12-year "masterplan" for the development of the Panamanian medical tourism industry. It ought to make interesting reading for anyone who's livelihood is tied to development of the global medical tourism market. Panama has the capacity to begin attracting substantial patient numbers, affecting competing destinations near and far.

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