It's been an interesting news week for medical travel as two very respected publications covered two very different aspects of the industry.
First, The New Yorker published an article examining the history of political world leaders seeking healthcare outside their countries as well as the impact the move had on both their physical and political well-being.
Second, Time magazine dove into the growing trend of expectant Chinese women traveling to the United States to give birth, thus ensuring benefits for the entire family that far outweigh mere delivery room options.
Both of these items are featured below under INDUSTRY NEWS.
But first we have two -- also very different -- interviews. The first, with Andrew Lloyd and one of the few lawyers in the United States with a practice dedicated to medical travel, delves into some of the risks foreign physicians take when they consult with an American patient in advance of travel. The second, with Jodi LeMarco of Summit, explores how one claims administration group is working to help PPOs appreciate the savings that medical travel can offer and what this benefits professional believes the future holds. (HINT: it's bright)
As always, we welcome your comments, story ideas, and press releases.
Amanda Haar, Editor
Medical Travel Today (MTT): At the recent conference you spoke about potential licensing issues facing the medical travel industry. Can you elaborate on those?
Andrew Lloyd (AL): As one of handful of attorneys working in the medical travel industry, I speak with a lot of overseas physicians who are trying to cope with the legal issues involved in working with American patients. While the issue of medical malpractice and the risk of being subject to litigation in the United States is naturally a concern, one topic of increasing interest is handling the licensure issues when dealing with patients before they travel. While there are some doctors who don't interface directly with patients before they arrive, many do and those conversations can easily cross over into diagnosis. I’ve been surprised by the number of physicians who don’t recognize that by talking with an American patient from abroad, they may well be practicing medicine in the United States.
Now there are those that recognize it but aren’t concerned as they view themselves as a small fry that won’t get caught. Yes, odds are in their favor that they won't get caught but you don't know when a given state medical board might start taking a more seriously look at this type of unlicensed medicine. It’s my view that non-compliance is not a long-term business strategy.
At prosecutions do happen. In February, a plastic surgeon from the Dominican Republic who had been flying up to New York City to do consults with patients at spas and health clubs. After the consultation, he would get them to travel to the Dominican Republic for cosmetic procedures. As it turned out, a number of his procedures went bad, patients complained, and he ended up being arrested for the unlicensed practice of medicine. A bad outcome is not typically a criminal affair, but this physician – if convicted – is facing 20 years. While flying in for a consult is a bit more obvious than a phone call or videoconference – and the fact that there were some reportedly very bad outcomes -- there’s no legal distinction and may well put a physician at risk for criminal prosecution.
AL: For internet or telephone consultations with U.S. patients, the question of whether practice of medicine will come down to diagnosis. If a clinic is calling just to discuss the facility, the OR, what have you, that clinic is probably well clear of practicing medicine. But once if the physician starts asking ‘how do you feel?’ ‘Where does it hurt?’ ‘Tell me about your medical history.’ In most states in the US, you’re now practicing medicine. Most doctors are cognizant of that line but the temptation to market themselves by providing those pre-operation services over the phone is a big one and an important part of marketing. Clinics should address this problem head-on and think about how to become compliant so they do not run afoul of licensing statutes in a good-faith effort to market their services.
About Andrew Lloyd
Mr. Lloyd is one of only a handful of attorneys in the United States with a practice dedicated to the emerging medical tourism industry. He represents clients who work in all aspects of the industry.
He can be reached at firstname.lastname@example.org
Medical Travel Today (MTT): Tell me a bit about Summit and your role there.
Jodi LaMarco (JL): Summit has been in business for 15 years as a claims administrator for fully self-funded and partially self-funded employer groups. We do everything an insurance company does, but it's just not our money we use to pay the claims. We have 26 employees and service 57 different groups. While our clients are throughout the country, a large percentage is based in the Southwest with some of those having locations or satellite offices elsewhere in the country. We service publishing companies, and a number of school districts as well as Indian tribes and the various entities that comprise the tribes. In fact, 44 percent of our clients are schools or tribes.
MTT: I understand you've been researching medical travel on behalf one of your clients for some time. Can you explain their interest and your findings?
JL: My research started in Nevada a few years ago when it became clear that the existing PPO contracts were insufficient for a number of patient needs. The biggest need revolved around surgeries involving implantables… hips, knees, pacemakers and so forth. Implantables can be a huge source of revenue for hospitals. The contracts that some networks have with hospitals are not always designed to limit how much a hospital can charge for a particular item. Some hospitals can be quite aggressive in their “mark ups.” Depending upon how the PPO allowance is calculated, if the allowance is determined at a percentage off billed charge, then the allowance could easily be 400 percent or more of Medicare. That simply proved too much for our clients. It was at that point that we began actively looking for alternatives.
We started working with HealthPlaceAmerica, which should give you a good sense of how long ago that was… We did our research and introduced it to a client. That client ended up sending 13 patients out of the area for care the first year.
As you probably know, HealthPlace is no more and they actually directed us to BridgeHealth, which we now use to coordinate care. All the care we've done so far has been U.S.-based. I don’t anticipate looking abroad for options just yet, but I think there's a strong possibility in the future.
MTT: How has the number of patients you're sending out-of-area for care changed?
JL: Actually it's gone down. This year, we had just five people use the benefit, but we've had three strong candidates queued up for the first quarter of 2011.
Let me add that the decline in numbers is largely due to the fact that in the first year, the cost of air travel was included, we waived the deductible and there was a generous recovery benefit. All of those things have gone by the wayside. As a result, the difference in savings -- while still very significant -- isn't quite as great.
MTT:I'm curious. How have the PPOs responded to your finding an alternative?
JL: Since we have implemented this program with only one client, the response has been minimal. However, certain hospitals in more rural areas have expressed some concern. In fact, we had a hospital in the Pacific Northwest actually come back and offer a better discount than the PPO was offering because of the potential for lost revenue. It makes sense that hospitals would provide more pushback than the PPOs. But in time, I suspect they'll get concerned, too.
MTT: Have you been able to share the results and savings with other clients to generate interest?
JL: We're currently compiling that information and certainly we've shared it anecdotally with clients. At this time, we only offer the option for high-dollar, high-frequency procedures, such as knee and hip replacements, spinal fusion, bypasses and valve repairs so that limits the conversation a bit, but really the biggest objection from others remains the question of liability. They all want to know what happens if something goes wrong. We can give them all the assurances they want regarding quality of care, the standards of the facilities and physicians, and the outcomes, but a lot of employers just aren't ready.
Even with the recommendation of our client who is delighted with how the program works and the savings, it's just not enough assurance. Yet.
MTT: So you think it will become a more viable option in the future?
JL: Yes, I think there's going to be a definite need and medical travel is going to be a meaningful option for saving money. Healthcare reform is only going to help push employers this way. The current changes are really hurting some employers. They're looking, but not jumping on just yet. Give it time. I think we'll be processing a lot more medical travel claims soon.
About Jodi LaMarco
Jodi Lamarco has worked in the administration of fully insured and self-funded employer group health plans for more than 25 years. She joined Summit Administration Services in 1997, a Scottsdale, Ariz.-based third-party administrator, where she is manager of claims and customer service administration. Summit handles all lines of employer-sponsored programs and has been in operation since 1996.
Editor's Note: We recently received an interesting email from Martina Todchuk regarding the establishment of an organization that addresses some of the gaps created by cross-border healthcare in Europe. Along with several colleagues, Ms. Todchuk has formed the European Cross-border Healthcare Organization (ECHO) to " facilitate the delivery of all necessary services related to cross-border healthcare of travelling or expatriate EU citizens and international medical travelers and expatriates at the highest level of quality in combination with fair and transparent cost policies." In the future, we will feature an interview with Ms. Todchuk that explores how the organization will pursue it's mission. In the meantime, we present her introductory email and encourage interested parties to contact ECHO for more information.
From Martina Todchuk, ECHO
When we attended the EMTC 2011 in Barcelona, one of the most heard phrases with regard to the European Directive on Patient’s Rights were variations of “there are some provisions, but at least as many gaps, uncertainties, ‘mays’ and ‘shoulds’.” Nearly as often as such remarks, we heard that there is a need for the private sector to start exactly where the directive stops and to contribute what is needed to develop a patient-friendly system of cross-border healthcare services.
ECHO s mission is to facilitate the delivery of all necessary services related to cross-border healthcare of travelling or expatriate EUcitizens and international medical travelers and expatriates at the highest level of quality in combination with fair and transparent cost policies.
PERSPECTIVES: Research and Opinion from the Center for M edical Tourism Research:Medical Tourism and the Impact of the Internet
"…about 50% of potential medical travelers from the U.S. said they would book the travel on their own and another 27.7% through the healthcare facility or provider."
Medical Tourism is a huge international, healthcare trend that Frost & Sullivan, the global thought-leadership firm, recently forecasted will be a $100 billion dollar market by 2012. Interesting to note, that this multi-billion dollar global industry has grown, over the years, primarily without much use of traditional advertising (print, radio, outdoor, television, etc.) methods. Instead, this industry has grown primarily by facilities and providers making themselves known to potential patients through the Internet, word-of-mouth (friends and family), referrals, and third party intermediaries (employers, payers, and facilitators).
Somehow, patients travelling for procedures outside of their home geographic region, this includes international and intraregional (within country- such as to another city, county, or state/ region/province) travel, are finding where to access the care they need or want using the Internet. For good or bad, research by the Center for Medical Tourism Research (CMTR) from early 2010 shows that the majority of potential patients are do-it-yourselfers (DIY). We found that about 50% of potential medical travelers from the U.S. said they would book the travel on their own and another 27.7% through the healthcare facility or provider. This is supported by research in the Journal of General Internal Medicine from December of 2010 that found that facilitators in the U.S. have only been responsible for thousands of patients travelling to other countries.
Meanwhile, studies of American medical travelers, by UCLA, the Department of Commerce, and the CMTR have forecasted numbers in the hundreds of thousands to low millions (a large percentage of these have been going to Mexico of course). From a couple of Gallup polls we find that, in a sample of 13 Asian countries, an average of 21% of residents of these countries travelling within the country to find better healthcare and from a joint EU-Gallup poll that 4% of all Europeans sampled are going to other countries for healthcare. Yet, we don’ t hear reports about travel agents or facilitators booking millions of these trips for these travelling patients. In a study from last year, PhoCusWright suggested that perhaps 41% (in this researchers humble opinion- this may be high) of all traditional tourists booking travel, in the U.S., utilized a travel agent.
These findings suggest that the majority of medical travelers are using the Internet, social media, friends and family, and referrals to make decisions about where to go and book the travel. Pew, the American research firm, recently announced that the third most common way that Americans use the Internet was to search for healthcare information (first is to send e-mail and the second is for social media sites). It was used by 80% of Internet users or 59% of all Americans (more than 80 million people are searching for health information on the Internet each month)! In the CMTR’ s research from 2010, over 75% of the potential travelers said they would use the Internet to research potential medical tourism providers and facilities. Some other findings about how these e-patients (although not specific to medical tourism—it is still important to understand) are using the Internet for health searches come from Pew (both 2002 and 2010), the California HealthCare Foundation (2010) and iCrossing (2010):
• Among Internet users who say their last health search had an impact, 58% say the information they found in their last search affected a decision about how to treat an illness or condition, 54% say the information led them to ask a doctor new questions or to get a second opinion from another doctor, and 35% say the information affected a decision about whether to see a doctor.
• Social media is increasingly relevant to health and wellness with 34% of health searchers using social media resources to delve into health-related topics.
• 84% of health searchers are turning to online social spaces to educate themselves about a disease or a condition.
• Of cell phone owners, 17% have used their phone to look up health or medical information and 29% of cell phone owner’ s ages 18-29 have done such searches. In addition, 9% have software applications or "apps" on their phones that help them track or manage their health (some 15% of those ages 18-29 have such “ apps” ).
• Individuals living is an urban area with a cell phone are more likely than those who live in suburban or rural areas to have a mobile health app on their phone. Cell phone users with an income of $75,000+ are more likely to use their cell phone to research health information.
• 78% of wireless Internet users have looked online for health information, compared with 70% of Internet users with desktop access and 59% of all American adults” .
The conclusion that this researcher comes to from these findings are that the Internet is probably one of the leading drivers of healthcare travel around the world (I know—not much of a reach here!) and will continue to be for some time (in China alone- the total Internet users has just reached 457 million in 2011!). It is my sincere hope that more research will be focused on the influence of this technology on medical tourism; in particular, the impact of wireless devices on medical travel. As indicated in the results above, it's clear that wireless users may be more likely to search for healthcare information. Whatever the future of medical tourism is, it is very likely to be powered by the Internet.
About the Center for Medical Tourism Research
The Center for Medical Tourism Research (CMTR) is located in the H-E-B School of Business & Administration at the University of the Incarnate Word in San Antonio, Texas. This is the first center in the world devoted to medical tourism research. The center founder and Director is David George Vequist IV, Ph.D. who is regarded as one of the leading academic speakers and authors on medical tourism.
About David G. Vequist
David G. Vequist IV, Ph.D. is the founder and Director of the Center for Medical Tourism Research (CMTR- www.medicaltourismresearch.org)- the first academic center devoted to research of the Medical Tourism industry. In his previous careers, Dr. Vequist was a Human Resources executive at a joint venture with HCA and a management consultant for Ernst & Young, LLP. He received his Ph.D. and Masters from the University of Tulsa and his B.S. from Northern Arizona University. Dr. Vequist is a well-known speaker and presenter on the subject of medical tourism around the world.
The New Yorker Examines Medical Travel and Political Leaders: ‘In Treatment, Out of Power?’
Editor's Note: Inspired by the recent trip of Yemen’s President, Ali Abdullah Saleh, to Saudi Arabia for medical treatment after being injured in an attack on his compound, The New Yorker's Arik Gabbai to a look back at some selective moments in politic-medical tourism and how that decision affected each leaders personal and political health.
The story can be view online by clicking here .
WorldMed Assist and Wells Fargo Insurance Services Team-Up to Promote Medical Travel to Wells Fargo Clients
Concord, CA (PRWEB) — WorldMed Assist, a leader in Medical Travel for self-funded employers and consumers, announced a joint marketing venture with the San Carlos, Calif., office of Wells Fargo Insurance Services, to promote Medical Travel programs to the company’s self-funded employers. As a result of this venture, Wells Fargo recently implemented a WorldMed Assist program with a 5,000-member client and leading supplier of professional services to the federal government. Through this program, the client's employees and dependents are accessing high-quality healthcare through WorldMed Assist's Centers of Excellence Network, while the client is reducing its healthcare costs.
“We are thrilled to offer our Medical Travel services to Wells Fargo Insurance's self-funded employers,” said Jim DiFalco, vice president of business development for WorldMed Assist. “Partnering with Wells Fargo's forward-thinking employee benefits team has been a pleasure. They take a strategic approach to helping clients consider new programs, such as medical travel. And when a client implements the program, they provide the right level of support to make sure the plan design is effective, and the implementation is smooth.”
According to Dick Keenley, Wells Fargo vice president for employee benefits, “We are always looking for innovative ways to help our self-funded clients manage their cost while improving their employee benefits offering. When we decided to offer medical travel to our self-funded employers, we wanted a partner with a proven track record of excellence in case management, had self-funded industry experience and were flexible enough to meet the demands of our clients. We are very satisfied with the WorldMed Assist partnership.”
Time Magazine Explores Yet another Motivation for Medical Travel: ‘ Pregnant and Bound for America: Why Chinese Moms Want to Give Birth on U.S. Soil’
Custom Assurance Placement Release Study on Medical Travel Insurance
Custom Assurance Placement, developers of the first specialty travel insurance policy covering medical tourists and medical travelers from almost any country against accidents and complications, has release a study examining utilization of their Global Protective Solutions (GPS) policy over the past three years. The results of the study are featured below.
Data is gathered from GPS client data only and is not an industry wide synopsis.
As the medical travel/tourism industry continues to grow, we see emerging trends that
1) Country of origin of traveler/tourist
Country where care is received
2) Average Premiums
The average premium for insured patients is $315.00 with the lowest premium of $72.00
3) Claim Activity
Claims have varied in type. The most frequent claim has been from a thrombosis or blood
There have been several re-admits back to the receiving facility for minor symptoms with
4) Stakeholder Liability Mitigation
Stakeholders such as receiving hospitals or facilitators have been relieved to find out that
- The hospital was able to guarantee payment recovery from the patient because
5) Consumer Cost Tolerance
It is also important to note here that all of the patients we have seen travelling for care
- To have a procedure that is not available in their home country
Healthcare Tax Cuts Boost India's Medical Tourism
digiworld.com— An Indian American doctor has suggested that India offer special tax exemptions to its healthcare industry to capitalize on a potentially $100 billion opportunity offered by the globalization of healthcare.
"The Indian government must reform fiscal policy relating to healthcare as India is one of the beneficiaries of the globalization phenomenon," Boston-based cardiac surgeon and healthcare economist Mukesh Hariawala told IANS.
Economic and patient traffic indicators show an annual 35 percent increment in medical tourism in the last few years with a projected market cap of $100 billion by 2017, he said, citing a report by Deloitte and company.
Medical tourism also opens up other business opportunities as retro customer satisfaction surveys conducted by the Medical Tourism Association reveal that most patients travel with a companion and also indulge in a post-treatment relaxing vacation, he said.
To read more click here .
New Zealand : Medical Tourism Creates Opportunities
BusinessDay.co.nz — Thailand's largest private hospital operator is shopping for New Zealand health software and technology as it seeks to cater to the booming medical tourism market.
Bangkok Dusit Medical Services (BDMS) operates 28 hospitals and is the second-largest private hospital group in Asia, after Australia's Ramsay Health Care.
Veerasak Kritsanapraphan, deputy managing director of the group's IT services subsidiary, said it already used business intelligence software from Auckland firm Cortell to get a picture of the profitability of procedures, and its 300-odd clinicians used digital dictation software from Auckland company Winscribe.
It was now on the hunt for innovative New Zealand health IT solutions, particularly electronic medical record software and technology that allows medical devices to communicate with patient record software.
Kritsanapraphan, in New Zealand to window-shop for health IT solutions, said it was still early, but Orion's health software integration engine Rhapsody was "top of the list," as were Auckland firm Nexus6's smart inhalers.
The group would also "do some more homework" on Adept Medical, which had developed a system for integrating medical devices with patient software.
"We can't find some of these solutions in Thailand so we are now trying to find them in other countries,” said Kritsanapraphan. “The United States seems to provide all these applications, but they are focused on their own market. That leaves the market open for New Zealand companies."
About 30 percent of the group's patients were medical tourists, coming to Thailand for elective surgery and often taking a holiday at the same time, he said.
"Most come from the Middle East, Myanmar, Britain and the United States,” said Kritsanapraphan. “They come for the whole range – hip replacements, knee replacements, heart surgery, dental work and cosmetic work."
Medical tourism was growing fast, and people could save up to 90 percent on procedures, he said.
"Last year, we had almost two million international patients. That will increase to close to five million by 2015."
Cortell Health chief executive Ernest Glad said the BDMS was consolidating different IT systems and that created opportunities for local firms. Its contract with BDMS had allowed testing and validation of software in a very large and complex environment.
Kritsanapraphan also met Wellington firms INR Online, which developed a system for managing the anticoagulant warfarin, and Learning Media, which, he said, could provide online courses in English to educate patients about procedures.
New Zealand companies were more flexible than others because they were prepared to work with clients to customize solutions, he said.
Thailand could also learn from providers of New Zealand payment systems, such as eftpos, Krisanapraphan said.
"We don't have that kind of thing in Thailand,” he said. “You either have to use cash or credit card."
Medical Tourism Hit Hard by Arab Turmoil
Petra.gov.jo — Medical tourism in Jordan was hit hard by the regional turmoil, the chairman of the Private Hospitals Association, Awni Bashir, said Tuesday.
Health Options Worldwide Launches Online Platform: Global Connectivity for Providers and Patients, Free Enrollment for Hospitals, Doctors, Dentists, Clinics and Providers
PRINCETON, N.J. -- June 14, 2011 -- Health Options Worldwide Inc. (HOW; www.healthoptionsworldwide.com), an online, international healthcare marketplace that connects patients to providers, today announced the launch of its intuitive and user-friendly Web site that
“ Providers seeking to attract local patients for routine office visits or to appeal to medical travelers
Don Boyd, senior vice-president, Business Development at Buffalo, NY-based Kaleida Health
About Health Options Worldwide
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Executive Forum Attracts Self-Funded Employers
Register today for The World Congress Executive Forum on Outcomes-Driven Benefit Design for Employers and Health Plans on July 11-12, 2011 in Chicago, IL. The mission of this agenda is to push the “value-based health care” strategy forward. Employers and health plans are evaluating and purchasing high value care, affecting engagement, and achieving ROI, through new and creative benefit design levers. Exclusive presentations from Laura Carabello, Editor-in-Chief of Medical Travel Today. Register now, save $400. To register, contact World Congress at 800-767-9499, mention code MZM532 (not valid on government rate). Learn more at www.worldcongress.com/outcomes
Global Reproductive and Fertility Tourism Congress and Expo
All aspects of fertility and medical treatment abroad will be addressed at the Global Reproductive and Fertility Tourism Congress and Expo to be held July 12-15, 2011 in Barcelona Spain.
Doctors will be talking about the latest advances in fertility care. Attorneys will be discussing the legal aspects involved within health tourism globally. Representatives from insurance companies and tourism agencies will also attend. The expo is a globally promoted event specific to tourism as it applies to reproductive infertility health.
Costs of fertility treatments are causing some American women to consider traveling abroad for procedures. Along with the allure of exotic destinations, traveling abroad may cost thousands of dollars less than they would at home. Pamela Madsen, executive director and founder of the American Fertility Association estimates the average cost for in vitro fertilization (IVF) in the U.S. to be approximately $12,000 per cycle. Some women have to go through several cycles.
Problems that experts are cautioning American women against include a decreased success rate compared to a U.S. procedure and egg donors not giving complete informed consent, which was the case recently at one Romanian clinic.
This year’s location for the 3rd International Temos Conference from 20 – 23 November 2011 will be the Mercedes Benz Center in Cologne, one of the most interesting and up-to-date Conference locations in Cologne. Enjoy the combination of Temos Conference high class speakers and the atmosphere of 125 years German high class car design. We are pleased to again carry out the Conference in cooperation with the German Aerospace Center, DLR.
Dates for Center for Medical Tourism Research 2012 Conference AnnouncedThe Center for Medical Tourism Research has announced it's 2012 conference will take place in San Antonio, TX on February 13-15.
Keynote speaker will be Dr. Tricia Johnson from Rush University.
Dr. Johnson is the co-PI for the $500,000 (USD) U.S. Department of Commerce grant to study inbound medical tourism to the U.S. and also is the co-author of the recent book "The Future of Healthcare: Global Trends Worth Watching"
She will be sharing the initial results of her study with our conference participants.
A call for papers will be issued soon.