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Our blog has moved. Please go to PremiereMedicalTravel.com

What are the qualifications of the doctors overseas?

In many case truly the best in the world. In other cases the best the countries have to offer. When we are making a recommendation, we are sure that the facility and its medical staff are appropriately trained and up-to-date. 

That verification can happen by several different methods. But the concern many may harbor of untrained or uncertified doctors is unfounded. State-of-the-art hospitals and facilities simply will not risk their reputation and business by hiring poorly trained or incompetent staff. There is a self-policing effect as they compete for patients. Of course we should, and will check. But it is foolish for them to risk bad public relations.

As a doctor practicing in the US, I have been very impressed by the skill and knowledge-base of foreign trained physicians. Admittedly, there can some initial language challenges with a slight accent etc., but the vast majority are very bright and adept at their specialties.

Travel Safe, Be Well.

Jim McCormick MD

Premiere Medical Travel Company

How long have you been dealing with medical tourism?

I started to perform my initial research into the industry in 2007. As I moved through my MBA program at Pepperdine University the research turned from an academic exercise to a business project that is my absolute passion. This is an industry that will create a genuine solution to some of the largest problems the US is facing in terms of healthcare and the expenses associated with it.

We plan on 'opening our doors' in early 2009. We will be negotiating with insurers and brokers over the next several months in order to begin our business.

Travel Safe, Be Well.

Jim McCormick MD

Premiere Medical Travel

Are there government resources to help decide about medical travel? resources

There are few formal government resources to help decide about medical travel as an option for your health needs. 

A quality medical travel company can provide guidance and background information about the choices. This should occur with the assistance of your doctor as well. We want the care and experience to be as seamless as possible. 

There is also an abundant amount of material available on the Internet. You should always take into account the bias of the source and reporting of the information. Also how current and accurate the information is as you read it.

Travel Safe, Be Well.

Jim McCormick MD

Premiere Medical Travel 

Why should I go outside the US for medical care and wellness?

The best example to help sort this out is the issue of time. How much is your time worth to you? How long of  a period in your life do you want to be less active or more uncomfortable because of scarce medical care resources?

I hope your answer is: as short a period as possible. 

When we are asked about long distance travel as an issue, I tend to turn the question towards this concept of time.  Yes some of these locations are relatively far in distance, but they are relatively close in time. Consider, a three or four month wait for an elective procedure to be performed to allow your to rehab and get back involved in your life. In some cases these waiting times are much longer. If you chose a 6 or 10 hour flight to accomplish the same procedure, you could easily be involved in your life before your turn came up for the open slot in our slow to respond healthcare system. 

There are always more than one way to look at an issue. To me, I would rather choose the option that made me healthier sooner. In many cases medical travel is the solution. Too many people are simply blind to the opportunity. 

We can help.

Travel Safe, Be Well.

Jim McCormick MD

Premiere Medical Travel

How does the facilitator get paid?

Pricing and fees are an area where people frequently have difficulty. You should feel comfortable knowing exactly what you are paying for with the company you choose.

It is important for you to know whether the travel facilitator receives commissions for referrals or has a fee for service structure. Commissions are a legitimate method of compensation in many fields. But there is growing concern that a facility may be steering referrals by the use of commissions. They appear to be the dominant method of revenue currently in place. 

There are also important value added or experience improving benefits that you can discuss with the facilitator. It is important if you are sharing the expenses with your insurer that you understand exactly what they will or will not pay for before you leave.

It is important to at least have a plan to help out should there be a complication in your recovery. Will you have access to additional cash or credit for an infection etc. 

Are you bringing a companion? How will their needs be addressed and paid for when you arrive? Good planning also includes attention to the important financial questions.

Travel Safe, Be Well.

Jim McCormick MD

Premiere Medical Travel

New Article Published!

To have another view of my thoughts and opinions on Medical Tourism, The article can be found at the Medical Tourism Association's website. It is on page 62 and discusses some of my experiences and insights on a recent trip to Asia.

More to follow as we move into the Global Health and Medical Tourism Conference where I will be a panelist and moderator. I look forward to meeting and speaking with many industry colleagues.

Travel Safe, Be Well.

Jim McCormick, M.D.
Premiere Medical Travel Company

What are my options if I am immobile or paralyzed?

Conventional travel has its challenges for those who are less mobile.

Has anyone discussed the medical issues you need to be aware of and how to prevent complications?
Has the destination hotel been enhanced to ensure that a wheelchair can into rooms? Are there accommodations for the bathroom? There are many other questions that need to be asked and answered before signing and sending money.

For those seeking healthcare abroad, the need to be sure about the process and have services in place to receive you are important. A good facilitator can ensure that the your needs are met and service the best possible.

Travel Safe, Be Well

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Do I need to speak a foreign language overseas?

Fluency in more than one language is always helpful but it is not necessary.

Premiere will coordinate with facilities that have fluency in English or the ability to readily access translators. Suppose you knew English and Spanish, but chose a Thai facility. That second language would not be very helpful. But if you speak Tagolog and English, you may have a cultural affinity for the Philippines.

We, at Premiere, will have understand who are your best choices: medically, financially, culturally etc.

Travel Safe, Be Well.

Jim McCormick, M.D.
Premiere Medical Travel Company
818.917.6189

How has the exchange rate (us dollar) affected medical tourism?

Currencies valuations fluctuate against each other all the time. In fact, it is the largest trading market in the world. Trillions of currencies are exchanged daily.

There may be an advantage comparing countries for the most favorable exchange rate. The likelihood of a sudden shift that will affect your terms are low. Timing your medical needs will not help you in any measurable way.

The dollar seems to be strengthening recently. This may help your purchasing power over the long haul. For that matter, the destination facilities may charge a higher price to offset the difference. The net result may be that you have a better deal, but can you wait 18 months or two to three years for that currency exchange to change significantly.

Time your healthcare to your medical needs and compare two or three countries simultaneously.  Premiere Medical can help with these issues. That is what a quality outfit can accomplish.

Travel Safe, Be Well.

Jim McCormick, MD
Premiere Medical Travel Company
818.917.6189

Should I choose to arrange everything myself?

You can change the oil on a car, but can you switch out a transmission. Even changing the oil has become more complicated. Which oil is right for your car, there are many grades and choices? Where do you dispose of the oil and filter? You can buy the oil and filter, but where is the best deal available. Do you have the oil pan? Do you have a filter wrench? How about the lift or ramps to get the car high enough to crawl under? Do you have a way to slide under the car? Or can a company do this for $20 and be done in 20 minutes? It appears that changing the oil is simple, but it is more efficient, quicker and cheaper to have someone perform this task for you.

Medical travel is far more complicated than that. It may seem only a travel issue, but it is not. There are many areas where poor planning and misunderstood process issues can greatly increase your costs. You choose this for value and quality, not price. We can help to ensure you receive that: value and quality.

Travel Safe. Be Well,
Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

How much does medical tourism typically cost?

This question which is frequently asked and is difficult to answer. Another approach is to know what you have, know what you need and then you can begin to search for a solution.

Premiere can create a package for a procedure in different locations throughout the world. The price will change dependent upon the destination, procedure, number of travelers, the duration of recovery care and several factors.

This is where a good facilitator can help by creating a needs list and define a price structure that is within your budget.

Travel Safe. Be Well,
Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Why won't insurance companies pay for this choice?

The question is probably better phrased "When will insurance companies pay for medical tourism?"

In my estimation they will, but there needs to be some significant developments in the industry before they fully enter the arena. These large businesses require structure to enter. The issues of lines of responsibilities and where transition points occur are very important. The clarity here must be crystal clear. There can not be an excess number of unanswered questions.

There is a very compelling reason for insurers to enter the space. My intuition says that the landscape must be formed and refined. Quite likely there are activities happening in the back ground that are creating the fog-shaping which leads to more certainty and clarity. The clarity leads to entry.

The First World Congress on Global Healthcare and Medical Tourism will be happening in San Francisco this September. The companies and entities attending will be meeting to help shape the environment. You will see them enter, but when the time and environment is well defined.

Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Do I need a visa to go to these countries?

Most of the countries we will be helping you with do not require a formal pre-approved Visa to enter. A simple card is filled out on the flight describing why you are entering the country. There are some governments who are developing online registration options. In either case these are country by country specific issues.

We at Premiere can help you to be sure that you entry, stay and exit are as seamless as possible.


Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Can our company help with financing my trip?

This is a good question fro a few reasons.
We at Premiere are strongly considering a financing arm to assist people with this option. Our impression is that it would help clients meet their medical needs. Arranging for financing requires a significant process to be developed on our part. We aim to eventually provide this service to qualified clients. We do not have it available at present.

WHen looking to finance an investment it is an interesting proposition to consider financing your health care needs. Cars for example depreciate with time, while investing in your health would carry implications that your life got better and you are able to potentially earn more money.

We will surely include this option as the company grows.

Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Do they understand who I am and what my culture is?

The facilities that I have visited make great efforts to blend US culture AND the cultures of many of their visiting patients. It was not unusual to find special areas with special scents to remind people of their home. They catered to cultural and religious dietary needs.

If your religion prohibits a male doctor examining a female patient that would be respected and addressed.

Time was also permitted for prayer services with directions to point towards Mecca.

In the lobby of the Bumrungrad Hospital I sat and simply observed the cultural flow in and out of the lobby for a few hours. It was clear that the people entering and exiting, at least outwardly, were at ease. For my culture specifically: McDonalds had a small location, Starbucks had a small area with Neil Young and similar notable songs were playing.

Cultural awareness is essential to a quality experience. US culture was not the only emphasis The destination facilities are aware that in order to succeed, the culture of the people coming for care is very important. It is my expectation that this practice will grow and become more common in the future.


Be Safe, Travel Well.

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

What is a Wellness Center?

We at Premiere define medical wellness clinics as a destination for you, a traveling patient, to gain powerful new insight into your particular disease or illness and how to best manage it.

In our view, having a pile of paperwork handed to you in an office after a hasty visit is not an effective way for you to learn about your illnesses and their management. We are developing offerings where in addition to your procedure, you receive an intense several week set of sessions that incorporate daily lessons, time to reflect, time to learn and time to renew who you are and how to best approach your illnesses.

What would daily lessons, nutritional tips, exercise instructions, yoga, meditation give you? In our belief, the best chances at a holistic and healthy life. Will you leave the experience illness free? Not likely, but you will be more empowered, more fulfilled and more likely to make the most effective changes in your life for the better.

In our view, the wellness clinic is an avenue to a new life and a rebirth or redefinition of who you are. Better nutrition, better exercise habits and healthier mindsets can change your physiology and potentially reduce the number of medications you need to take. Reducing medications, can reduce costs and medications related complications. This alone is a leading cause of preventable deaths in hospitals. Pills are easier solutions to write out when time is compressed so much in the office setting. It would seem to us at Premiere Medical that the investment in your health will pay for itself very quickly from a financial, health and well being perspective.


Be Well, Travel Safe


Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Medical Tourism: The Economist Article 8-16-2008

The Economist a prestigious business and politics magazine has a brief article on Page 12 that discusses the impact of Medical Tourism from several points of view. See Article Here

The dialogue discusses the impact on destination hospital resources and infrastructure. The contention is that the inbound traveler is adversely affecting utilization and redirecting resources from the desperate needs of the local population. There is another impact, the elevation of local economies and the active attempt to retain skilled talents in these countries to serve the growing population.

For instance, the Philippines is considering an offering to retain nurses to work in a hub of medical tourism in Cebu. The country sees the potential for this growth industry and needs to build a workforce to meet the needs of the patients. The influx of outside money is almost always beneficial to a local economy.

The article also cites a number from other recent publications that represents the lost revenue as a result of the siphon effect from domestic US healthcare by medical travel. This is a compelling example of market forces affecting price and demand curves. The price in some minds is excessively high in the US. A new competitor is entering the territory and that beneficial competition will affect pricing. That effect's positive or negative effects are centered upon where you as a business are positioned. As a consumer, you may well see prices begin to move downwards, but not enough to offset the margins that medical travel have to offer.

There is far more value available for those seeking medical travel abroad. Stay tuned!
As they say... May you live in interesting times.


Be Well, Travel Safe.

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Can my family come with me? Is that part of the cost?

Of course. We at Premiere would encourage you to have at least one significant individual accompany you. The initial excitement about going abroad for healthcare has a double edge to it. Except for the most self-reliant people, we all need our social fabric. When you travel abroad for healthcare, that fabric is disrupted at a time when support is critical.

Premiere will have cutting edge valuable options to bridge that gap and ensure you are still woven into your social network while getting the best healthcare options can offer. None-the-less if your spouse, partner, friend etc. is physically present, the intervening gap is not as wide.

Having them present has its associated costs and affects that individual. But it is well worth the money.

We will be there available to you 24x7 but a family member or friend present at the site is an even more effective solution.

Be Well, Travel Safe


Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Does the Federal Government support medical tourism?

The federal government is an enormous organization. There has not been a position transmitted by the Administration to our knowledge. However there is an arm of an important healthcare agency that has at its core, a mission to ensure patient safety for those seeking healthcare abroad.

Previous posts have discussed this in more detail, but the Joint Commission, previously JCAHO, has an affiliate arm, The Joint Commission International. It is this second body's role to review facilities and organizations abroad.

The Joint Commission International is invited to facilities in order to review their safety procedures, quality procedures, licensing and providers credentialling processes and other key organizational issues. They will render a determination that the facility is on par with US requirements or deficient in certain areas. They do not certify that the care is better or worse. Only that the safety features in quality programs and patient care problem resolution are effective and have an equivalence to those found here.

This is an important distinction. Our healthcare system is certified periodically by the former organization, The Joint Commission. They do not state that the healthcare at one facility is better than another, rather they certify that the same features described before exist and are effectively used. Loss of this certification is a death blow to a facility.

Be Well, Travel Safe,

Jim McCormick, MD
Premiere Medical Travel Company
818.917.6189

Is the medical care equal to, or better than the US?

As my business professors would answer...that depends.

What metrics and outcomes are you comparing and how are you comparing them? If you are comparing the World Health Organization's statistics on healthcare monitors we, in the US are doing a terrible job. If you are asking for the ability to go to a cutting edge tertiary care hospital and receive the latest greatest and hopefully best options we have more than you can imagine. They are however very expensive and not cost effective solutions to large scale healthcare issues.

Now mentally go to a community hospital or an inner city hospital faced with significant budget issues and concerns. There are less choices and less cutting edge (read more expensive) options available. Some places must transfer out heart attack patients for cardiac catheterizations. Other hospitals must transfer patients out for brain surgery emergencies and others for trauma patients. So if you had one of these conditions and the facility you wound up at does not treat that condition than you are at an potentially inferior hospital for that specific condition.

Some hospitals only specialize in a specific disease class or age groups. Examples would include cancer specialty hospital, eye institutes, orthopedics facilities and geriatric or pediatric hospitals. So arguably if you are in one of these hospitals and develop a condition outside their scope of practice you may receive inferior care or need to be transferred to receive adequate care.

Now move to a nitty gritty facility with many poor people who are very ill consuming many precious resources. They should have access to their needed medical care. But can the facility or the government spend endlessly to provide the latest, greatest and most expensive care?

Given the scenarios, I think we can agree that in the US there are different levels of care available which create a significant impact on the care received by our citizens.

Now let us move outside the US and examine this question again. Is it possible that there are hospitals outside the US who exist in countries that provide the latest, greatest care for those who can afford it? The clear answer is Yes. Then move to areas similar in capability to the US and the same gradients of care options appear.

As a medical traveler, you want to be helped in identifying the best facilities and the best providers for your condition in these locations. Then you can comfortably say that the care is comparable. On a more granular level you can say that the care is better than or equal to the US. But the question at that point is more a matter of all the amenities that you can afford when you select medical travel. These options are not even considerations when in the US seeking medical care.

Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Is it safe to go outside the US for medical care and wellness?

Yes it is safe.
No more and no less safe than walking around a major US city. Our media has a tendency to hype events overseas in order to grab your attention. None-the-less attention and due caution are reasonable actions. When in Rome act more Roman than American. Blending in can be worthwhile.

There are also safety bulletins issued by the US State Department. The CIA provides up-to-date information guides about specific countries. Ask us for them when you call or email. We will gladly facilitate your getting timely and accurate information to make decisions.

No one can guarantee your complete safety outside the US. Perhaps the better question to ask would be: is it more unsafe abroad than when you are inside the US? We have significant violent crime issues in most of our major cities and suburbs. So asking a more precise question may help to clarify this question in your mind.

Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

Does the American Medical Association support medical travel?

The American Medical Association (AMA) acknowledges that the industry exists. Recently, they published a set of guidelines that can be found at their site and are general principles.

The AMA will need to speak for itself as an entity regarding active support, passive support, acknowledgement and resistance postures and statements. Speaking for myself, it is good to see the guidelines. It is a new level of dialogue. Nearly all dialogue is beneficial and productive. I can envision that the AMA will see the value and quality available. However, as an organization representing US physicians, their mission and goals are potentially geared in a different direction.

Time will tell how this new mode of healthcare delivery works its way into the public mindset.

Be Well, Travel Safe

Jim McCormick, MD
Premiere Medical Travel Company
818.917.6189

What about my rights to privacy, can they be enforced?

The US laws overseeing the release of medical record information and patient confidentiality laws is called HIPAA. While in the US as a patient these regulations oversee your privacy. That does not guarantee your privacy. It ensures that every step is taken to protect your concerns and if a breech occurs you are told about it and the individuals who were unauthorized to view your records are held accountable. This can mean criminal prosecution with financial penalties and jail time. You as a patient may have civil recourse as well. For that you would seek legal counsel.

Protecting your privacy overseas has its challenges. Consistently the facilities I have visited express a desire to ensure your privacy was a priority. However the legal remedies and accountability are inconsistent. Having said that, any destination facility that wants to continue working in this space will need to move closer to the customers (your) needs and make these issues more defined and favorable for our clients privacy needs. It is my belief that they are doing that and actively work to ensure your best interests are served.

We need to be careful in assuming that everything needs to be enforced in a legally binding manner as in the US. It may be that culturally violating a confidence is unacceptable and perhaps carries more impact than our system. Issues like privacy can be different and better outside our borders than the methods we choose to address them locally. It is worth asking your medical travel company how the destination(s) you are choosing are working to ensure your privacy.

Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

What is Medical Travel and Tourism?

There are several running definitions.

We, at Premiere, consider the emphasis of the trip to be the important determinant. For those who travel specifically to receive medical care then we feel that medical travel is more appropriate. This does not make other definitions wrong, it is how we choose to characterize the process.

There are those who travel for business reasons and become ill or injured. They are not medical tourists or travelers.
Similarly those who travel for tourism and become ill or injured are not medical tourists or travelers.

Those whose emphasis for the trip is to seek medical care as a by-product of a tourism related trip would be characterized as a medical tourist. The medical care is an incidental to a vacation trip.

Jim McCormick MD
President and Founder
Premiere Medical Travel Company
818.917.6189

Why is a pre-trip assessment and prearranged aftercare potentially beneficial?

Comprehensive end to end services. Simple words, complex solutions.

That is the basis for what we believe will be a successful company going forward. Those companies that provide simple elements without having the necessary options available for clients to purchase are making potential mistakes for their company and the industry. Clients who seek medical care abroad may not realize the complexity of the undertaking. We should be there to help them understand what is needed and what is required. Simple price points do not address issues such as who will care for wounds when you return home.

Medical Travel companies should consider these problems solved long before you book your first client. Having solutions already built into your business plan will save time, money and reputation when a problem surfaces. Your company should know who will manage the care and how it will be paid for. This complex issue happens occasionally when clients return with a problem and no one was willing to assist them.

There are expectations for continuity of care from the patient through the insurer/payer to regulatory agencies. As a participant in arranging a trip for the clients, our companies may appear to be their contact for services going forward. Simply letting them dangle to find their own aftercare does not help anyone in the arena.

You will get the commission on the first client, but that will not propagate into recurrent trips or referrals for friends and family. Good service and a comprehensive approach is one of the best methods of advertising. One satisfied customer can generate many new leads, while one unhappy client can lead to dozens of negative reports that amplify themselves and suppress potential leads. Is it worth the short term profit to create a self destructive cycle of negative advertisements?

How about screening people before they leave? Is there a value added service in providing this to your client? At first pass who would want to say no to a client. We all want to say yes to a sale. But look a bit deeper and there is a compelling reason to screen and say: ' No our services are not for you. Thank you for your inquiry.'

If you compete in a market on cost than you will need to accept nearly everyone to make up for small margins. The dilemma begins when a client purchases a package from your website and company and something was not screened well or reported by the client. Perhaps they were inaccurate about a condition or they had inappropriate expectations. They traveled with your company name and spent a good portion of their money on the roundtrip flight and some hotel expenses.

Then they arrive at the hospital. They are not candidates for the procedure. What happens next? Who refunds what to whom? Policies can help, but this will be a mess and quickly mushroom.

The patient almost always has the upper hand initially. It can be a very difficult situation to defuse. It is a battle of words. Regardless of the true findings later on, the initial PR stain can hurt your brand. Document can help but it is a reactive approach to the entire set of events and interactions.

You could develop a process and value added package that allows for both parties to meet, assess decide together whether this is the right person, right facility and right service(s) prior to engaging in a more expensive transaction.

Food for thought. Proactive preemption will nearly always beat reactive post hoc solutions.

Be Well, Travel Safe,

Jim McCormick MD
President and Founder
Premiere Medical Travel Services Company
818.917.6189

Medical Travel Speaking Engagements!

A conference is coming up you do not want to miss! Itwill be a terrific opportunity to meet and speak with so many of the individuals who are active in Medical Travel and Tourism. From September 9th through the 12th The Medical Tourism Association is conducting the First World Congress on Medical Tourism and Global Health. Many leaders and contacts will be available for you to get important insights and networking.

I am going to be a panel speaker on developing a business in this space along with three other companies in different phases of development. A second speaking engagement will have me moderating a key aspect of medical travel and tourism: Aftercare and Continuity of Care. For those interested in understanding how to generate a successful business in medical travel, join the conference: www.medicaltourismcongress.com.

We, at Premiere Medical Travel Company, look forward to helping you become successful. We are available to consult and provide expert advice on how to approach and build a successful company. There is far more to this than a quick website.

Enjoy!!

Travel Safe, Be Well.
Jim McCormick, MD
Premiere Medical Travel Company, LLC

What do the AMA guidelines for Medical Tourism mean?

They are a set of principles that are a balance between the acknowledgment that this industry exists, is here to stay and a need to meet their member's concerns. Medical Travel and tourism are future competitors with general US medical practice. The industry is not large enough to be a business concern, but it is predicted to grow to that point.

The guidelines are available at the AMA website. It is worthwhile to discuss them. The first one: Medical Tourism must be voluntary. Yes I agree voluntary, but who or what company would force this option upon an unwilling client? Forced care overseas is a recipe for a medical and public relations disaster. So I agree voluntary, but the Medical Tourism industry has ethical participants.

In the second, third and fourth, there are important issues that are discussed. It is very important for many reasons to have Joint Commission International or International Society for Quality in Health Care certification. These two bodies ensure that facilities are using the right process and procedural mechanisms to ensure patient safety. The countries and facilities have the same quality assurance that we do or a different, but equivalent, process for assurance. This is important to the longevity of the industry. They are benchmarks that help us interpret important safeguards across cultural, political and language barriers.

The next two are intimately tied together. Follow-up care must be financed and coordinated prior to departure. A less well defined one: coverage for travel outside the US for medical care must include the costs of necessary follow-up care upon returning to the U.S. I am a strong proponent of aftercare. It is essential that this is available to the patient. Who should pay for the cost of after care is a more difficult question. Should the insurance company who receives the financial benefit of success care rendered abroad? Should the patient who is uninsured seeking the care overseas at a steep discount to the price a U.S. physician and hospital would charge? Should the destination facility be responsible for this fee? Should the facilitators? The premise is medically correct, aftercare should be available upon return. The business aspects of who pays for are open for discussion.

Physician outcome data and HIPAA Compliance issues are reasonable requests as goals. We do not have full transparency on specific physician outcomes and do not fully enforce HIPAA in the U.S. that is our goal, to move the country in that direction. It is the right goal for everyone. Our colleagues abroad may feel it is unreasonable to ask for a perform better than we do on our own metrics. But the goal is valid.

The last one we fully embrace at Premiere Medical Travel. First and foremost is the healthcare. We have taken a particular stance in calling ourselves medical travel and not medical tourism. We believe tourism highlights the tourism component too much. For simple procedure or health check ups, this is feasible, but to recover from major surgery while on safari is unreasonable. Health first, experience next and everything should follow properly.

In general the AMA has it right in our view. There are some gaps in expectation and performance domestically on the aftercare, payment, outcome measures and HIPAA issues that warrant further examination. We can only expect others to perform at the level we set, embrace and enforce for ourselves.

Travel Safe, Be Well.

Jim McCormick, MD
Premiere Medical Travel Company, LLC
818.917.6189

Healthcare Travel or Tourism?

Can we be both to you, our customer and patient?

Frankly, I am a bit skeptical. There are conditions that suit themselves to a combination trip. But can that brush be applied so broadly? Can you have heart bypass surgery and spend time traveling around a country with relatively fresh wounds that are still healing? Will your hip or knee replacement allow you to walk with enough ease to cover a significant amount of touring 1 week post operatively?

There are companies in this industry that are marketing themselves to be all things, to all customers, for all occasions and at all times. This is an impossible goal to achieve. It can lure many people in and then disappoint many as well. The providers, the facilitators, the customers need clarity.

Who wants to provide, or receive, what service(s) to, or for which patients?

Clarity:
The first issue and choice is the Quality of the Healthcare.
The second issue and choice is the Quality of the Value proposition.
The third issue and choice is the additional components built around the first two core questions if it is possible.

Does it make sense to you as a customer of healthcare providers to simply book a procedure on-line, book the travel on-line and jet off to a destination around the world and not fundamentally understand the first two core concepts?

Some companies break this down into a simple process map. Components of that process can be mapped and defined. It is a process that can be broken down into enough granular detail so any given set of details appear to make sense. But when you pull back up to the macro level, does it all still fit together in a manner that makes sense?

Yes; you can get a bypass for a great value. Yes; you can travel around an exotic country. Yes; you can fly to and from that location. Is it realistic to expect that the wounds will be healed sufficiently at 1 or 2 weeks post operative to have you truly enjoy the tourism? A critical question for you the consumer and purchaser: Are you expectations for the trip in line with the proposition offered and reality? If not, are you are setting yourself up for disappointment.

The investment, even at a huge discount to domestic care, still requires thought, planning and guidance. That is where a skilled professional services company can provide valuable guidance and assistance. The booking is the easy part.

Jim McCormick, MD
Premiere Medical Travel Company, LLC
818.917.6189

Bangkok Hospital Medical Center Offers Valve Replacement

The facility is terrific, the staff excellent and the offer appears to be a great value.

The BHMC released a statement offering heart valve replacement with an inclusive package that seems quite attractive. The ~$17,000 fee covers the hospital charges (labs, imaging, OR time, CCU time) and the service fees for the physicians. Having visited the facility earlier this year, I would feel very comfortable receiving my care here.

The charges a US citizen would incur for this procedure domestically would be more than 10 times the price above. Even adding in the airfare, lodging for a companion and a short stay trip for yourself post-op and the charges between the two countries are very far apart.

Government data for the year 2006, the latest available, shows US hospital charges were around $120,000 for valve replacement surgeries. This is the hospital inpatient charges which, in many cases, will not cover: cardiothoracic surgeon, anesthesiologist, cardiologist, CCU attending (Intensivist), pulmonologist, hospitalist or internist, radiologist, pathologist and other assorted professional service fees.

Each physician charges for the professional services that they provide to you the patient. These fees can be a few hundred to several thousand dollars each. It adds up quickly. Commonly patients see a hospital bill and assume that this is the total. Often it is not. Additional bills can arrive after you are discharged.

This package offered by BHMC has an attractive value offering to US clients in need of valve replacement. It is unclear from the new release whether a complication is covered. Air fare lodging and other costs do need to be factored in. But there is still no comparison if you have no insurance or are significantly underinsured.

A high quality medical travel or medical tourism company can help guide you with choices and options for you and a companion. We can help.

Be Well, Travel Safe

Jim McCormick, MD
Premiere Medical Travel Company, LLC
818 917-6189

New estimates for Medical Travel traffic?

So who is right? Two powerful consulting groups came up with very different endpoint assessments for the industry analysis.

There are two widely disparate assessments on the size and activity of the medical tourism markets.
The links to the original articles are:

http://www.mckinseyquarterly.com/Mapping_the_market_for_travel_2134_abstract
http://www.deloitte.com/dtt/article/0%2C1002%2Ccid%25253D217866%2C00.html

It is critical to read and understand how each organization defines the traveler for medical care. There appears to be too much investment and construction in the areas of infrastructure and capacity for medical tourism to be justified by the lower boundary defined by The McKinsey Group(TMG) assessment. The Deloitte article may overshoot the actual number. One reasonable conclusion is that the truth is somewhere in the middle of the two.

Going forward, this will continue to be a new growth arena for leaders to enter. Challenges exist in changing mindsets and biases, to which incentives and marketing will be critical. Already large industry forces are moving to create incentives to ease the transition to get elective and semi-elective healthcare outside the US. This is beginning to look similar to several recent 'disruptive technological shifts'.

This means the paradigm, our current structure of thinking, will be changed dramatically. Acute care medicine will still be practiced locally. But opportunities to move many aspects of care abroad exist. Radiology is moving in that direction, pathology, lab specimen processing, procedures, annual visits and much, much more.

What would make you, a US healthcare consumer, interested in seeking care outside the US?
What would prevent you, a US healthcare consumer, interested in seeking care outside the US?

We would enjoy to have a dialogue. Feel free to submit your comments and suggestions.


Jim McCormick MD
Premiere Medical Travel
Be Well, Travel Safe

Who is Your Client?

Before we get to the answer to that question, the situation in Thailand has settled for the time being. Remember situational awareness is an important component of advising potential travelers.

So who is your client?
Is it the destination facility?
Is it the potential patient?
Is it the affiliate for whom you generate fees?

A critical and analytic eye can help to identify who your potential client(s) are in a given business arrangement. The better you identify the client or customer the more you are able to provide valuable products and services to them. Being stuck in the middle and providing all things to all clients is a difficult position. It is a shotgun approach that can deplete capital rapidly. Focus allows precision, which preserves capital and creates a more effective use of content and cash.

While static sites allow anyone to find you, are you finding your customers?

The decision to be focussed is difficult. It mandates that you, as a business, potentially lose customers. There are benefits to shedding some customers and developing a more focussed approach.

We at Premiere Medical Travel can help you define an approach that best suits your business needs. Feel free to contact us and discuss the options that will help to grow your business.

Travel Safe, Be Well,

Jim McCormick, MD
Premiere Medical Travel
818 917-6189

Thailand: Update on Conflict in Area

This is where a quality and value added service oriented medical travel company can assist in decision making. While the likelihood of violence spreading into the Bangkok area is minimal, there are reports in The Economist that Cambodia and Thailand are saber rattling over the disputed Angor Wat temple region.

There is a long history here and significant religious concerns for the peoples on both sides of the border. So if you were deciding to go abroad, would you want to know that there is conflict in an area where you are considering? If you were to engage in a simple transactional website that does not keep abreast of the current state of affairs, you may make a mistake. Thailand is a very very safe country and its people wonderful, it just makes the decision more sophisticated for you the party investing in your health if you have all the facts.

The issue has been handed over to the Security Council of the UN to settle the disputed area. Meanwhile local tensions are reportedly running high. Would I travel to Thailand today? Yes. But I would have contingency plans, contacts and knowledge of the embassy and consulate locations as a safe precautions.

Information, both current and accurate will always help make decisions that are in your best interest. That is why Premiere Medical Travel is a value added company. We look to provide you with the right tools and information to make the right assessments and make the best out of your medical travel experience.

We also can help with the medical components of the trip. We will be offering services for you right up to departure and throughout your stay. We will stay in touch with you and your facility, if you desire, to make sure your experience is the best it can be. We do not simply book you and send you packing.

Ever wonder about a volcano, typhoon, hurricane, economic instability and other issues when you are beginning to decide on a location? Nearly every area involved in medical travel has some element of one, or more, of these risks. We stay current so we are sure you are current.

Travel Safe, Be Well,
Jim McCormick, MD

Does a Complication Always Have to be a Disaster?

Truthfully no.

Medicine is a scientific art practiced by human beings. These three components fail. Even machines and computers running perfectly and incessantly fail at times.

Perhaps the better questions are:
1) Was the mistake or complications foreseeable and preventable?
2) Did the provider(s) make the best of the situation to correct the complication for the patient?
3) Do the people and the organization learn from the error and work to prevent it from happening again?

These are essential process components to any quality system. JCI mandates their existence at a surveyed institution.
Recently, I interviewed a patient who underwent abdominal surgery. She felt quite abandoned by her country and insurance company. The insurer contradicted itself in her mind. It would not perform the corrective surgery until she lost weight. They would not perform weight loss surgery until she corrected her first condition.

At this facility she had her weight loss surgery. One of her pre-existing hernias became stuck unrelated to her weight loss surgery. She was rushed back in the OR and had the hernias corrected. All performed quickly and with as much safety as could be achieved. The problem was rapidly identified and corrected. A turn she had not expected, but it was managed masterfully by this institution and its personnel.

To say that she was simply glowing is an understatement. There was not enough time to hear how happy she was that someone, this facility, took the time to give her the needed services that would allow her to get back to a healthy life. It took a complication in a foreign country to give her the keys for her life. The hernias were no longer there to cause her pain and discomfort. It was an inspiring story to hear her tell the events. She clearly felt and had the impression that this facility and its staff were on her side and acting to improve her health. It was clear in her mind which party had served her poorly.

So complications can have good outcomes. Not all, but some do end up with favorable events.

Travel Safe, Be Well
Jim McCormick MD
Premiere Medical Travel Company
www.premieremedicaltravel.net

What is a DVT and what does it mean for me as a medical traveler?

DVT= Deep venous thrombosis = blood clot (Typically in the leg) The real concern is if these clots break off and travel to your lungs. This can cause some significant medical complications.

There are certain important predisposing risks to developing a DVT. 

• Long Flights
• Underlying cancer
• Previous history of DVT
• Birth control pills 
• Obesity
• Recent hospitalizations
• Several other conditions.

So from the list we can see that this is a condition that is not exclusive to the medical traveler.

There are quite a few things that can be done to reduce the chance of this condition. First walking, simply walking is very helpful it pumps the blood out of our legs and back to the heart. Stroll around before the flight, wander up and down the aisles during the flight and walk after the flight. Getting up several time to move around when it is acceptable to the flight crew is important.

Flexing your feet. If you are unable to walk due to flight conditions or other restrictions, simply pumping your calves mimics the walking. It may be as effective, but it is likely better than nothing. You can also do this far more frequently than walking. 

Compressive stockings are available to purchase. These support hose fit more snugly and increase the pressure in the lower legs. This helps to move blood out of the legs and back to the heart.  

Importantly, none of these require a physician to assist you with or guide you. These can be performed easily, by nearly anyone.

The next options require some guidance by a physician. Even aspirin, which is a blood thinner should be taken with a medical travel physician's advice. This may seem a simple medication, but if you thin your blood some surgeries may be delayed. Some blood thinners: wafarin (coumadin), clopidrogel (Plavix), enoxaparin (Lovenox) and others are more aggressive therapies. These require active physician oversight and written orders to administer. While there may be a role for these medications, it is likely small.

The benefit to all these medications is a reduction in the risk of DVT. There is always a downside. By thinning your blood you may find yourself bruising more easily. More significant bleeding can occur internally. They can also interact with other medications you are taking.

Begin with the first three and consult a medical travel physician for advice on the more involved options. 

Travel Safe and Be Well,

Jim McCormick, MD

Premiere Medical Travel Company

How will the challenging economic times in the US affect Medical Travel?

Similar to the economic challenges that are impacting the country faces, these forces will impact medical travel. While no one has a crystal ball, these are some thoughts on how this may play out going forward. 

Clients, both payers and patients, will want a better value for the money. The financial business landscape has changed significantly from less than a year ago. There are two most likely scenarios from my perspective. 

These very tough times will increase costs for the simpler transactional web based models for medical travel. The margins will squeeze tighter and tighter as the cost floor on these web based models making their environment difficult. Higher jet fuel costs, higher inflation, rising unemployment, a weakening dollar, and less available flights etc. will eat into their pricing structures. 

Those companies that have prepared themselves, anticipated these potential conditions and made adjustments to their operating models will fare better. Not without some difficulty. Those who are ready can create a growing client volume by best targeting clients, services and destinations. Markets are made by bringing these components together. 

The winners will need to add value to absorb or offset the rising costs and justify their pricing to begin with. These times make the potential client to expect more for their hard earned money. Our challenge is to deliver. Create value and return value. 

By focusing resources specifically, we can ensure that our strategies are more likely to succeed. It will not be good enough to be all things for all clients. There are some clear gaps in service that, if filled, will more than likely generate traffic. 

Tough times can also compel some interested parties to enter an arena, that they previously felt was not a viable option. Medical travel may become a forced market sooner than I had contemplated previously. Tightening belts can help companies and people to see the opportunities that lie ahead. 

Even in the most difficult of economic adversity, there are those who are willing and able to pay to improve their health. Who are they? Where are they? How do we find them? How do we communicate a value proposition that resonates within the client? That requires the crystal ball and skilled collaborative approaches.

In all challenges lie opportunity. 

This one and these times are no exception.

More to follow from Central America in the next few days!!

Jim McCormick MD

Premiere Medical Travel

818.917.6189

First World Congress on Medical Tourism in the US

In September the Medical Tourism Association, based in Florida, is hosting a tremendous event in San Francisco. Here is the link and the affair's name: http://www.medicaltourismcongress.com The affair will last from September 9th through the 12th. Workshops, lectures, guest speaker and a floor with booths will provide great opportunities to learn about the field, network with the attendees and develop business opportunities.

I am honored to have been asked to speak about aftercare issues within the industry. I am looking forward to the share both my medical knowledge and my understanding of aftercare as a gap in the service provided to patients.

This would prove to be a very exciting event and a great avenue for new entrants to participate. A special thanks to Renee Stephano, C.O.O. of the Medical Tourism Association for her hard work!

Safe Travel and Best Health

Jim McCormick, MD

818.917.6189

How would we promote Medical Travel from non-west coast states?

I was recently asked about how to move patients from a non-West coast location to receive medical travel related healthcare. This was the response. The original posting can be found at: http://fastcompany.com/blog/james-mccormick-md/medical-travel-tourism

There are many global destinations that can provide healthcare, besides asian locations. We can assist your patients in sourcing care that is medically appropriate, culturally relevant, geographically important, or for purely interest in a location for medical care. All that can be done at an attractive value proposition.

A potentially important consideration in the analysis is the delay for a client to return to an active productive life.  A 6 t0 12 hour flight and recovery time next week is potentially more attractive, than a several month wait for a procedure appointment slot in a hospital bed, OR, day surgery or conscious sedation suite etc.

There are some important obstacles for some clients that will prevent their opting for this type of care plan. We can incentivize clients to move past their internal biases and concerns. We need to help them move from a place of hesitancy and uncertainty about medical travel to a zone of comfort and excitement. We must lead that campaign. That is where a physician led organization has a role. I understand patients, their needs and how to communicate to them.

Our perspective looks at the price issue from a different angle. It is and always will be, a avalue proposition. How much does a potential patient value their time hampered by a quality of life condition that can be corrected in an expeditious manner? What value does a patient place on waiting to return to an active, productive and involved life? 

Price cutting implies (in patient's minds) quality shortcuts. While the assumption may not be valid, it is likely at the forefront of any healthcare consumers mindset when we discuss price cuts.

The size of the destination facility can be less important than the capability, skill and expertise of the providers. Many of the existing facilities have designated areas in the hospital for medical travels to cater to their needs. Some are specializing in specific types of care.

We both know that complete solutions are never simple. There are important initiatives that the industry is currently building to implement in order to strengthen confidence for consumers of non-acute healthcare.

This industry can not solve our problems entirely. Rather it will be a important contributor to the solutions of the the US healthcare dilemma we face now and going forward for several years.

We, as an industry, are working to ensure that US standards are incorporated into the processes and practices abroad. JCI, an international arm of JCAHO, inspects facilities abroad. They certify that these standards are in place. I believe this certification is essential to ensure confidence and growth.

In my opinion, facilitators should play a role beyond booking flights etc. They should ensure seamless travel, privacy, and bidirectional transfer of medical information. This promotes the conditions for the best possible outcome for all involved.

There will be an important role for expert physicians and teams that can ensure the care and process are at a level acceptable to US payers, facilities and patient needs.

I would enjoy speaking to you and your group about this subject.

Jim McCormick, III M.D.

General Manager and President 

Premiere Medical Travel

818 / 917- 6189

http://premiere-medical-travel-blogspot.com/

What can Medical Wellness offer our clients?

A growing movement to encourage wellness AND medical travel is important to build client traffic. Medical wellness may mean different things. I was able to recently engage in a conversation with well placed individuals on this subject. 

Here is what we discovered. Clients devote time in a more introspective and exotic location to learn about themselves and their medical conditions. Trained professional dietary consultants, physical trainers, medical specialists, cooking teachers and the host facilities would help the clients learn about the management of the illnesses.

How to manage diet, habits, physical activity and weight all prevent future medical complications. Not just booklets, but committed everyday learning and activity. Teaching these concepts in a more self-intensive location, allows more time to focus and learn. 

This pattern strengthens the teachings by incorporating these new habits into daily routines. Teams can develop to support each other at the destination. There is time to fully embrace and live this new life, free from the distractions of modern life.

In building this state of mind, strength of mind and habit changing activity, clients have a better chance of returning as a stronger person with new habits and learnings to successfully maintain their new found lives.

We want to develop groups of similar people who will travel, live, learn and return together. This team building approach also builds a better support network for when they return and challenges appear.

Best of health!

Jim McCormick MD

Premiere Medical Travel

Is the Philippines moving forward at a faster pace?

Recent conversations with a well placed individual in Manilla's healthcare system would clearly say "YES!"

More and more facilities are coming to understand the importance of JCI certification in order to have US clients feel more comfortable about medical care abroad. The government bodies that oversee this field are encouraging a broader embracing of participation in this important program.

There was a fair degree of certainty that the new air line terminal will open in the very foreseeable future. A welcome addition to the experience. It is an important improvement to the first impression that clients will experience.

As I stated in a previous blog post, there is tremendous investment in infrastructure here that will bear fruit. Perhaps sooner than I had expected. It is a welcome change in the schedule. The quicker the infrastructure and capacity is built the faster the market can mature here.

How do the privacy laws work when I choose medical travel?

For patients in the US, there are strict laws (HIPAA) that prohibit the release of medical records without permission of the patient. This prohibition extends to spouses and domestic partners etc. 

When you leave the US, and our jurisdiction, you enter another one. Local laws will prevail. There may be no privacy laws to enforce. Votes can be cast with the choice of a destination that values your privacy.  This is an indirect means of enforcement.

You can ask for a privacy clause to in your contract. The contract enforcement will likely be in the other country, where the services are rendered. A client who has their privacy compromised, would likely have to file their lawsuit in another country which can be very difficult.

Carefully choose your facilitator and website. Travel service placement providers may not be subject to HIPAA.  Choose a company that holds your privacy dearly. They should maintain your privacy whether the regulations apply or not. The release of patient conditions can be damaging to the patient, the company and the industry. It is bad patient care and bad business.

One health care worker released medical records to a tabloid. The person is now facing federal criminal (penalty and jail) and civil suits that far exceed the few thousand dollars she received for the release.

Jim McCormick, MD

Premiere Medical Travel

How do I know that this is the right choice for my medical needs?

The best answer lies within yourself. To be sure that medical travel is a viable route for your medical care, you must be very comfortable with several things before considering a facility. 

1. Do you know what procedure you need or can you designate a doctor to communicate your need(s) to the destination facility?
2. Do the facilities have high quality reputations that will meet your satisfaction?
3. Do you have access to someone that can explain the process and procedures to your satisfaction?
4. Are the facilities involved with international certification processes? If not, why not? Did the answer meet your satisfaction?
5. Are you comfortable with the culture (food, customs, habits etc. ) of the destination facility's country? 
6. Are you comfortable with the time frame involved for the travel there and back?
7. Are you comfortable with the time frame to recovery? 
8. Do you have a family member or significant other who can be with you during this trip?
9. Do you have any concerns that you are afraid to ask ?
10. Most importantly, are you uncomfortable with the idea of medical travel.

If you can not answer and resolve these questions with crystal clear clarity in your mind there are two options. One: find out more information to answer the questions and doubts to your satisfaction. Two: do not invest the time and money.

It is your health at stake and both your time and money to be invested by you as a medical traveler. The value to you as a consumer must be clear. Be very clear in your mind about how you move through this phase in your life. Quality organizations and providers can help to make this a seamless process if you are ready. But be ready and informed.

James McCormick MD

Premiere Medical Travel

Are there agencies that oversee the standards of care in countries providing medical travel?

The answers depends on the interpretation of the word oversee.

In the US, the Joint Commission International (JCI) that reviews international hospitals on an invitation basis. If the facility meets preset standards for patient care and safety, quality controls, lab and radiology processes, and other important benchmarks to ensure your care is comparable to the United States; then it is a certified. 

The Council of Trent Accreditation Scheme is a UK based not-for-profit organization that serves a similar function to the JCI. It appears to play a similar role in certifying a hospital or organization outside the UK has comparable care.

There is no enforcement ability per se, except removal of the certification. This can mean significant loss in patient volume. The impact of a loss of certification may not be as powerful an indicator to medical travelers who arrive from countries other than the United States. It is important to understand that these organizations can not impose their standards on destination hospitals. 

These organizations are working to ensure that quality is the lead benchmark indicator. The presence of their certification should be reassuring, but not a guarantee of perfection. They are essential and contribute tremendously to the global growth of the industry. 

Jim McCormick, MD

Premiere Medical Travel

 

The Philippines is going to grow by leaps and bounds. When I was there recently, the commitment to creating the necessary capacity and quality facilities was in plain site. St Luke's Hospital, Makati Medical Center, Asian Medical Center and the Tagaytay facilities were all undergoing renovations, additions or building completely new facilities. 

A recent post to the RSS newsfeed for medical travel also discussed the growth and investment in Cebu City. Similar efforts are underway in Subic Bay. 

This will be a significant area of opportunity for medical travel/tourism in the very near future.

Jim McCormick, MD

Premiere Medical Travel

Thailand

While visiting facilities in Thailand. Two colleagues underwent an impromptu evaluation, on a Sunday morning, without an appointment time. They were met with gracious happy receptionists and staff, were escorted to the exam area, dressed in light jogging suits (no exposed areas), then assessed for nearly 3 hours. 

They had a history and physical performed, an expansive array of blood work, EKG, Chest x-ray, abdominal ultrasound, and an exercise treadmill test. The price was unbeatable. More importantly they were very impressed with the high quality customer service experience and felt they had received a terrific value.

In my opinion, this is the cornerstone to grow this industry. It is not a competition for price point, but rather an option to receive the best value. As more facilities move into this space, the focus needs to move to value and customer service, not simply price. 

Jim McCormick, MD

Jim McCormick MD Premiere Medical Travel

Welcome to a leading edge site on medical travel and tourism. We encourage and welcome your input and participation. Our goal is to generate an educational and informative channel for the sharing of ideas, experiences, perspectives and information.

Best of Health

Jim McCormick, MD