THIS WEEK IN MEDICAL TRAVEL TODAY
Volume 5, Issue 17
by Amanda Haar, Editor

Greetings,

Slowly, but surely, medical travel seems to becoming part of the American vernacular. Recent stories on PBS and in “Sports Illustrated” as well as plans to build a Korean-funded stem cell facility in Vermont and Satori World Medical Group's increased medical travel benefits for U.S. employers/employees all seem to indicate a growing understanding and acceptance of the opportunities provided by medical travel.

But even with that news –and the likes of Sonia Gandhi traveling to the United States for care — significant education/convincing still needs to be done. Stories regarding the potential downside of medical travel (see A One-Way Ticket to Surgical Complications under INDUSTRY NEWS) still seem to grab more media and, thus consumer, attention in the United States and abroad.

Whether it's the economic sense, the efficacy, or the experience, it behooves each of us to seek opportunities to tell the story of medical travel. That's not to say we disregard the risk, but that we temper it with the fact that risk is inherent in any medical procedure performed anywhere in the world.

The story of medical travel is being written. I, for one, am willing to do my part to ensure a happy ending.

As always, we welcome your comments, story ideas, and press releases.

Cheers,

Amanda Haar, Editor
ahaar@cpronline.com

SPOTLIGHT: PART II: Karol Wicker and Rainer Hilgenfeld, Press Ganey Associates, Inc.

Karol G. Wicker, MHS, assistant vice president, Press Ganey Associates, Inc.

Rainer Hilgenfeld, M.D., Ph.D., MPH, international coordinator for the International Quality Indicator Project, Press Ganey Associates, Inc.

Publisher’s Note: The following is Part II of a two-part interview conducted with Karol Wicker and Rainer Hilgenfeld, of Press Ganey. To read Part I, click here .

By way of background, in 2010, Press Ganey acquired the International Quality Indicator Project® (IQIP), which assists healthcare organizations in identifying opportunities for improvement in patient care. Nearly 350 healthcare organizations in 17 countries use IQIP tools to collect, analyze and compare clinical and administrative healthcare data. For more information, view the informational brochure (PDF file). A list of available Acute, Psychiatric, Long-Term, and Home Care measures can be found here .

Medical Travel Today (MTT): Typically, how long does it take for a hospital to go through IQIP? How long does the reporting take?

Rainer Hilgenfeld (RH): First, the initial contracts would always be for two years. The reason is because it takes the hospital about one year to really get robust data to report.

It is essential that hospitals worldwide understand the definitions of the indicator(s) and how to measure clinical performance. Decisions need to be made regarding which patient cases to include or exclude according to our criteria. Therefore, participation always starts with an initial training on the indicators available, the science behind them, statistics and other related topics.

We usually find that in the first year or so, hospitals will go back and re-enter data because they find that they didn’t count all cases correctly. In the second year, they have a range of statistical tools in our software that enables them to also be involved in process control and to analyze the data.

So, it’s a two-year commitment and after that the contract extends on an annual basis.

MTT: So the first year is actually getting the data and collecting it. In the second year, they can use the tools to analyze it?

RH: Yes, they can actually enter the data immediately following each quarter. Reports are issued automatically on a quarterly basis. Approximately two weeks after they enter data, healthcare organizations will receive a report for the previous quarter.

Karol Wicker (KW): Basically, we find that during the first year, they are struggling with the right processes to do the correct data collection to meet the requirements for our measures.

In the second year, they begin to really focus: “Now that I have my data, what do I do with it? How do I analyze it?”

But in the third year, while we are always there to help, the hospital is more “on its own” in the sense that they know what they are doing. They keep monitoring the measures over time, using them as dashboard indicators.

Of course, we connect with them frequently via phone and email, and at least once a year face-to-face, to share experiences. We also have other forums and newsletters for sharing stories and best practices.

MTT: What does this typically cost the hospital?

KW: It’s really hard for us to even give a range because the cost varies by client and specific needs. I apologize for not being able to be more specific.

MTT: How do costs compare to undergoing JCI or any of the other quality accreditation programs? There’s a lot of angst amongst hospitals that JCI is way too expensive and many of them are contemplating dropping this accreditation. Would this replace it? Enhance it? Complement?

RH: Compared to JCI preparation, we are very inexpensive. We also differ in focus: JCI will assess the structure of a hospital and also, in part, the processes used to deliver care. JCI also does not assess outcomes of care. This is where IQIP comes in.

MTT: So, is it likely that a hospital that has gone through JCI accreditation may decide not to undergo JCI re-accreditation and simply work with IQIP tools to assess quality and report outcomes?

RH: Probably not. JCI is focusing more on the structure of a hospital and on the processes in healthcare while IQIP is looking at outcomes of medical care as well as at processes. In a way, only accreditation and outcome measurement combined give a healthcare organization a full picture of the quality of care that it is providing to its clients.

We have hospitals in many countries that have JCI accreditation and, at the same time, participate in IQIP for many years because they get an ideal reporting system for outcomes.

MTT: So, it’s imperative for the hospitals to not only be accredited, but to also report on outcomes — side by side?

RH: I would say it’s not imperative, but it’s certainly important to report on a shiny new hospital building and have processes under control that monitor clinical outcomes and benchmarks them against other healthcare organization comparable.

MTT: There’s been some talk about the LeapFrog Group coming out with standards for hospitals and their quality indicators. Do you see that as competition? Do you see it as a good thing for the industry?

KW: I don’t know enough about what LeapFrog is contemplating.

Press Ganey is the only company that has a single integrated program for hospitals to look at the experiential, the clinical, the financial and the operational performance of the hospital. IQIP is a component of this.

MTT: How are you marketing this product?

KW:As part of the Maryland Hospital Association (MHA), we never really had the capacity to promote IQIP in the traditional sense. It was always word of mouth.

People would attend a class at the Johns Hopkins School of Public Health taught by a MHA senior vice president and learn about IQIP there. Then they would go back to their home countries and spread the word.

We would also speak at conferences and make presentations to get the word out – as well as through periodic articles.

We are excited that IQIP is now part of Press Ganey, that we can actually use some of the more traditional approaches to marketing that make prospective clients more aware of what is available, beyond our attendance at some of the international conferences.

MTT: But you get to attend the international conferences?

KW: Yes, we always have in the past. For example, we always make an effort to attend the annual meeting of the International Society for Quality in Healthcare and our client hospitals already had a number of opportunities at this and other conferences to present our findings.

I don’t think that’s going to change now that we are a part of Press Ganey, but we will have more ground resources in these countries where we are marketing.

MTT: How do you view the American traveler’s willingness to venture outside the country for medical care; particularly, to places that are very far away including Asia, Singapore? Do you believe Americans will make those trips?

RH: When I visited a hospital in Bangkok a couple of weeks ago, I found they already had quite a few medical tourists there.

So if a patient had a choice, for example, of a $40,000 co-payment in the United States for an elective procedure, it would be very appealing to be treated in Asia for less than half that amount (without co-payment). If the time to travel and quality is comparable, it really gets people thinking.

MTT: What about hospitals offering procedures that are not FDA-approved, regenerative medicine stem cell treatment in China or Greece? How do you measure the quality of those outcomes? To my understanding, there’s very little data on those outcomes.

RH: We have indicators that measure overall outcomes of medical care, such as surgical site infection rates for certain procedures including fractures, appendectomies, etc.

At this moment, we offer only a few disease-level indicators because we believe the overall rate of device-associated infections in intensive care or the overall number of patient falls in a organization says much more about quality of care than a specific indicator limited to a more or less smaller group of patients.

MTT: If you were anticipating going to China for a stem cell procedure, you could not find IQIP outcome data on those procedures?

RH: Maybe a hospital is participating in IQIP and reporting on the overall infection rate attached to those procedures. No, we don’t have any indicators on stem cell procedures.

MTT: Should employers look at Press Ganey outcomes and IQIP quality indicators to make decisions about choosing hospitals for their medical travel benefits?

RH: Yes, certainly.

About Karol Wicker

Ms. Wicker has more than 17 years experience in the health information and data analysis industry supporting quality improvement initiatives to improve patient care processes and reduce costs.

Karol has architected and managed the processing, interpretation and presentation of aggregate and patient-level clinical data for hospital improvement initiatives, ensured validity and reliability of clinical data and monitored hospital performance at an individual and aggregate level while providing guidance and direction to information technology staff to implement tools supporting data gathering, analyses and presentation of hospital data.

Ms. Wicker has co-authored five research articles published in the Journal of Evaluation in Clinical Practice and Quality and Safety in Health Care. She has also presented at Academy Health’s annual research meeting, the American Public Health Association’s annual meeting and exposition, and the Maryland Patient Safety Center’s annual conference.

Karol received two Bachelor of Science degrees with honors from Goucher College and her Master of Health Science with honors in International Health and Population Policy from the Johns Hopkins University Bloomberg School of Public HealthShe also holds Six Sigma Green Belt certification.

About Rainer Hilgenfeld

Since 2008, Rainer Hilgenfeld has been international coordinator of the International Quality Indicator Project (IQIP), a product of Press Ganey Associates, Inc. For IQIP, he is responsible for training and coordinating hospitals and healthcare facilities outside the United States that participate in IQIP ( www.internationalqip.com ).

In his previous position as director of the Healthcare Quality Division at epos Beratungsgellschaft, a Frankfurt, Germany based consulting firm, he introduced and supported IQIP clinical performance measurement in China, Germany, Italy, Luxembourg and Switzerland..

Dr. Hilgenfeld has extensive experience assessing and preparing hospitals for accreditation by the Joint Commission International in Austria, Germany and Italy tertiary care centers in other countries including Pakistan as expert for the World Health Organization. He is also a certified trainer for the German accreditation system KTQ as well as an assessor for the European Foundation for Quality Management.

About Press Ganey Associates, Inc.

Recognized as a leader in performance improvement for 25 years, Press Ganey partners with more than 10,000 healthcare organizations to create and sustain high-performing organizations and, ultimately, improve the overall healthcare experience. The company offers a comprehensive portfolio of solutions to help clients operate efficiently, improve quality, increase market share and optimize reimbursement. Press Ganey works with clients from across the continuum of care – hospitals, medical practices, home care agencies and other providers – including 50 percent of all U.S. hospitals. For more information, visit www.pressganey.com

SPOTLIGHT: PART II: Elisabeth Schuler Russell, Patient Navigator, LLC

Elisabeth Schuler Russell, founder and president, Patient Navigator, LLC

Guiding your journey through illness and aging....

Publisher’s Note:The role of patient navigators is addressed under healthcare reforms, specifically for the Health Insurance Exchanges. Part II of this interview reflects a consumer group – not physicians – which is filling this critical role. To read Part I, click here .

Medical Travel Today (MTT):So, tell us how many patients do you counsel yearly?

Elisabeth Schuler Russell (ER): Ongoing, about 12–15 a month.

MTT: How do they find you?

ER: Most find me through the Internet or referrals. In March, 2011 there was an article in “ MORE Magazine,” and that has helped people to find us. We’re actually working with several people who found us there.

MTT: Are they mostly family members or the patients themselves?

ER: It’s both. I’m in northern Virginia near Washington, D.C., and most of our clients are not from here -- they are from across the country.

It’s even friends. We are working with one person whose friends contacted us and are paying us. We are helping to find some resources to deal with depression and a number of other ongoing issues.

So, it can be a friend, a family member, or the people themselves.

MTT: How do you get compensated? Are you paid a fee directly?

ER: We charge by the hour. We do offer a sliding scale and we offer two hourly fee prices depending upon the service.

If offer a reduced fee for subscribing to our network. The Patient Navigator network also gives our clients a lot of content including roadmaps, which are a sort of do-it-yourself guide covering the many aspects of the healthcare system.

The member fee is $100 per hour for our services; the non-member fee is $125 per hour. I do reserve a number of pro-bono cases per year, and offer a sliding scale.

MTT: For patients that sign up for the hourly fee, is it capped at a certain amount?

ER: We always do a free consultation of 15-20 minutes to first discover what is needed and whether we can help.

Sometimes we can’t, or sometimes they need an attorney or an estate planner. Sometimes we just can’t help at all.

In most cases, there’s something we can do. In the initial conversation, we talk about what’s going on, the priorities and how we might help. Then we send a proposal with the deliverables spelled out, estimating how many hours it might take.

Most of our work involves 3-5 hours, but we have ongoing clients that are with us for months and years -- and then it’s sporadic. Sometimes there’s 10 hours per month, sometimes there’s one hour per month; it depends.

MTT: Tell us about your background? How did you get involved?

ER: My background is unusual, I think.

This is a second career and, more appropriately, a second calling.

In my first career, I served as a Foreign Service Officer at the State Department for almost 24 years. I was in government service. I officially retired from that career at the end of 2008, but I had started Patient Navigator at the end of 2004, and sort of moon-lighted during those years with help from my colleague, Debora Harvey.

I made the change because of my personal experience. When we returned to the D.C. area in 1998 from our overseas assignment in Nicaragua, our daughter (we have two children, a boy and a girl) was only 2 years old. One month after her second birthday, she was diagnosed with an inoperable brain stem tumor. We were so new to the area that I didn’t even know where the hospital was located.

We were thrown into this universe of cancer and brain tumors and terror -- with no lifeline, no background experience and no previous experience with cancer in our family. Having to make these life-and-death decisions was very terrifying.

In 1998, the Internet was not what it is now, but my goal was to learn as much as I could, as fast as I could. It was the most important assignment I ever had, and I became her advocate to seek treatments.

I sent her MRIs to multiple brain surgeons around the country, and researched options. I really came to believe in integrative oncology care after I had asked her oncologist at one point what could I do to build up her immune system. The doctor responded, “Give her Flintstones Vitamins.”

Right then I knew that was inadequate, and I had to figure it out myself. They gave our daughter six months to live, and she is now 14.

We have been incredibly and miraculously blessed. In those intervening years, more and more people started finding me through brain tumor listings and things like that.

I started learning more about cancer and the healthcare system, and it just evolved into this. I had an epiphany one day of what I wanted to do: I want to help people navigate through the system because it is so confusing, expensive and inefficient. That’s how I came up with the name Patient Navigator.

I started the company while I was still working full-time. In my family, everyone thought I was crazy, but I did it anyway -- and that was good because we built the infrastructure, some experience and now we are in it full-time.

MTT: Do you have a medical advisory board?

ER: I have medical advisors that I draw upon. I operate a Patient Navigator group on Linked-In, which is a professional networking site that includes almost 400 people.

It’s for people who are doing this kind of work and are interested in doing it. I’ve got a lot of doctors, nurses, social workers and all sorts of people in that group. But, I do also have specific M.D. s that I consult with and who help me on cases when necessary.

MTT: Did you say you have a partner in this business?

ER: Debora Harvey is my associate. I am the owner, but she has been working with me since 2006. I’ve needed help because I had that other full-time job.

Debora is wonderful; so we kind of did this together. She’s a real wiz on insurance problems – getting appeals resolved and patients reimbursed. We are real proud of that too.

Our biggest reimbursement was for $27,000. The insurance company said one of our clients wasn’t covered service, but we took it all the way to the state commissioner and got it covered.

MTT: You are really a part of our medical travel community because you do a lot of what medical travel facilitators do. Do you ever make or arrange for plane reservations or any of the travel?

ER: I haven’t had to do that yet. I did look into the free angel flight for someone once. We would do it if we had to, but I haven’t actually had to yet. When we were thinking that we might be able to get a locked-in patient to France, I started looking into how that would work with the airlines.

MTT: The airlines give a lot of discounts to medical travelers going to particular countries.

ER: Yes, if we could get him somewhere outside the United States, I may call for help.

When people find me, they’re usually pretty desperate. They haven’t been well served by the U.S. health system, insurance is a problem and doctors, in general, have lost their intellectual curiosity. The system has probably beaten it out of them.

So, if a person does not fit into their box, they write them off. This woman in Indiana was told that they didn’t know what was wrong -- and good luck.

MTT: So, do you think healthcare reform is going to make things more complex, more challenging?

ER: Yes, and I think it’s a good thing that more people have access. Unless costs are reined in, it’s going to implode.

I really don’t think it’s going to work. When I speak to Europeans – the locked-in patient, for example -- and I tell them what things cost in the United States, they literally gasp. When I told the lady in France that they charge $25,000 per week on a self-pay basis for stroke rehab in the United States, I could visualize her jaw dropping.

MTT: Have you ever traveled to any of these foreign hospitals?

ER: No, not really.

MTT: You would find it very interesting and eye-opening. Not only are their facilities impressive, but their outcomes are equally impressive, and their costs are much lower.

ER: In the United States or abroad?

MTT: Abroad. In the United States as well, but abroad it is a big eye-opener when we go to these places and see what they are doing. We always think that America is the best.

ER: That is a complete fallacy. It is so untrue. I can tell you 50 people we worked with that the system has failed. So, when politicians say that “America’s healthcare system is the best,” that is just hogwash as far as I am concerned.

This discussion is very interesting. As a matter of course, I just look the best place in this country is for this person, I never really realized what I was doing is medical travel.

About Elisabeth Schuler Russell

Elisabeth Russell is the founder of Patient Navigator, a company established in 2004 to help patients and families navigate illness and the U.S. healthcare system. She is also the vice president of the National Association of Healthcare Advocacy Consultants. In 2009, she was trained as an integrative oncology “Cancer Guide” by the Center for Mind-Body Medicine in Washington, D.C. She has completed a continuing education course on conventional medicine at Georgetown University. In 2007, Elisabeth was trained as a Certified Senior Advisor (CSA)®. She has been a hospice bereavement counselor, in 1991 launched a Parent Loss Support Group and has facilitated grief-support groups for years. In her first career, Elisabeth worked 22 years as a Foreign Service Officer at the U.S. Department of State, where she earned nine prestigious Honor Awards. She holds a master’s degree from Georgetown University’s School of Foreign Service and a bachelor’s from the American University in Paris, France. Her daughter’s survival following a pediatric brain tumor led Elisabeth to her new calling as a patient navigator so that she can advocate, educate and solve problems for patients and families.

About Patient Navigator

Patient Navigator LLC provides individualized services and tools to patients and families confronting illness or chronic disease including the multitude of challenges associated with aging parents. We advocate overcoming obstacles to care and to ensure that stressful, time-consuming administrative tasks -- including insurance issues -- are properly managed. We educate clients so that patients can eliminate the anxiety of deciphering the healthcare system and their medical condition, learn how to communicate with their medical teams and know where to find resources and to access services. We integrate the full-range of nutritional and complementary therapies that can contribute to a treatment, recovery and survivorship plan. We bring healthcare and life care together.

Special to Medical Travel Today: Scott Frankum: Value Innovation in High-Volume Focus
Hospitals – Part III

In our last issue, we were pleased to present   Part II of Scott Frankum's exploration of why High-Volume Focus Hospitals could define health travel’s future . This week, he looks at how these hospitals save money and why domestic health travel may be part of everyone’s healthcare. Please address questions to:   TheWellReport@gmail.com

HOW HIGH VOLUME FOCUS HOSPITALS SAVE MONEY

Third in a Series on Value-Innovated Medicine

The Law of Technology

You’ll recall that High Volume Focus Hospitals (HVFHs) create value-innovated surgery costs, medical outcomes and patient experiences. They are a natural fit with Precision Medicine surgeries, where diagnosis and treatment are known. Let’s look at the factors that may drive HVFHs out of traditional, general hospitals and the corresponding increase in domestic medical travel.

The law of technology is that a specialized tool will always be superior to a general-purpose tool.  General hospitals are a counterpoint to the law of technology in that hub-and-spoke design, (a functional description of traditional hospitals), is sort of the opposite of a specialized tool.

The culture of hospital medicine values the flexibility of trained doctors practicing intuitive, artisan and customized medicine. This leads to the situation we have today where general hospitals aspire to offer every tool in modern medicine’s toolkit. Put succinctly, general hospitals are designed to do everything for everybody. This sounds good, but it raises costs and lowers medical outcomes. Shouldn’t we ask, “What’s the right tool for the right job?”

Intuitive, Empirical and Precision Medicine

Some definitions.

Intuitive Medicine: Emergencies, trauma and diseases that are statistical outliers, consultative and expensive to diagnose.

Empirical Medicine: Chronic diseases that require a high level of coordination, trial and error to stabilize. Correct diagnosis is vital.

Precision Medicine: Popular surgeries where the diagnosis and treatment are known.

In The Innovator’s Prescription Clay Christensen observes that general and tertiary hospitals are a natural fit with Intuitive Medicine because it is value-added and iterative. However, because Intuitive Medicine cannot be standardized or routined easily it is a bad fit for focus hospitals.

Empirical Medicine can partner with Intuitive Medicine to properly diagnose chronic diseases. Diagnosis, especially of co-morbidity, should stay in a general hospital setting. When that is accomplished, Empirical Medicine should move out of the general hospital into a purpose-built facility where overall costs are lower and process engineering raises outcomes.

Focus diabetes centers are great examples of Empirical Medicine. Early intervention, full-spectrum care and bundled prices for the full episode of care raise outcomes and lower overall prices. However, the long-term nature of chronic disease means there isn’t a good fit with Precision Medicine.

Precision Medicine is rarely a good fit with general hospitals. If we already know the diagnosis and treatment, subjecting patients to another layer of cost and complexity destroys value. For Precision Medicine surgeries, like those in our HVFH models, we can immediately focus on the fix.

Legacy Buildings for Legacy Medicine

Empirical and Precision Medicine fit poorly with hub-and-spoke hospitals because general hospitals are the equivalent of a general-purpose tool. Empirical and Precision Medicine each need their own business models, value-chains, operations management and process-designed facilities to maximize savings and outcomes. A look at Figure 1 shows why.

A Management View of Savings

A management view of medical delivery already recognizes that costs are lowest and outcomes are highest when Intuitive, Empirical and Precision Medicine each have different delivery models.

Here’s why. Where diagnosis and treatment are known, procedures and processes design out inconsistency, predict costs, squeeze-out inefficiencies and isolate problems for correction. The right tool for the right job allows us to manage patient hand-offs, which are where most of the extra risks, higher costs and variability are introduced to hospital medicine.

Hyper-Expertise Leads to Hyper-Value

It is understandable that Shouldice and Narayana Hrudayalaya (NH) looked to manufacturing models with set processes and procedures when working toward value-innovated medicine. The simple explanation for gains from manufacturing-style-management is that everyone involved becomes expert at their jobs in an environment of continuous improvement.

Supporting data comes from surgeons themselves. We know that the best surgical and medical results come from surgeons who do lots of surgeries.  There is a component of natural ability, but it seems that the greater part of superior surgical expertise comes from the frequency and quantity of surgeries performed.

Getting to Value-Innovated Costs

Simplistic descriptions of value-innovated savings don’t do justice to the genius of how Shouldice and NH actually accomplish low costs. Surface assumptions about savings, such as pointing to NH’s longer surgeon hours, also don’t highlight how closely cost savings are linked to high quality.

The real explanation of savings comes from lean production theory based on the Toyota Production System ( TPS ),the granddaddy of comprehensive management philosophy and operational practice.

High Volumes Reveal Waste

TPS reveals the counterintuitive nature of waste. Applying TPS management shows why value-innovated costs and quality are optimized at high volumes. Put simply ― waste hides until a process runs at capacity.

Toyota categorizes operational savings three ways: inconsistency, burden and waste. TPS further breaks-out waste into seven elements: over-production, motion, waiting, conveyance/transportation, compensating/processing, inventory & mistakes. I placed savings identified by Shouldice and NH into the TPS format on a graphic in Figure 2. Most of us think of waste as a necessary evil, but closer inspection shows that waste is destructive beyond just materials costs.

The big takeaway is a fuller understanding of how HVFHs paradoxically achieve value-innovated costs. In other words, consistent, repeatable quality saves money… which is the opposite of the truism that quality naturally costs more.

Real Savings at Shouldice Hospital

Standardized tasks are the foundation of continuous improvement. Consequently, we can see why Precision Medicine is uniquely suited to TPS-style gains.

Daryl Urquhart, Shouldice Hospital’s director of business development, calculates that Shouldice saves 94 eight-hour operating room utilization days per year for each room. The savings accrue because Shouldice optimizes its facility configuration, work processes and work flow. Together, these design adjustments enable faster operating room turn-around between operations, when compared to a general hospital. There are analogous labor savings, too. Urquhart estimates that time savings are far greater than hard costs.

Urquhart writes, “At Shouldice instruments, supplies, surgical staff, OR prep and absolute advanced knowledge of the case load allows for a turnaround time between patients of only 90 seconds. The efficiencies are real and the savings of time is astounding!”

Increased Domestic Medical Travel

I hope the realness of value-innovated cost, quality and experience surgery gains are becoming apparent. If we look at the recent national conversation over budget deficits and entitlement reforms, healthcare costs are there in bright red. Eventually, health reform becomes an upward driver of quality and a downward driver on costs, but it could be years before those savings emerge. HVFHs could help now.

Let’s look at a plausible scenario. Medicare’s consumer-directed Quality Care Finder just launched at http://www.medicare.gov/quality-care-finder/ . This website rates doctors, hospitals and other healthcare providers on a growing number of factors including quality and patient satisfaction.

Let’s imagine what happens when a well-regarded institution or clever start-up opens a new HVFH heart hospital where I live in Los Angeles. Very soon, the focus hospital gets higher medical and customer ratings than USC, UCLA-Reagan, Cedars and other prestige hospitals.

When the Quality Care Finder website becomes broadly utilized and known (as it will), demand shifts as the new entrant’s reputation grows. When we add in the force of insurance companies driving patients toward the value-innovated costs, the allure becomes irresistible. Suddenly, patients from Palm Springs, San Diego and Bakersfield are willing to travel domestically.

I think we’re looking at a medical future of increased quality, controlled costs and decreased convenience.

About Scott Frankum
Scott Frankum is an author, analyst, blogger, speaker and creative director with a master’s of business administration in global management. He helps consumers become highly informed patients and smart healthcare shoppers. He helps governments, businesses and high-potential start-ups find growth through analysis, innovation and impact. His new book, “The Well Report ― How to Shop for Hip Surgery,” publishes in August.

TheWellReport@gmail.com
https://twitter.com/TheWellReport
www.TheWellList.com

Copyright © 2011, Scott Frankum. All Rights Reserved.

INDUSTRY NEWS

Sports Illustrated: A pitcher’s firsthand experience with stem cell treatment

By C.J. Nitkowski, Special to SI.com — The Bartolo Colon story has intrigued me since it first broke, a once-great pitcher whose career seemed to be lost and is now pitching effectively again for the Yankees at age 38. I did more than raise an eyebrow when I heard that his incredible comeback was aided by a relatively unknown stem cell procedure. As an injured pitcher in my late 30s, I had to know more. It didn't take long for me to find Colon's doctor, Joseph Purita, of the Institute of Regenerative and Molecular Orthopedics, in Florida.

To continue reading, click here.

Vermont Spotlights Foreign Financing Role for Stem Cell Facility
Fiercebiotech.com — Almost two years after announcing plans to build a new stem cell research and manufacturing center near the Canadian border, South Korea's AnC Bio and a Vermont entrepreneur says the joint venture is ready to start construction. AnC representatives and Bill Stenger, who runs the Jay Peak ski resort, gathered with Vermont Gov. Peter Shumlin and Sen. Patrick Leahy (Vt.-D) to announce that they would renovate and expand an old clothing factory in Newport with plans to hire 200 workers as it pursues work on the development of replacement organs in 2013.

The deal hinges on the federal EB-5 program, which opens up U.S. residency to foreign investors who can come up with at least $500,000. News reports from the announcement touted Newport's "close proximity" to four research universities including Dartmouth in New Hampshire, but Vermont is well off the beaten biotech path in the United States.  

To read more, click here.

Satori World Medical to Offer U.S. Employers Medical Travel Benefit Option

HealthEZ Expands Product, Offers Access to International Medical Providers

SAN DIEGO, CA/BLOOMINGTON, MINN. – August 8, 2011 – Satori World Medical has partnered with HealthEZ, a Minnesota-based health plan, to offer its global health care program to its members and clients.
 
Through this collaboration, Satori World Medical will provide HealthEZ’s members access to a full-service, high-quality medical travel program, also known as medical tourism or global healthcare. Under the program, specialized surgical procedures, such as orthopedic, cardiac, bariatric, cosmetic and major dental work, can be performed at cost savings of between 40-80 percent when compared to pricing in the United States .
 
Part of a family owned healthcare company founded in 1982, HealthEZ is a state-of-the-art, high-tech, high-touch health plan that offers innovative services and solutions for companies with self-funded health plans including America’s PPO -- the nation’s first PPO.
 
“We are very pleased to work in collaboration with Satori World Medical,” said Amir Eftekhari, president, HealthEZ. “Satori's program is consistent with our organization's vision to provide our clients with access to the best healthcare services available, while consistently seeking to lower their health plan costs.”
 
“Offering a medical travel program is a great opportunity for a healthcare network and benefit administrator to expand and enhance product offerings,” said Steven Lash, president and CEO, Satori World Medical. “By providing an international network option, HealthEZ’s clients will now have access to additional quality providers and save significant medical expense, leading to an increase in client retention and profitability.”
 
Satori World Medical has done extensive due diligence on hospitals and physicians to find the best the world has to offer. Its network features hospitals that meet or exceed U.S. standards of care, are accredited and monitored regularly by Satori on the quality delivered.
 
For more information on HealthEZ, visit https://www.healthez.com/.

CIGNA Expands Global Operations to Turkey

hcbd.biz — CIGNA (NYSE: CI), a leader in direct marketed supplemental health, life and accident insurance in the international marketplace, today announced the launch of a new office and operations in Turkey. CIGNA Hayat Sigorta S.A., based in Istanbul, will offer individuals in Turkey products and services that provide supplemental healthcare and financial protection. These products and services are marketed through affinity partners and direct channels, such as the Internet and Direct Response Television.

CIGNA’s decision to enter Turkey follows a detailed analysis of the local insurance industry and needs and behaviors of the Turkish people.

To read more, click here.




Reporter's Notebook: India's New Baby Boom

PBS News Hour — India's medical tourism industry has long pitched "first world-quality medical care at third-world prices." In the booming business of assisted reproduction and surrogacy — reported to rake in nearly half a billion dollars annually -- the industry goes one compelling step further: legal peace of mind.

An Indian surrogate mother cannot challenge the commissioning parents for custody of the child. Economic realities also make it less likely she'll want another mouth to feed. That's in sharp contrast to the United States, where disputes surrounding parental rights have led a dozen states to restrict or ban surrogacy. In Britain, a surrogate mother can, by law, assert full parental rights -- should she choose -- and surrogacy is banned altogether in several European nations.

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Sonia Gandhi's Surgery Abroad Points to Medical Tourism Trend: Quality over Price

Although India is touted as a rising global medical destination for its relatively cheap care, most long-distance medical travel is driven by a desire for higher quality, not lower prices.

CSMonitor.com — India's ruling party said its leader, Sonia Gandhi, underwent surgery abroad and is recuperating in intensive care.

The country is watching developments closely. Ms. Gandhi wields tremendous power behind the scenes of her hand-picked prime minister, Manmohan Singh. During her hospitalization, she has delegated party business to a committee of four including her son, Rahul Gandhi, a descendent of three Indian prime ministers.

Few details have leaked. Her ailment remains unknown. Media reports say she went to the United States for treatment. Among the mysteries being parsed by the press: Why did she travel abroad for care when India is a global medical destination?

Indeed, India has been touted as a major player in the emerging medical tourism field, with stories of budget-minded Americans traveling to India for super cheap hip replacements. But despite the hype, Gandhi’s reverse journey may still be more representative of what’s actually happening: medical travel for higher quality, not lower price.

“Most [medical travelers] seek the world’s most advanced technology, better quality, or quicker access to medical care,” reads a 2008 report from The McKinsey Quarterly.

The report found that 40 percent of medical travelers were seeking the world’s top technologies, mostly by going to the United States. Only 13 percent were looking for lower-cost care.

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Sanivisit International, Medical Tourism Facilitators Sign Contract with Clinica Colsanitas S.A., Leading South American Healthcare Provider

Sanivisit International has signed a contract with Clinica Colsanitas, a leading South American healthcare services provider, offering state-of-the-art, high-quality medical services at the renowned Clinica Reina Sofia and Clinica Universitaria Colombia, in Bogotá.

Prior to signing the agreement, Sanivisit’s Management and medical tourism advisors visited the facilities that are part of Clinica Colsanitas S.A. to ensure premier quality service throughout the entire process.

Clinica Colsanitas is known for a strong focus on personal care and top scientific quality orientation to service patients. Clinica Colsanitas is certified following strict international standards and received numerous awards including Safe Hospital Recognition and Clean Hospital Recognition by the Pan American Health Organization and the World Health Organization.

Sanivisit International LLC, dedicated to the facilitation of medical tourism, is located in Reston, Va.

Sanivisit makes medical travel easier, assisting patients with their travel needs, and is present at destination to help throughout the entire process and ensure the best experience possible.

Through a dedicated case manager, Sanivisit makes every effort to help patients find the best alternative for their particular case and guide them throughout the entire journey with a personalized service designed to eliminate the stress of a “do-it-yourself” experience.
Sanivisit provides a complete VIP service; helping patients schedule a travel itinerary and coordinate all logistical details associated with the medical procedure and vacation.

A One-Way Ticket to Surgical Complications

Digitaljournal.com — Medical tourism, in which patients travel abroad for surgery, is a rapidly expanding global phenomenon, particularly for cosmetic surgery. However, despite the increasing number of plastic surgery patients who seek procedures outside of the United States, there has been little data reported on outcomes, follow-up, or complication rates. In response, researchers from Nassau University Medical Center in New York conducted a survey of U.S. plastic surgeons to help define the scope of the problem, particularly in relation to complication rates, finding that there is a need for improved public awareness and education regarding medical tourism. The results of the study were published in the article “Complications from International Surgery Tourism,” which appears in the August issue of the "Aesthetic Surgery Journal."

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Stem Cell Technologies: World Market Outlook 2011-2021

How will the stem cells market develop this decade? When will significant numbers of stem cell therapies be launched? Which disease areas hold the greatest potential for stem cell therapies? What are the most crucial drivers and restraints in the development of stem cell therapies? How significant are other uses for stem cells, beyond therapy?

A new study shows the revenue prospects for stem cells at total world, submarket and product levels to 2021, including therapeutic applications, such as technologies, products and services to help assess events, opportunities and activities shaping the industry.

In addition, the report provides revenue forecasts, growth rates and market shares. SWOT/STEP review and analysis of companies, technologies and regulations as well as opinions from research surveys are included. 

To learn more about this report, click here.

 UPCOMING EVENTS

OVERVIEW:
Considerable attention has been given during the past five or more years to international medical tourism as a tool for healthcare purchasers to provide a lower cost alternative for applicable targeted high-cost procedures. While international medical travel continues to experience overall growth, there remains material reluctance on the part of a significant portion of employers, health plans and consumers to participate in these international programs for various reasons. 

However, due to both cost and quality concerns with complex care delivered locally throughout widespread portions of the country, the concept of Domestic Medical Travel is receiving significant interest. Within the United States, increased focus on variations in quality and cost has brought new energy to the concept of channeling care to Centers of Excellence. Historically, its application was limited to transplants, but now some employers are adopting this concept for other complex, high-risk surgical procedures. 

Medical travel, even domestically, when sponsored by employers, health plans or other purchasers, still raises legal and regulatory concerns and issues that should be adequately addressed by purchasers seeking to pursue such initiatives. Medical travel legal expert Kevin J. Ryan, of Epstein Becker & Green, identifies and discusses potential approaches to key issues in this regard.

The most prominent large employer initiative in this regard may be the relationship Lowe's and Cleveland Clinic entered into last year. Now with more than a year of experience to draw upon, Kyle Wendt, vice president - Benefits of Lowe's Companies, and George Wagoner, FSA, MAA, senior partner of Mercer, discuss the experience, issues and implications of their initiatives.

Lowe’s full-time employees and their covered dependents enrolled in the company’s self-funded medical plan may elect to schedule qualifying heart surgery procedures at the Cleveland Clinic in Cleveland, Ohio, at an enhanced benefits coverage level. For patients approved for the qualifying heart surgery, the Lowe’s program will cover all medical deductibles and coinsurance amounts as well as travel and lodging expenses for the patient and a companion plus concierge services to make the arrangements. With fiscal year 2008 sales of $48.2 billion, Lowe’s Companies, Inc. is a FORTUNE 50 company that serves approximately 14 million customers a week at more than 1,700 home improvement stores in the United States, Canada and Mexico.

Mercer worked with Lowe's to design the program and negotiate a bundled provider payment rate structure on its behalf. Mercer is also working with other national employers to implement similar programs with a small number of nationally renowned medical facilities. Mercer actively monitors emerging results and works with employers to adjust and expand these initiatives.

Participants will be able to:

• Examine the specific Domestic Medical Travel program designed by Lowe's Companies, in consultation with Mercer.
  
• Consider the experience and implications of the Lowe's and Mercer initiatives to date.
  
• Identify legal and regulatory issues to address when designing and operating Domestic Medical Travel programs
  
• Evaluate potential approaches in addressing Domestic Medical Travel legal and regulatory concerns.

REGISTRATION:
Individual Registration Fee: $195. Audio Conference CD-ROM: $40 for attendees; $285 for non-attendees after the event.

Corporate Site licensing also available. Click here to register or call 209.577.4888

Second Annual Health 2.0 Europe Conference to Explore Impact of Web 2.0 Technology on European Healthcare

Event in Berlin, Germany, Oct. 27-28, 2011, will explore user-generated healthcare in a boundary-less online world and connecting patients and providers in diverse systems

Berlin, Germany, July 14, 2011– Health 2.0 Europe, a conference dedicated to how Web 2.0 tools, data and social media are transforming healthcare systems in Europe, announced that its second annual event will take place Oct. 27-28, 2011, in Berlin. Co-hosted with partner K.I.T. Group, this second edition will reconvene leaders and stakeholders in the Health 2.0 community for a day-and-a-half of technology demos, networking and brainstorming.

Health 2.0 Europe 2011 will present the latest thinking about content, search & communities, data utility layer and analytics, provider and consumer tools for care management, and financing, mobile devices, smartphones and ‘unplatforms’ in a European context. In particular, the conference will address what a “boundary less” online world means for consumers and physicians working in different healthcare systems. Technologies that are shaping the future of European healthcare will be featured in live demonstrations, along with special videos, keynotes and interactive sessions. In addition, during Launch!, a signature part of all Health 2.0 conferences, start-ups will demo innovative technologies. The call for speakers is open.

“Doctors, patients, and healthcare organizations are adopting a new generation of online and mobile technologies, and are fundamentally changing the way healthcare works,” said Indu Subaiya, co-chairman and CEO of Health 2.0. “This is particularly fascinating with Europe, given each country’s different system, language and methods.”

“We’re thrilled to be bringing Health 2.0 Europe to Berlin. And we’ll again be contrasting and contextualizing the best of European health technology,” said Matthew Holt, co-chairman of Health 2.0.

“Health 2.0 is more than a conference: it is a network, a community, and a complementary suite of activities tailored for the Health 2.0 community,” said Pascal Lardier, international director at Health 2.0.

First held in San Francisco in 2007, the annual Health 2.0 conferences are rapidly expanding to other continents as the use of web and mobile technologies in health grows worldwide. Its inaugural European event was held in Paris in April 2010 and attracted more than 500 attendees. Future conferences are planned for India and China, all featuring Health 2.0’s unique format.

 3rd International TEMOS Conference
HEALTHCARE ABROAD & MEDICAL TOURISM
 
November 20 - 23, 2011
Cologne / Germany

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.

Further information about the Advisory Board, program and exhibition will be published soon on www.temos-conference.com.

Early bird rates are available until 31 July 2011. 

Main topics:
– Medical Tourism I: case management & importance of non-medical services
– Medical Tourism II: state-of-the-art medicine & upcoming topics
– Germs, viruses & Co: “unrequested passengers” of Medical Tourism
– Insurers perspective: treatment abroad
– Repatriation by air: requirements for/of hospitals, insurances and assistances
– Quality Management: standards for international patient treatment
– Telemedicine in Medical Tourism: mission – vision – proven applications
 
Social program:
– November 20: Welcome Reception at Mercedes Benz Center
– November 21: Conference Dinner at Rheinterrassen
– November 22: Visit of Christmas Market in Cologne
Registration fee includes participation in Welcome Reception and Conference Dinner.

 
Information about this event and the preliminary program is now available on the TEMOS Conference Website.

Dates for Center for Medical Tourism Research 2012 Conference Announced

The 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.

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